Brazilian Guidelines for transcranial doppler in children and adolescents with sickle cell disease

Lobo, Clarisse Lopes de Castro; Cançado, Rodolfo Delfini; Leite, Ana Cláudia Celestino Bezerra; Anjos, Ana Claudia Mendonça dos; Pinto, Ana Cristina Silva; Matta, André Palma da Cunha; Silva, Célia Maria; Silva, Gisele Sampaio; Friedrisch, João Ricardo; Braga, Josefina Aparecida Pellegrini; Lange, Marcos Christiano; Figueiredo, Maria Stella; Rugani, Marília Álvares; Veloso, Orlando; Moura, Paulo; Cortez, Paulo Ivo; Adams, Robert J.; Gualandro, Sandra Fátima Menosi; Castilho, Shirley Lopes de; Thomé, Úrsula; Zétola, Viviane Flumignan

doi:10.5581/v33n1a14

Cited by 9 publications

(12 citation statements)

References 23 publications

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“…12,22 As a result, TCD surveillance is now considered standard management for the prevention of first-ever stroke in children with HbSS and HbS/β0 between the age of 2 and 16. 11,13,23,24…”

Section: Resultsmentioning

confidence: 99%

Transcranial Doppler screening for stroke risk in children with sickle cell disease: a systematic review

Mazzucco

Diomedi

Qureshi³

et al. 2017

International Journal of Stroke

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Background Sickle cell disease (SCD) is one of the most common causes of stroke in children worldwide. Based on the results of the Stroke Prevention Trial in Sickle Cell Anemia (STOP), annual transcranial Doppler ultrasound (TCD) screening for affected children is standard practice. However, the need for TCD surveillance programs could override the accuracy of the screening, affecting the correct stratification of stroke risk and subsequent clinical management of the target population. Aims To shed light on this issue, a systematic review of the literature on TCD screening for children and adolescents with SCD was carried out (CRD42016050549), according to a list of clinically relevant questions, with a particular focus on screening practices in European countries. Quality of the evidence was rated using the grading of recommendations assessment, development and evaluation. Summary of review Thirty-three studies published in English or French were included (5 randomized controlled trials, 8 experimental non-randomized, and 20 observational studies). The quality of the retrieved evidence ranged between low and high, but was rated as moderate or high most of the times. TCD is effective as a screening tool for the primary prevention of stroke in SCD children. There is no high-quality evidence on the effectiveness of alternative screening methods, such as imaging-TCD with or without angle correction or magnetic resonance angiography. No evidence was found on effectiveness of the screening on children on hydroxyurea and with genotypes other than HbSS and HbS/β0. No European data were found on screening rates or adherence of screening practices to the STOP protocol. Conclusions High-quality studies on alternative screening methods that are currently used in real-world practice, and on screening applicability to specific subgroups of patients are urgently needed. Considering the low awareness of the disease in European countries and the lack of data on screening practices and adherence, clinicians need up-to-date guidelines for more uniform and evidence-based surveillance of children with SCD.

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Section: Resultsmentioning

confidence: 99%

Transcranial Doppler screening for stroke risk in children with sickle cell disease: a systematic review

Mazzucco

Diomedi

Qureshi³

et al. 2017

International Journal of Stroke

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“…Based on different studies and considering that SCD is the most common monogenic hereditary disease, occurring predominantly among African descendents, guidelines for transcranial Doppler in children and adolescents with SCD were developed to contribute in reducing morbidity and mortality resulting from this pathology in different settings. [13]…”

Section: Discussionmentioning

confidence: 99%

Evaluation of transcranial Doppler abnormalities in children with sickle cell disease in El-Obeid Specialized Children's Hospital

