STROKE RISK ASSESSMENT IN PAEDIATRIC PATIENTS WITH SICKLE CELL DISEASE AT THE LAGOS STATE UNIVERSITY TEACHING HOSPITAL: A PRELIMINARY REPORT

Abstract

Background: Despite significant sickle cell disease
(SCD) burden in Nigeria, data on stroke risk are scarce
and there is poor access to transcranial Doppler (TCD)
screening in most clinics. We add to existing data by
identifying asymptomatic children with SCD and high
primary stroke risk as well as investigate associations
with clinical and laboratory parameters.
Methodology: The study site was the paediatric SCD
clinic of the Lagos State University Teaching Hospital.
Primary stroke risk was determined by TCD in 83 children
with SCD in steady state. Associations between clinical
and haematological parameters, foetal haemoglobin and
high stroke risk were described by multivariate analysis.
Results: High stroke risk was assigned to 9.6% of
subjects, all with the genotype HbSS. Abnormal TCD
studies correlated negatively with packed cell volume
(PCV) (p < 0.05), Hb (p < 0.01) and positively with total
WBC count (p<0.05). The probability of a child having
high stroke risk was 0.8 if the child had critical values of
PCV ≤ 21.7%, WBC ≥14.4mm3 and reticulocytes ≥2.0%.
Conclusion: Highrisk for sickle-related stroke is
common, making routine screening necessary for better
outcome in SCD. Critical levels of hematologic indices
may be useful in identifying children with genotype HbSS
at highest risk.