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Transcranial doppler ultrasonography in primary stroke prevention in children with sickle cell disease: our initial experience

Background Transcranial Doppler (TCD) ultrasonography is now a standard screening test for stroke risk in sickle cell disease (SCD). But TCD was hitherto unavailable in Nigeria despite having a huge SCD burden, with a stroke prevalence of 5.4%1. Objectives To evaluate parental uptake of TCD and the scan abnormalities present in paediatric SCD. Methods From July 2009, following a 6-weeks UK training, TCD was offered to all consecutive SCD children aged ≥36 months, attending the paediatric haematology clinic, after detailed counselling. Results TCD uptake was 100%. All eagerly consented. Ninety-three children, 66 males and 27 females, ages 37–183 months (mean±SD=108.8±44.3) were studied. All were thick blood smear-negative for malaria parasites. The highest velocities were recorded in the middle cerebral and internal carotid arteries. Seven children had high risk velocities (table 1). No parent consented to periodic blood transfusion for stroke prevention. All seven accepted oral hydroxyurea. Abstract G125 Table 1 TCD screening results classified according to Adam's criteria TCD class HbSS (%)* Hb SC (%)† Standard risk 60 (73.2) 10 (90.9) Conditional 13 (15.9) 1 (9.1) High risk 7 (8.5) 0 (0.0) Inadequate 2 (2.4) 0 (0.0) Total 82 (100.0) 11 (100.0) * Sickle cell anaemia. † Haemoglobin S+C disease. Conclusion TCD uptake is excellent and abnormalities are frequent in Nigerian SCD children. Periodic blood transfusion for primary stroke prevention in children with SCD appears not to be a viable option in Nigeria. Alternative preventive measures are needed in resource-poor countries, where the major burden of SCD resides.