Prevention of a First Stroke by Transfusions in Children with Sickle Cell Anemia and Abnormal Results on Transcranial Doppler Ultrasonography
Open accessAbstract
BACKGROUND: Blood transfusions prevent recurrent stroke in children with sickle cell anemia, but the value of transfusions in preventing a first stroke is unknown. We used transcranial Doppler ultrasonography to identify children with sickle cell anemia who were at high risk for stroke and then randomly assigned them to receive standard care or transfusions to prevent a first stroke. METHODS: To enter the study, children with sickle cell anemia and no history of stroke had to have undergone two transcranial Doppler studies that showed that the time-averaged mean blood-flow velocity in the internal carotid or middle cerebral artery was 200 cm per second or higher. The patients were randomly assigned to receive standard care or transfusions to reduce the hemoglobin S concentration to less than 30 percent of the total hemoglobin concentration. The incidence of stroke (cerebral infarction or intracranial hemorrhage) was compared between the two groups. RESULTS: A total of 130 children (mean [+/-SD] age, 8.3+/-3.3 years) were enrolled; 63 were randomly assigned to receive transfusions and 67 to receive standard care. At base line, the transfusion group had a slightly lower mean hemoglobin concentration (7.2 vs. 7.6 g per deciliter, P=0.001) and hematocrit (20.4 vs. 21.7 percent, P=0.002). Ten patients dropped out of the transfusion group, and two patients crossed over from the standard-care group to the transfusion group. There were 10 cerebral infarctions and 1 intracerebral hematoma in the standard-care group, as compared with 1 infarction in the transfusion group -- a 92 percent difference in the risk of stroke (P<0.001). This result led to the early termination of the trial. CONCLUSIONS: Transfusion greatly reduces the risk of a first stroke in children with sickle cell anemia who have abnormal results on transcranial Doppler ultrasonography.
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Chronic prophylactic transfusions prevent stroke in 90% of children with high cerebral blood velocities measured by transcranial Doppler.
“chronic prophylactic transfusions prevent stroke in 90% of children with high cerebral blood velocities as measured by transcranial Doppler (148).”
From Pathophysiology of Sickle Cell Disease (2019) · cites this paper as [148]
The Results report that transfusions lowered the risk of a first stroke by 92% compared with standard care—close to the claimed 90%. But the study was limited to children with sickle cell anemia and confirmed high Doppler velocities; it did not establish that transfusions prevent stroke in 90% of children with high velocities generally. (LLM, conf=0.86)
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- Authors
- Adams, R. J., McKie, V. C., Hsu, L., Files, B., Vichinsky, E., Pegelow, C., Abboud, M., Gallagher, D., Kutlar, A., Nichols, F. T., Bonds, D. R., Brambilla, D., Woods, G., Olivieri, N., Driscoll, C., Miller, S., Wang, W., Hurlett, A., Scher, C., Berman, B., Carl, E., Jones, A. M., Roach, E. S., Wright, E., Zimmerman, R. A., & Waclawiw, M.
- Affiliations
- Augusta University (US)
- Emory University (US)
- East Carolina University (US)
- University of Miami (US)
- Medical University of South Carolina (US)
- New England Research Institutes (US)
- National Institutes of Health (US)
- Children's National (US)
- St. Jude Children's Research Hospital (US)
- NewYork–Presbyterian Hospital (US)
- Tulane University (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1998-07-02
- Volume
- 339
- Issue
- 1
- Pages
- 5-11
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2314213298
- Cited by
- 1,866
- References
- 22
- Citations by year
- 2026: 64 · 2025: 55 · 2024: 78 · 2023: 59 · 2022: 92 · 2021: 77 · 2020: 87 · 2019: 74 · 2018: 68 · 2017: 107 · 2016: 124 · 2015: 70 · 2014: 75 · 2013: 82 · 2012: 92
- FWCI
- 22.02
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- New England Research Institutes
- National Heart, Lung, and Blood Institute (U10HL052016, U10HL052193)
- Topics
- Health Sciences › Medicine › Genetics › Hemoglobinopathies and Related Disorders
- Health Sciences › Medicine › Biochemistry › Blood transfusion and management
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- sickle cell disease, stroke prevention, blood transfusion, transcranial Doppler, cerebral infarction, intracranial hemorrhage, children, cerebral blood flow velocity
- MeSH terms
- Adolescent, Anemia, Sickle Cell, Blood Flow Velocity, Blood Transfusion, Cerebral Hemorrhage, Cerebral Infarction, Cerebrovascular Circulation, Cerebrovascular Disorders, Child, Child, Preschool, Female, Hemoglobin, Sickle, Humans, Male, Risk, Incidence, Ultrasonography, Doppler, Transcranial, Disease-Free Survival
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