TY - JOUR
T1 - Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography
AU - Adams, Robert J.
AU - Mckie, Virgil C.
AU - Hsu, Lewis
AU - Beatrice Files, Files
AU - Vichinsky, Elliott
AU - Pegelow, Charles
AU - Abboud, Miguel
AU - Gallagher, Dianne
AU - Kutlar, Abdullah
AU - Nichols, Fenwick T.
AU - Bonds, Duane R.
AU - Brambilla, Donald
AU - Woods, Gerald
AU - Olivieri, Nancy
AU - Driscoll, Catherine
AU - Miller, Scott
AU - Wang, Winfred
AU - Hurlett, Anne
AU - Scher, Charles
AU - Berman, Brian
AU - Carl, Elizabeth
AU - Jones, Anne M.
AU - Roach, E. Steve
AU - Wright, Elizabeth
AU - Zimmerman, Robert A.
AU - Waclawiw, Myron
PY - 1998/7/2
Y1 - 1998/7/2
N2 - 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.
AB - 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.
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U2 - 10.1056/NEJM199807023390102
DO - 10.1056/NEJM199807023390102
M3 - Article
C2 - 9647873
AN - SCOPUS:0032474692
SN - 0028-4793
VL - 339
SP - 5
EP - 11
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 1
ER -