Raquel Gutiérrez Zuñiga
Background. Current guidelines recommend Transcranial Doppler (TDC) monitoring for sickle cell disease (SCD) patients to identify those at high risk of stroke and to guide treatments. However, low rates of TCD screening have been reported, suggesting physicians’ lack of knowledge of the role of TCD in SCD. Objective. To describe the results of TCD monitoring in patients with SCD after its incorporation into the neurosonology portfolio of the Neurology Department in a Stroke Center with the collaboration of the pediatric haemato-oncology unit. Material and methods. Retrospective study of patients with SCD between January 2014 and December 2017. Age, sex, risk factors, neurological manifestations, DTC-Time Averaged Maximum Mean (TAMM), brain MRI findings and treatment decisions were analyzed. Results. Of a total of 16 patients with SCD, 12 (75%) were studied. The majority were HbSS homozygotes (58.3%). Seven were males and average age was 12 years (SD 5.5). Ten patients (83.3%) presented normal values of TAMM, none of them suffered a stroke and did not show alterations in MRI. In one case (8.3%) a conditional TAMM was found, so more frequent controls were scheduled and hydroxyurea was restarted. Another patient (8.3%) not attending DTC controls had a cerebral infarction and had a pathological TAMM so was programmed for hypertransfusion. Conclusions. The incorporation of a TCD monitoring protocol in patients with SCD has made it possible to guarantee follow-up in primary stroke prevention and guide the treatment of this disease without the occurrence of symptomatic or silent strokes in the patients evaluated.
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