Children and adolescents with sickle cell anemia are not getting appropriate transcranial Doppler screening and treatment with hydroxyurea, although overall screening and treatments have increased over the past decade. Healthcare providers should seek to improve their screening and treatment strategies to address these disparities.
Sickle cell anemia is a blood disorder that commonly affects African Americans, and is associated with a high risk of complications and mortality. Guidelines recommend the use of transcranial Doppler screening (TCD) to identify stroke risk factors in children and adolescents 2–16 years of age, and treatment with hydroxyurea to reduce the risk of severe complications that could lead to mortality.
A recent study conducted by the Centers for Disease Control and Prevention (CDC) analyzed data from the IBM MarketScan Multi-State Medicaid Database. Data concerning TCD screening and hydroxyurea use in 3,352 children and adolescents with sickle cell anemia who were enrolled in Medicaid in 2019 were evaluated. Around 5% of children and adolescents who were receiving blood transfusion therapy were excluded from the study.
Results from the analysis found that TCD screening increased by 27% among children and adolescents aged 10 to 16 years from 2014 to 2019. However, 47% of children aged 2 to 9 years and 38% of children and adolescents aged 10 to 16 years received TCD screening by 2019. In addition, hydroxyurea use increased from 2014 to 2019 in children aged 2 to 9 years (27%) and children and adolescents aged 10 to 16 years (23%). However, in 2019, 38% of children aged 2 to 9 years and 53% of children and adolescents aged 10 to 16 years received treatment with hydroxyurea.
According to the analysis, numerous children and adolescents with sickle cell anemia were not receiving TCD screening or hydroxyurea in 2019. As more than 90% of patients with sickle cell disease are Black or African American, potential barriers to care may come into play. Healthcare providers should carry out improved strategies to increase TCD screening and hydroxyurea treatment, especially in communities that are affected by barriers to care.
Schieve, L. A., Simmons, G. M., Payne, A. B., Abe, K., Hsu, L. L., Hulihan, M., Pope, S., Rhie, S., Dupervil, B., & Hooper, W. C. (2022). Vital Signs: 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, 71(39), 1241-1246. https://doi.org/10.15585/mmwr.mm7139e1