Risk of recurrent stroke in children with sickle cell disease receiving blood transfusion therapy for at least five years after initial stroke.
OBJECTIVE
To test the hypothesis that children with sickle cell disease (SCD) who have an initial stroke temporally unrelated to another medical event are at higher risk for recurrent stroke than are children who had strokes temporally related to medical events.


METHODS
A retrospective cohort study of children with SCD and stroke who received regularly scheduled blood transfusions for a minimum of 5 years was conducted. Medical records were examined for the documentation of antecedent or concurrent medical events (hypertension, acute chest syndrome, aplastic crisis, fever associated with infection, exchange transfusion) associated with physician contact within 14 days before the initial stroke.


RESULTS
A total of 137 pediatric patients from 14 centers were studied. Mean age at first stroke was 6.3 years (1.4 to 14.0 years) with mean follow-up of 10.1 years (5 to 24 years). Thirty-one (22%) patients had a second stroke (2.2 per 100 patient years); 26 patients had an identified medical or concurrent event associated with their initial stroke. None of these patients had recurrent stroke 2 or more years after the initial event. The remaining 111 patients had an ongoing risk of recurrent stroke (1.9 per 100 patient-years) despite long-term transfusions (P =.038).


CONCLUSIONS
The absence of an antecedent or concurrent medical event associated with an initial stroke is a major risk factor for subsequent stroke while receiving regular transfusions.
Scothorn
Douglas J
DJ
University of Texas Southwestern Medical Center, Dallas, TX, USA.
Price
Cynthia
C
Schwartz
Daniel
D
Terrill
Cindy
C
Buchanan
George R
GR
Shurney
Wanda
W
Sarniak
Ingrid
I
Fallon
Robert
R
Chu
Jen-Yih
JY
Pegelow
Charles H
CH
Wang
Winfred
W
Casella
James F
JF
Resar
Linda S
LS
Berman
Brian
B
Adamkiewicz
Thomas
T
Hsu
Lewis L
LL
Ohene-Frempong
Kwaku
K
Smith-Whitley
Kim
K
Mahoney
Donald
D
Scott
J Paul
JP
Woods
Gerald M
GM
Watanabe
Masayo
M
Debaun
Michael R
MR
D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000628:therapy*; D001803:Blood Transfusion; D002648:Child; D015897:Comorbidity; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*