Ismail

Elnour

Mustafa

2019

J Family Med Prim Care

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Objectives: This study aims to evaluate transcranial Doppler abnormalities in children with sickle cell disease (SCD) in a specialized children's hospital in El-Obeid. Materials and Methods: This is a cross-sectional study done on 119 patients (2–18 years of age were included) who attended the sickle cell clinic in a specialized children's hospital in El-Obeid from December 2016 to February 2017; when patients do not have recent stroke symptoms, blood flow velocities were measured in both proximal internal carotid and middle cerebral arteries (MCAs) using non-imaging Doppler method, and time average mean velocities were recorded along with hemoglobin concentration and of the patients. Results: None of the study population had MCA velocity higher than 200 cm/s; also no high conditional velocity (170–199 cm/s) was recorded, so no patient was at high risk to develop stroke. About 20.1% of patients showed low velocities in one or both MCAs; 4.2% had abnormal MCAs’ interhemispheric ratio; 4.2% of study population showed absent flow in one of their MCAs, reflecting previous occlusion. About 4.2% had poor temporal window. It was difficult to measure the velocity in one of the four vessels in 5.9% of the patient due to uncooperativeness. There was statistically significant relationship between hemoglobin concentration and blood velocity in the left MCA. Conclusion: Despite the international recommendations, using transcranial Doppler ultrasonography (TCD) as a stroke screening tool in children with SCD in Sudan is still not a well-known practice. Successful strategies to improve TCD screening rates must be encouraged in all healthcare institutions.

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“…7 TCD should be performed and interpreted in accordance with the parameters defined by the STOP study, and should be done at least once a year in patients aged 2-16 years, based on previous guidelines. 8 Blood cell transfusion is indicated in patients with a mean cerebral blood flow velocity over 200 cm per second on two consecutive TCD examinations. The presence of mean cerebral blood flow velocity below 70 cm per second suggests severe stenosis and a repeat evaluation should be done 1 month later.…”

Section: Introductionmentioning

confidence: 99%

“…The presence of mean cerebral blood flow velocity below 70 cm per second suggests severe stenosis and a repeat evaluation should be done 1 month later. 8 It is important to note that chronic blood transfusion should not be interrupted by increasing age as suggested by the STOP-2 study, in which interruption of this procedure was associated with reversion to abnormal cerebral blood flow velocity and increased risk of stroke. 9…”

Section: Introductionmentioning

confidence: 99%

Clinical utility of carotid and transcranial ultrasound in cerebrovascular diseases

Lange¹,

Figueiredo²,

Zétola³

2014

JVD

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Carotid and transcranial (CTU) ultrasound is a useful tool in a number of clinical settings, particularly in cerebrovascular diseases. CTU is the only method that provides real-time determination of velocity and the spectral waveform of blood flow in the extracranial and basal intracranial arteries, and is effective in the detection of stenosis and occlusion. When transcranial ultrasound is considered, CTU is the only method that allows visualization of microembolic signals in the intracranial arteries. CTU makes a rapid differential diagnosis possible, improving therapeutic decision-making in acute stroke and determining the risk of recurrence and prognosis based on its findings. It is also the standard of care in children with sickle cell disease, when selecting patients for chronic blood transfusion, and for reducing the risk of ischemic stroke in these patients. CTU has some advantages, ie, relative simplicity in terms of interpretation and performance, and affordability, noninvasiveness, and portability. The main concern with ultrasound is that it is an operator-dependent tool and requires a high level of expertise and knowledge of three-dimensional cerebrovascular anatomy for correct interpretation of sonograms. The most significant limitation of intracranial evaluation by transcranial ultrasound is the absence of a suitable bone window in approximately 10% of patients. This paper gives an overview of the current utility and importance of CTU in the prevention and evaluation of ischemic cerebrovascular disease.

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Brazilian Guidelines for transcranial doppler in children and adolescents with sickle cell disease

Cited by 9 publications

References 23 publications

Transcranial Doppler screening for stroke risk in children with sickle cell disease: a systematic review

Transcranial Doppler screening for stroke risk in children with sickle cell disease: a systematic review

Evaluation of transcranial Doppler abnormalities in children with sickle cell disease in El-Obeid Specialized Children's Hospital

Clinical utility of carotid and transcranial ultrasound in cerebrovascular diseases

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