Debaun Michael R, Galadanci Najibah A, Kassim Adetola A, Jordan Lori C, Phillips Sharon, Aliyu Muktar H
NASHVILLE, TENNESSEE.
Trans Am Clin Climatol Assoc. 2016;127:17-33.
In the United States, primary stroke prevention in children with sickle cell anemia (SCA) is now the standard of care and includes annual transcranial Doppler ultrasound evaluation to detect elevated intracranial velocities; and for those at risk, monthly blood transfusion therapy for at least a year followed by the option of hydroxyurea therapy. This strategy has decreased stroke prevalence in children with SCA from approximately 11% to 1%. In Africa, where 80% of all children with SCA are born, no systematic approach exists for primary stroke prevention. The two main challenges for primary stroke prevention in children with SCA in Africa include: 1) identifying an alternative to blood transfusion therapy, because safe monthly blood transfusion therapy is not feasible; and 2) assembling a health care team to implement and expand this effort. We will emphasize early triumphs and challenges to decreasing the incidence of strokes in African children with SCA.
在美国，镰状细胞贫血（SCA）患儿的原发性卒中预防现已成为标准治疗方案，包括每年进行经颅多普勒超声评估以检测颅内血流速度升高；对于有风险的患儿，进行至少一年的每月输血治疗，之后可选择羟基脲治疗。这一策略已使SCA患儿的卒中患病率从约11%降至1%。在所有SCA患儿中有80%出生的非洲，不存在原发性卒中预防的系统方法。非洲SCA患儿原发性卒中预防的两个主要挑战包括：1）确定输血治疗的替代方法，因为安全的每月输血治疗不可行；2）组建医疗团队来实施和扩大这项工作。我们将强调在降低非洲SCA患儿卒中发病率方面取得的早期成效和面临的挑战。
