Morning Report: 9/6/2013

Thanks to Dr. Bradby for today’s Morning Report!

Stroke in Sickle Cell Disease

Neurological and Hematological Emergency

• 24% of sickle cell disease patients have a stroke by the age of 45 years
  • these people have an increased risk of secondary stroke 2-3 years after initial CVA (recurrence rate of 66%)
• Ischemic variant – 54% of all CVAs is highest during the first decade of life and after age 30
  • In the 20s – hemorrhagic CVA is most predominant
• 10-30% of SCD patients have “silent strokes”
  • Radiologic findings consistent with diffuse white matter disease
  • Associated with cognitive deficiencies

Prevention:

• Hydroxyurea
• Chronic transfusion with goal of maintain HbS <30% (STOP 1, 2 trials – Optimizing Primary Stroke Prevention in Sickle Cell Anemia)

Management:

• Head CT, Stroke Labs, Consults
• Treatment:  EXCHANGE Transfusion; no place for tPA in these patients
• Consults:  Neurology, Hematology, MICU, Renal (for Shiley placement)
• Call blood back – need 8-10 units for exchange transfusion
• Call NY Blood Blank and ask to initiate exchange transfusion – this can take several hours
• Place Central Line – need a large bore femoral line for exchange (ex. Shiley)
  • This is where your renal consult comes in if necessary

References:

• Luis A. Verduzco and David G Nathan.  Sickle Cell Disease and Stroke.  Blood. December 10, 2009. Vol. 114, no 25, p5117-5125.
• Switzer JA, Hess DC, Nichols FT, Adams RJ. Pathophysiology and treatment of stroke in sickle-cell disease: present and future. Lancet Neurol. 2006 Jun;5(6):501-12. Review. PubMed PMID: 16713922.

The following two tabs change content below.

• Bio
• Latest Posts

Jay Khadpe MD

• Editor in Chief of "The Original Kings of County"
• Assistant Professor of Emergency Medicine
• Assistant Residency Director
• SUNY Downstate / Kings County Hospital

Latest posts by Jay Khadpe MD (see all)

• Save of the Month! December 2015 - December 23, 2015
• Morning Report: Unprovoked First Seizure in Adults - September 11, 2015
• Morning Report: Extramural Deliveries in the Emergency Room - September 10, 2015