In sickle cell disease, which group should be screened with transcranial Doppler ultrasonography to assess stroke risk?

In sickle cell disease, which group should be screened with transcranial Doppler ultrasonography to assess stroke risk?

• A. All sickle cell patients
• B. All sickle cell patients 2-16 years
• C. Adults
• D. Neonates

Answer: (B)

Transcranial Doppler screening is used to identify stroke risk specifically in children with sickle cell disease, because the risk of first stroke is highest in early childhood. Large studies, notably STOP, showed that annual TCD screening in children aged 2–16 with sickle cell disease detects those with high flow velocities due to intracranial arterial narrowing. Those with abnormal TCD velocities have a high short-term risk of stroke, and initiating chronic transfusion therapy reduces that risk. Therefore the group to screen is children 2 to 16 years old with sickle cell disease. Routine TCD screening is not established for adults or for neonates.

Transcranial Doppler screening is used to identify stroke risk specifically in children with sickle cell disease, because the risk of first stroke is highest in early childhood. Large studies, notably STOP, showed that annual TCD screening in children aged 2–16 with sickle cell disease detects those with high flow velocities due to intracranial arterial narrowing. Those with abnormal TCD velocities have a high short-term risk of stroke, and initiating chronic transfusion therapy reduces that risk. Therefore the group to screen is children 2 to 16 years old with sickle cell disease. Routine TCD screening is not established for adults or for neonates.