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Stroke risk returns when children with sickle cell disease stop transfusions

Stopping regular blood transfusions in children with sickle cell disease who are at risk for a stroke means their stroke risk likely will return, researchers have found.

A study of children whose stroke risk was reduced by blood transfusions found that within a few months of halting transfusion, 14 of the 41 children resumed at-risk status and two children had strokes, says Dr. Robert J. Adams, neurologist and stroke specialist at the Medical College of Georgia who authored the article in the Dec. 29 New England Journal of Medicine.

None of the 38 children who continued transfusions resumed at-risk status or had a stroke.

"We hoped that maybe we were dealing with something that was relatively short-lived over a few years in a child's life," says Dr. Adams. "Most of the time, that doesn't seem to be the case. Although there were eight children in the halted-transfusion arm that were followed for more than 25 months without any apparent problem, they were the minority and we have no way to predict who they are."

The study, headquartered at MCG and involving 25 sites in North America, was to enroll 100 patients, but the Data and Safety Monitoring Board appointed by the National Heart, Lung and Blood Institute recommended early closure in late 2004 because so many children resumed their at-risk status. The NHLBI issued a clinical alert in December 2004 to coincide with the closure saying the 10 percent of children with sickle cell disease who have a high stroke risk need ongoing transfusions.

The NHLBI funded the $11 million STOP II study looking at whether children needed to continue transfusions after their stroke risk normalized. That followed another NHLBI-funded study, led by MCG, which showed monthly transfusions cut stroke risk by 90 percent.

STOP II participants included patients identified at risk by abnormal blood flow studies of their brain whose studies had normalized after at least 30 months of transfusion; pa
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Contact: Toni Baker
tbaker@mcg.edu
706-721-4421
Medical College of Georgia
29-Dec-2005


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