Hypertension, Convulsions, and Cerebral Hæmorrhage in Sickle-Cell Anæmia Patients After Blood-Transfusions

Royal, Joyce E.; Seeler, Ruth Andrea

doi:10.1016/s0140-6736(78)92193-1

Cited by 54 publications

(25 citation statements)

References 3 publications

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“…Other than the presence of aneurysms, risk factors for hemorrhagic stroke include low Hb, high steady-state leukocyte, 3 recent blood transfusion (in the last 14 days), treatment with corticosteroids, or ACS. [13][14][15][16][17] An evidence-based approach to care is lacking in patients with SCD presenting with acute hemorrhagic stroke. Recognition of associated risk factors for hemorrhagic stroke is important in treatment stratification, including strong consideration for cerebral angiography in order to exclude intracranial aneurysm.…”

Section: Differential Diagnosis Of Acute Presentation Of Focal Neurolmentioning

confidence: 99%

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How I treat and manage strokes in sickle cell disease

Kassim

Galadanci

Pruthi³

et al. 2015

Blood

111

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Neurologic complications are a major cause of morbidity and mortality in sickle cell disease (SCD). In children with sickle cell anemia, routine use of transcranial Doppler screening, coupled with regular blood transfusion therapy, has decreased the prevalence of overt stroke from ∼11% to 1%. Limited evidence is available to guide acute and chronic management of individuals with SCD and strokes. Current management strategies are based primarily on single arm clinical trials and observational studies, coupled with principles of neurology and hematology. Initial management of a focal neurologic deficit includes evaluation by a multidisciplinary team (a hematologist, neurologist, neuroradiologist, and transfusion medicine specialist); prompt neuro-imaging and an initial blood transfusion (simple followed immediately by an exchange transfusion or only exchange transfusion) is recommended if the hemoglobin is >4 gm/dL and <10 gm/dL. Standard therapy for secondary prevention of strokes and silent cerebral infarcts includes regular blood transfusion therapy and in selected cases, hematopoietic stem cell transplantation. A critical component of the medical care following an infarct is cognitive and physical rehabilitation. We will discuss our strategy of acute and longterm management of strokes in SCD. (Blood. 2015;125(22):3401-3410)

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Section: Differential Diagnosis Of Acute Presentation Of Focal Neurolmentioning

confidence: 99%

“…17,48,49 Table 1 provides the checklist we use when organizing an exchange transfusion therapy in an individual with focal neurologic deficit. 50 In adult patients with SCD presenting with acute ischemic stroke, the preferred initial approach remains an exchange transfusion because of the very high risk of recurrent cerebral infarcts.…”

Section: -29mentioning

confidence: 99%

How I treat and manage strokes in sickle cell disease

Kassim

Galadanci

Pruthi³

et al. 2015

Blood

111

View full text Add to dashboard Cite

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“…In a recent study of 15 children with SCD and HS, factors associated with hemorrhage included pre-morbid hypertension, transfusion within the last 14 days, treatment with corticosteroids, and perhaps non-steroidal anti-inflammatory drugs [24]. Other risk factors identified in cohort studies and case series of SCD include: age, low steady-state hemoglobin concentration and high steady-state leukocyte count [33], as well as cerebral aneurysms, moyamoya, hypertension, acute chest syndrome, and overly aggressive transfusion [34][35][36][37]. Appropriate treatment after HS in SCD is unclear; however, patients with SAH and IPH with arterial occlusive disease are often placed on transfusion therapy as they are for ischemic stroke [38].…”

Section: Special Populationsmentioning

confidence: 99%

Hemorrhagic Stroke in Children

Jordan

Hillis

2007

Pediatric Neurology

112

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Hemorrhagic stroke accounts for approximately half of stroke in childhood. Unlike arterial ischemic stroke, there are no consensus guidelines to assist in the evaluation and treatment of these children. We review the literature on the evaluation, treatment, etiology and neurologic outcome of hemorrhagic stroke in children. Important differences between pediatric and adult hemorrhage are highlighted, as treatment guidelines for adults may not be applicable in all cases. Needed future research and potential therapies are also discussed.

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“…The remaining 122 papers were reviewed for relevance, resulting in a total of 14 case reports or studies meeting the above inclusion criteria [6][7][8][9][10][11][12][13][14][15][16][17][18][19] and 5 papers describing adverse sequelae. [20][21][22][23][24] These papers contained information on 42 individuals who were then stratified by treatment modality into the following categories:…”

Section: Resultsmentioning

confidence: 99%

“…A similar association between SCA and this syndrome was subsequently described in 2 patients. 21 One patient was treated for priapism and was transfused with 2 units of packed erythrocytes. Four days later he complained of a headache, appeared lethargic, and experienced multiple generalized seizures.…”

Section: Adverse Sequelae To Transfusion Therapymentioning

confidence: 99%

Myth: Blood transfusion is effective for sickle cell anemia—associated priapism

Merritt

Haiman

Henderson

2006

CJEM

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Objective: Priapism is a recognized complication of sickle cell anemia (SCA). When initial conventional treatments fail, simple or exchange blood transfusion has been advocated as a secondary intervention. However, recent literature suggests this may not be an effective therapy and may have significant neurologic sequelae. This paper reviews and summarizes the effectiveness and risks of blood transfusion compared with conventional priapism therapy. Methods: All relevant papers identified from a MEDLINE search were systematically examined for data related to the use of blood transfusion in the setting of priapism due to SCA. The effectiveness of conventional therapy was compared with transfusion therapy using the outcome of "time to detumescence" (TTD). In addition, papers documenting adverse neurologic sequela were reviewed and summarized. Results: Forty-two case reports were identified containing complete information with regard to patient age and TTD. The mean TTD was 8.0 days with conventional therapy (n = 16) and 10.8 days with blood transfusion therapy (n = 26). Adverse neurologic sequelae from blood transfusion therapy was described in 9 cases, with long term outcomes ranging from complete resolution to severe residual deficits. Conclusion: The current literature does not support the contention that blood transfusion is an effective therapy in the treatment of priapism due to SCA, as defined by an acceleration of TTD. In fact, numerous reports suggest that serious neurologic sequelae may result from this treatment. We feel the routine use of this therapy cannot be recommended. RÉSUMÉObjectif : Le priapisme est une complication reconnue de la drépanocytose. En cas d'échec des traitements initiaux classiques, on recommande le recours à la transfusion simple ou d'échange à titre d'intervention secondaire. Cependant, la littérature récente suggère qu'une telle thérapie pourrait ne pas être efficace et qu'elle pourrait laisser des séquelles neurologiques importantes. Le présent article examine et résume l'efficacité et les risques de la transfusion sanguine comparativement à la thérapie classique pour le priapisme. Méthodes : Tous les articles pertinents relevés lors d'une recherche de MEDLINE furent examinés de façon systématique quant aux données liées au recours à la transfusion sanguine pour les cas de priapisme dus à la drépanocytose. L'efficacité de la thérapie classique fut comparée à la

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Hypertension, Convulsions, and Cerebral Hæmorrhage in Sickle-Cell Anæmia Patients After Blood-Transfusions

Cited by 54 publications

References 3 publications

How I treat and manage strokes in sickle cell disease

How I treat and manage strokes in sickle cell disease

Hemorrhagic Stroke in Children

Myth: Blood transfusion is effective for sickle cell anemia—associated priapism

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