PREVENTION OF A FIRST STROKE BY TRANSFUSIONS IN CHILDREN WITH SICKLE,CELL ANEMIA AND ABNORMAL RESULTS ON TRANSCRANIAL DOPPLER ULTRASONOGRAPHY

Citation
Rj. Adams et al., PREVENTION OF A FIRST STROKE BY TRANSFUSIONS IN CHILDREN WITH SICKLE,CELL ANEMIA AND ABNORMAL RESULTS ON TRANSCRANIAL DOPPLER ULTRASONOGRAPHY, The New England journal of medicine, 339(1), 1998, pp. 5-11
Citations number
30
Categorie Soggetti
Medicine, General & Internal
ISSN journal
00284793
Volume
339
Issue
1
Year of publication
1998
Pages
5 - 11
Database
ISI
SICI code
0028-4793(1998)339:1<5:POAFSB>2.0.ZU;2-J
Abstract
Background Blood transfusions prevent recurrent stroke in children wit h sickle cell anemia, but the value of transfusions in preventing a fi rst stroke is unknown. We used transcranial Doppler ultrasonography to identify children with sickle cell anemia who were at high risk for s troke and then randomly assigned them to receive standard care or tran sfusions to prevent a first stroke. Methods To enter the study, childr en with sickle cell anemia and no history of stroke had to have underg one two transcranial Doppler studies that showed that the time-average d mean blood-flow velocity in the internal carotid or middle cerebral artery was 200 cm per second or higher. The patients were randomly ass igned to receive standard care or transfusions to reduce the hemoglobi n S concentration to less than 30 percent of the total hemoglobin conc entration. The incidence of stroke (cerebral infarction or intracrania l 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 stan dard care. At base line, the transfusion group had a slightly lower me an hemoglobin concentration (7.2 vs. 7.6 g per deciliter, P = 0.001) a nd 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 i nfarctions and ? intracerebral hematoma in the standard-care group, as compared with 1 infarction in the transfusion group - a 92 percent di fference 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 a bnormal results on transcranial Doppler ultrasonography. (N Engl J Med 1998;339:5-11.) (C) 1998. Massachusetts Medical Society.