A case study of a four year HBSS child diagnosed with high risk for stroke from multiple Transcranial Doppler (TCD) scan with no sign/symptom of stroke

Transcranial Doppler (TCD) is a well-established predictor of the risk of ischemic stroke in Sickle Cell Disease (SCD) children aged 2-16 years. TCD measures the time-averaged maximal mean velocity (TAMMV) in distal intracranial portions of the internal carotid artery and the proximal middle cerebral artery (MCA). Stroke prevention for SCD trial proposed guidelines for the appropriate use of STOP TCD technique to achieve high sensitivity and specificity in the detection of high mean velocity TAMMV values for prediction of likely stroke events in children with sickle cell anaemia and recommended the use of chronic blood transfusion regime as preventive therapy. Stroke prevalence in untreated SCD children with abnormal TCD is poor (3%). However, the case study revealed a 4-year-old Hemoglobin SS, despite persistent results of high risk for stroke from multiple TCD scans has had no clinical symptoms. Conclusion: This young child will benefit from combined treatment with hydroxyurea and chronic transfusion therapy with continuous monitoring to reduce the probability of developing stroke in future without intervention. Magnetic Resonance Imaging (MRI) to detect Silent Cerebral Infarct (SCI) will be required to augment her risk for stroke. Recommendation: There's a need for a more sensitive and specific method of screening for stroke risk among SCD children as the sensitivity of TCD scan may be weak in specialist centres nationwide, early referral of SCD children to a paediatric haematologist for optimal care and incorporation of health care financing schemes for SCD children to increase adequate care and stroke prevention.