Blood Transfusions May Cut Stroke Risk From Sickle Cell
Study found children who got monthly infusions were less likely to suffer another attack
But the children were followed for only three years. And it's reasonable to assume that preventing silent strokes would ultimately protect brain function, said Dr. Martin Steinberg, director of the Center of Excellence in Sickle Cell Disease at Boston University School of Medicine, who wrote an editorial published with the study.
The big questions, according to Steinberg, center on how to translate this treatment from a clinical trial, done at large academic medical centers, to the real world.
"The results of this trial are solid," Steinberg said. "But it could be very difficult to do this in a community hospital setting, where the resources might not be there."
Monthly transfusions are not a simple matter, Steinberg noted. For one, kids have to be monitored for side effects like "iron overload," which is very common. Excess iron in the blood is potentially dangerous because the mineral can damage organs, and it may require treatment with special "chelating" drugs that draw excess iron from the blood.
And while this study ran for three years, blood transfusions would almost certainly have to continue for a longer time, according to Steinberg.
"I don't think three years would be enough," he said. "Sickle cell disease doesn't go away." He pointed to a 2005 study where transfusions were used to prevent overt -- not silent -- strokes; as soon as the treatment was stopped, patients' stroke risk climbed again.
Casella said that based on his team's findings, it's reasonable for children with sickle cell to have an MRI brain scan before starting elementary school. If there are signs of a silent stroke, transfusions could be considered.
But whether that will become the standard remains to be seen. Casella agreed that the hospital resources might not be there, depending on where a family lives. And at least for now, insurers are unlikely to cover the costs.
Steinberg's advice to parents: "First of all, if you can, go to a center with expertise in treating sickle cell disease. I wouldn't run out and try to get MRI screening without that consultation."
Casella said he is not suggesting blood transfusions are the final answer to sickle-cell-related strokes -- and continuing research into alternatives is vital.
Steinberg agreed. "This is a difficult disease," he said. "To make it better, the body has to make better red blood cells. Research is underway, and there are drugs under development. But they're not here yet."