TITLE:
Factors Associated with Abnormal Transcranial Doppler and Stroke Risk in Children with Sickle Cell Disease Followed at the Center for Research and Control of Sickle Cell Disease (CRLD) in Mali
AUTHORS:
Kéné Sékou, Diakité Abdoul Aziz, Touré Abdoulaye, Ouologuem Moussa, Kanta Mamadou, Koureichi Mohamed Moustapha, Berthe Drissa, Fofana Yaya, Tessougué Oumar, Berthé Toumany, Pérou Souleymane, Touré Boubacar Ali, Sarro Yeya dit Sadio, Guindo Aldiouma
KEYWORDS:
Sickle Cell Disease, Stroke, Transcranial Doppler, Child, Mali, Africa, Hydroxyurea, Anemia
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.16 No.6,
November
3,
2026
ABSTRACT: Background: Stroke is a severe complication of sickle cell disease (SCD) in children. Sickle cell cerebral vasculopathy is the underlying predisposing condition. Transcranial Doppler (TCD) is the gold standard for screening this vasculopathy. Chronic transfusion programs and, more recently, hydroxyurea, are the main preventive strategies for children with abnormal TCD. Objective: To determine factors associated with abnormal TCD, defined as time-averaged mean of the maximum velocity (TAMMV) ≥ 200 cm/s according to the Stroke Prevention Trial in Sickle Cell Anemia (STOP) criteria, in a population of children with SS and Sβ0-thalassemia followed for two years, and to describe the incidence of clinical stroke during follow-up. Methods: This was a prospective monocentric cohort study conducted from January 2023 to December 2024 at the Center for Research and Control of Sickle Cell Disease (CRLD) in Bamako, Mali. A total of 207 children with SCD (195 SS, 12 Sβ0-thalassemia), aged 2 to 15 years, in steady state, were included. Steady state was defined as absence of vaso-occlusive crisis (VOC), acute chest syndrome (ACS), acute infection or hospitalization within the previous 15 days and absence of blood transfusion within the previous 3 months. All children underwent TCD performed according to the STOP protocol. TCD results were categorized using STOP classification as normal (TAMMV Results: Mean age was 8.3 ± 3.6 years; 52.7% were male. At inclusion, 204 TCDs were interpretable (98.5%): 152 normal (73.4%), 34 conditional (16.4%), and 18 abnormal (8.7%); 3 were uninterpretable (1.5%). In univariate analysis, factors associated with abnormal TCD were age Conclusion: This study demonstrates the feasibility of TCD screening in routine practice in Mali. Age