Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography

Robert J. Adams, Virgil C. Mckie, Lewis Hsu, Files Beatrice Files, Elliott Vichinsky, Charles Pegelow, Miguel Abboud, Dianne Gallagher, Abdullah Kutlar, Fenwick T. Nichols, Duane R. Bonds, Donald Brambilla, Gerald Woods, Nancy Olivieri, Catherine Driscoll, Scott Miller, Winfred Wang, Anne Hurlett, Charles Scher, Brian BermanElizabeth Carl, Anne M. Jones, E. Steve Roach, Elizabeth Wright, Robert A. Zimmerman, Myron Waclawiw

Research output: Contribution to journalArticle

1194 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)5-11
Number of pages7
JournalNew England Journal of Medicine
Volume339
Issue number1
DOIs
StatePublished - Jul 2 1998

ASJC Scopus subject areas

  • Medicine(all)

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    Adams, R. J., Mckie, V. C., Hsu, L., Beatrice Files, F., 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., ... Waclawiw, M. (1998). Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. New England Journal of Medicine, 339(1), 5-11. https://doi.org/10.1056/NEJM199807023390102