Exchange transfusion for first stroke associated with sickle cell anemia

Article Outline

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In this issue of The Journal, Hulbert et al provide new insight into the optimal urgent management of children with sickle cell disease (SCD) at the time of a first overt stroke. They performed further analysis of a previously published (J Pediatr 2002;140:348-54) 14-center retrospective cohort study of management and long-term follow-up (mean 10.1 years) of 137 patients with SCD and stroke. The main finding of that analysis was that a first stroke in the absence of an antecedent or concurrent associated medical event was the major risk factor for recurrence despite chronic transfusion therapy. In the current analysis, and taking the previous finding into consideration, children whose management of first stroke was a simple transfusion versus an exchange transfusion had a 5.0 times relative risk (95% confidence interval 1.3, 18.6) of a second stroke.

In another article, Uong et al report a prospective study of the value of daytime oxygen saturation measurements (SpO₂) made in the first six months of life for predicting subsequent episodes of pain and acute chest syndrome. They found that awake, daytime, SpO2 values were not predictive, which stands in contrast to recent reports of nocturnal oxygen saturations predicting first time strokes and pain crises.

In an accompanying editorial, Redding-Lallinger discusses the findings of these studies and optimizing the medical care and quality-of-life outcomes for children with sickle cell disease.