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Year : 2017  |  Volume : 4  |  Issue : 1  |  Page : 3-8

The management of stroke in sickle cell anemia: A single site experience in a low-income setting

Paediatrics Haematology-Oncology Unit, Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria

Correspondence Address:
Jamilu A Faruk
Department of Paediatrics, Ahmadu Bello University Teaching Hospital, P.M.B. 06, Shika - Zaria, Kaduna State
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ssajm.ssajm_42_16

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Context: Stroke is a devastating complication of sickle cell anemia (SCA) and is fatal in about 5% of patients, with chronic sequelae in survivors. The occurrence of stroke is predictable and preventable. However, up to 50% of children in some low-income settings are deprived of optimal care. Aims: The study aimed to document the presentations of stroke in sickle cell patients, and the interventions utilized. Settings and Design: A descriptive, retrospective review was conducted. Materials and Methods: Case records were manually retrieved of patients managed for sickle cell stroke from April 2011 to March 2016. Statistical Analysis Used: Descriptive and analytic statistics were utilized. Results: A total of 21 patients were analyzed, comprising 38.1% males, with a male-to-female ratio of 1:1.6. The mean age at the time of diagnosis of SCA was known to parents was 1.9 ± 1.7 years, and the chronological age of patients, at the time of first registration in the unit for sickle cell related care was 3.9 ± 2.6 years. Ten children (47.6%) were presenting for the first time on the account of the stroke, while the rest had been on follow-up visits in the unit, prior to stroke occurrence. Age at the occurrence of sickle cell stroke was 5.8 ± 2.7 years. Only 2 (9.5%) had a transcranial Doppler (TCD) examination prior to experiencing the stroke. The symptoms of the stroke were observed 8.3 ± 19.2 days before medical care was sought. The interval between onset of stroke and medical intervention was 11.5 ± 21.3 days. Only 2 (9.5%) had intervention within 24 h of the onset of symptoms, and only 4 (19%) patients had complete recovery of stroke symptoms. Conclusion: Although many of the participants were known to have SCA at an earlier time by parents, they were not presented for specialist care until stroke had developed. In addition, TCD was not accessible or available to majority of the patients, and there was also delay in seeking and providing medical intervention for majority of patients after stroke occurrence.

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