Transcranial Doppler Scanning and the Assessment of Stroke Risk in Children with HbSC disease

Colin Deane ¹, David Goss ¹, Sandra O'Driscoll ¹, Sarah Melllor ¹, Keith Pohl ², Moira C Dick ¹, Susan E Height ¹ and David C Rees ^1*

¹ King's College Hospital, London, United Kingdom
² Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom

^* To whom correspondence should be addressed. E-mail: david.rees{at}kch.nhs.uk.

Accepted 8 October 2007

Abstract

Objective:

To assess the role. of transcranial Doppler (TCD) scanning in assessing the risk of stroke in children with HbSC disease. TCD scanning has an established role in primary stroke prevention in sickle cell anaemia (HbSS) but its value in HbSC is unknown.

Design:

A retrospective audit of routinely performed TCD scans and routinely collected clinical data.

Setting:

A paediatric sickle cell clinic in a teaching hospital in South London.

Patients:

46 children with HbSC disease who had routinely performed TCD scans and steady state blood tests. Main outcome measures: The time averaged mean of the maximum velocity (TAMMV) in the middle cerebral artery circulation, correlated with clinical and laboratory data.

Results:

The mean TAMMV was 94cm/s, with a 98th centile of 128cm/s. This is significantly less than the published ranges for HbSS, with a mean reading of 129cm/s. One child had a stroke at the age of 5 years, when her TAMMV was measured at 146cm/s.

Conclusions:

Further studies are needed to assess stroke risk in HbSC, but we suggest that TCD measurements are potentially useful in this condition, and that readings greater than 128cm/s are abnormally high and warrant further investigation.

Keywords: HbSC, sickle cell disease, stroke, transcranial doppler scanning

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