92000
document
Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography . 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 .
92001
Intervention_Physical
Blood transfusions
92002
Intervention_Physical
standard care or transfusions
92003
Intervention_Physical
Transfusion
92004
Outcome_Physical
mean hemoglobin concentration
92005
Outcome_Physical
hematocrit
92006
Outcome_Adverse-effects
cerebral infarctions
92007
Outcome_Adverse-effects
intracerebral hematoma
92008
Outcome_Adverse-effects
infarction
92009
Outcome_Physical
risk of a first stroke
92010
Participant_Condition
sickle cell anemia
92011
Participant_Age
children
92012
Participant_Condition
sickle cell anemia
92013
Participant_Condition
sickle cell anemia
92014
Participant_Condition
stroke
92015
Participant_Age
children
92016
Participant_Condition
sickle cell anemia
92017
Participant_Condition
stroke
92018
Participant_Sample-size
130
92019
Participant_Age
8.3+/-3.3 years
92020
Participant_Sample-size
63
92021
Participant_Age
children
92022
Participant_Condition
sickle cell anemia