Transcranial doppler ultrasound: an essential tool in preventing neurological complications in children with sickle cell disease

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Introduction: Sickle cell disease (SCD) is a genetic disorder causing erythrocyte deformation, vaso-occlusive crises, and hyper-hemolysis. Stroke, a major complication, affects up to 11% of children before age 20, with high morbidity and mortality. Transcranial Doppler ultrasound (TCD) assesses intracranial blood flow velocity, identifying at-risk children. International and national guidelines, such as those from the American Stroke Association and the Brazilian Ministry of Health, recommend TCD. However, its implementation remains challenging in low- and middle-income countries. Objective: The aim of this study was to review the evidence on TCD’s role in preventing neurological complications in pediatric SCD, focusing on stroke risk reduction, quality-of-life impact, and implementation barriers. Methods: A systematic review was conducted in PubMed, Scopus, Web of Science, and SciELO (2010–2024). Studies in English and Portuguese on TCD in pediatric SCD were included, while case reports and narrative reviews were excluded. Clinical trials, cohort studies, and guidelines were prioritized. Results: In total, 36 studies (12 clinical trials, 18 cohort studies, five guidelines) confirmed TCD’s effectiveness in detecting intracranial blood flow velocities above 200 cm/s, linked to a 40-fold increased stroke risk. Systematic screening, combined with regular blood transfusions for high-risk children, reduced stroke incidence by up to 92%, as shown in the STOP trial. In Brazil, initiatives such as the National Neonatal Screening Program have expanded access to TCD, with promising results. However, logistical challenges, limited professional training, and gaps in long-term follow-up hinder its full impact. Conclusion: TCD is a crucial tool for preventing neurological complications in pediatric SCD, with strong evidence supporting its role in stroke prevention. Despite advancements, large-scale implementation faces regional and operational obstacles. Expanding TCD access and improving healthcare professional training should be public health priorities to ensure equitable care.

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