title: Hydroxyurea therapy lowers TCD velocities in children with sickle cell disease.
abstract: BACKGROUND
  Hydroxyurea (HU) improves hematologic parameters and decreases adverse events in patients with sickle cell disease (SCD). HU has been proposed as an alternative to chronic transfusions for secondary stroke prevention. Transcranial doppler (TCD) is an accepted method of stroke risk stratification in patients with SCD. We sought to determine if HU affects TCD velocities in children with SCD.
  
  
  METHODS
  A cohort of 24 children with HbSS with a baseline TCDi prior to HU and a follow-up after at least 6 months of therapy was analyzed. Twenty-four age-matched children with HbSS formed the control group. Differences in hematologic parameters before and after HU therapy were evaluated.
  
  
  RESULTS
  TCDi velocities decreased in the HU-treated patients. The adjusted mean change in TCDi velocities was -13.0 cm/sec (95% CI -20.19, -5.92) in the HU-treated group and +4.72 cm/sec (95% CI -3.24, 12.69) in the controls. Changes in TCDi between the two groups were statistically significant (P < 0.001). Changes in hematologic parameters were not predictive of changes in TCDi velocities in the treated patients. Four out of five patients with TCDi velocities >170 cm/sec had normalization of TCDi velocities on HU. Mean change was -34.75 cm/sec in this subgroup. No patients experienced cerebrovascular accidents (CVA) while on HU.
  
  
  CONCLUSIONS
  HU-treated patients experienced statistically significant decreases in TCDi velocities compared to age-matched controls. Changes in hematologic parameters were not predictive of changes in TCDi velocities in the treated group. The decrease in TCDi velocities is not a consequence of changes in hematologic values in patients treated with HU.
authors.affiliation: Pediatric Hematology/Oncology, Walter Reed Army Medical Center, Washington, District of Columbia, USA.
authors.forename: Tonya
authors.initials: T
authors.lastname: Kratovil
authors.forename: Dorothy
authors.initials: D
authors.lastname: Bulas
authors.forename: M Catherine
authors.initials: MC
authors.lastname: Driscoll
authors.forename: Barbara
authors.initials: B
authors.lastname: Speller-Brown
authors.forename: Robert
authors.initials: R
authors.lastname: McCarter
authors.forename: Caterina P
authors.initials: CP
authors.lastname: Minniti
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D001783:Blood Flow Velocity; D002648:Child; D002675:Child, Preschool; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006918:Hydroxyurea / Q000627:therapeutic use*; D007958:Leukocyte Count; D008297:Male; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D006454:Hemoglobins; D006918:Hydroxyurea