title: Risk of recurrent stroke in patients with sickle cell disease treated with erythrocyte transfusions.
abstract: OBJECTIVE
  To determine the effect of a transfusion program on risk of stroke recurrence in children with sickle cell disease.
  
  
  METHODS
  The clinical course and experience with transfusion therapy at eight centers were reviewed for subjects whose initial stroke occurred after January 1988.
  
  
  RESULTS
  Sixty subjects were observed for 191.7 patient-years. Eight had a single recurrent stroke (two intracranial hemorrhages and six infarctions) for a prevalence of 13.3%, or one recurrence for each 24 patient-years of observation. Thirteen subjects had 15 transient neurologic events; two of these had subsequent strokes, but the overall risk was similar for those who did and those did not have transient events. Hemoglobin S levels were greater than the desired maximum of 30% at the time of 7 of 16 transient events and five of six recurrent infarctions. The stroke recurrence rate was similar to those in previous reports of children receiving long-term transfusion therapy but significantly less than that reported for children who did not receive transfusions (p < 0.001).
  
  
  CONCLUSIONS
  We conclude that maintenance of hemoglobin S at a level less than 30% appears to be effective in reducing the rate of recurrent infarction but does not prevent transient neurologic events. Transient neurologic events are common but do not appear to be related to recurrent stroke.
authors.affiliation: Department of Pediatrics, University of Miami School of Medicine, Florida 33101, USA.
authors.forename: C H
authors.initials: CH
authors.lastname: Pegelow
authors.forename: R J
authors.initials: RJ
authors.lastname: Adams
authors.forename: V
authors.initials: V
authors.lastname: McKie
authors.forename: M
authors.initials: M
authors.lastname: Abboud
authors.forename: B
authors.initials: B
authors.lastname: Berman
authors.forename: S T
authors.initials: ST
authors.lastname: Miller
authors.forename: N
authors.initials: N
authors.lastname: Olivieri
authors.forename: E
authors.initials: E
authors.lastname: Vichinsky
authors.forename: W
authors.initials: W
authors.lastname: Wang
authors.forename: D
authors.initials: D
authors.lastname: Brambilla
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000628:therapy*; D002544:Cerebral Infarction / Q000209:etiology / Q000517:prevention & control; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion; D005260:Female; D006451:Hemoglobin, Sickle / Q000032:analysis; D006801:Humans; D007223:Infant; D008297:Male; D012008:Recurrence
chemical_list: D006451:Hemoglobin, Sickle