An 8-year-old boy with sickle cell disease (HbSS) has never had a stroke. Which screening modality is recommended annually to assess stroke risk and guide chronic transfusion therapy?
- A Transcranial Doppler ultrasonography (TCD) ✓
- B Magnetic resonance angiography (MRA) of the brain
- C Carotid artery duplex ultrasound
- D CT perfusion scan of the brain
Correct answer: A. Transcranial Doppler ultrasonography (TCD)
Explanation
Transcranial Doppler ultrasonography (TCD) is the recommended annual screening tool for children aged 2-16 with sickle cell disease. Elevated cerebral blood flow velocities (>200 cm/sec) predict high stroke risk and warrant chronic transfusion therapy (STOP trial). MRA is used for follow-up or equivocal TCD findings but not routine screening. Carotid duplex screens extracranial vessels, not intracranial.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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