A new study has reported limited use of transcranial Doppler (TCD) ultrasound screening to identify an elevated risk of stroke in pediatric patients with sickle cell anemia (SCA), which accounts for approximately 75% of cases of sickle cell disease (SCD).

The study, published in Morbidity and Mortality Weekly Report, noted that TCD screening and hydroxyurea therapy for those at risk can significantly reduce the occurrence of life-threatening complications.

“Previous studies documented underutilization of both TCD screening and hydroxyurea, and barriers to receipt of both interventions have been described,” the authors wrote.

The current study examined TCD screening and hydroxyurea use in patients with SCA aged 2–16 years with SCA.

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The research team analyzed IBM MarketScan Multi-State Medicaid Database data from 3352 children and adolescents with SCA who were continuously enrolled in Medicaid in 2019 and compared the results with a sample of 3858 children and adolescents with SCA who were enrolled in Medicaid in 2014. Demographic and health profiles were similar between the two groups.

Rates and proportions of TCD screening and the use of hydroxyurea were calculated, along with their percentage change between 2014 and 2019. Results were stratified by age (2-9 years and 10-16 years).

The results showed that, although both TCD screening and hydroxyurea use increased over the 5-year period, less than 50% of those aged 2 to 16 years underwent TCD screening in 2019. Additionally, less than 50% of children aged 2 to 9 years used hydroxyurea, and approximately half of those aged 10 to 16 years used it.

The authors recommend that healthcare providers implement strategies in collaboration with community-based organizations to overcome barriers to care and increase the rates of these potentially life-saving strategies for young people with SCD.


Schieve LA, Simmons GM, Payne AB, et al. Use of recommended health care measures to prevent selected complications of sickle cell anemia in children and adolescents—selected U.S. states, 2019. MMWR Morb Mortal Wkly Rep. 2022;71(39):1241-1246. doi:10.15585/mmwr.mm7139e1