David Rees on stroke prevention in children w sickle cell. At KCH they screen S/bthal & SC although not included in original data #BSH2017
20-30% inadequate scans in 2-3 yr olds -poor cooperation but stroke risk highest in this age. MR under GA if still no scan by age 3 #BSH2017
What to do with persistently abnormal TCD despite tx ?add HU ??consider HSCT? #BSH2017
Target hbS in STOP was <30%; can aim lower but law of diminishing returns #BSH2017
Overnight hypoxia important in stroke risk in sickle - ?O2 ?adenotonsillectomy ??CPAP #BSH2017
Role of aspirin unclear - in UK moyamoya is considered contraindication, in France its considered an INDication! #BSH2017
As with all things anticoagulation/antiplatelets seemingly, those with most to gain are at highest risk of side effects #BSH2017
TWiTCH showed transfusn = HU after a year of transfusion support- but ~50% would rather stay on transfusions #BSH2017
Multiple burr holes an alternative treatment option for moyamoya?? ncbi.nlm.nih.gov/pmc/articles/P… #BSH2017
Valentine Brousse: sickle in children. BabyHug was critical trial of HU vs placebo in 9-18 month olds ncbi.nlm.nih.gov/pubmed/21571150 #BSH2017
Jo Howard on When to transfuse in sickle. Peer review shows vast variation in practice even in the UK #BSH2017
NICE recommend automated exchange for sickle patients needing long term transfusion - is cost effective compared to manual exchange #BSH2017
Recommendation based on TAPS is that HbSS and SBthal w hb<90 should have top up transfusion prior to surgery #BSH2017
Blood for transfusion in sickle should be CDE and kell matched. And HbS neg! #BSH2017
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