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Review
. 2022 Nov 22;14(11):e31778.
doi: 10.7759/cureus.31778. eCollection 2022 Nov.

Blood Transfusion Vs. Hydroxyurea for Stroke Prevention in Children With Sickle Cell Anemia: A Systematic Review and Meta-Analysis

Tamara A Hafiz  1 , Sarah S Aldharman  2 , Ruby N AlSubaie  3 , Lena D Alzahrani  3 , Ibrahim Ahmed J Albalawi  3 , Yara A Alali  3 , Maisaa M Yousuf  3 , Hayat M Alharbi  3 , Nawaf S Alamri  4 , Syed F Jamil  5   6   7
Affiliations
Review

Blood Transfusion Vs. Hydroxyurea for Stroke Prevention in Children With Sickle Cell Anemia: A Systematic Review and Meta-Analysis

Tamara A Hafiz et al. Cureus. .

Abstract

Sickle cell anemia (SCA) is a hereditary condition that can lead to severe complications in children such as acute coronary syndrome, splenic sequestration, renal failure, and stroke. Blood transfusion and hydroxyurea (HU) therapy are used to prevent stroke in children with sickle cell disease (SCD). Preliminary data show considerable variation and inconsistency in the use of these two therapeutic interventions. Therefore, this systematic review was carried out to compare the effects of blood transfusion to HU therapy in preventing stroke for children with sickle cell disease. There was an extensive literature search in reliable and authentic databases like PubMed, Medline, Scopus, Cochrane, and Science Direct to obtain relevant articles. This study used the standards and guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). During the systematic review, data were obtained focusing on the following parameters: the size of the sample in the study, the age of the subjects involved in the study, the type of Intervention, and the outcome. After an initial search of 163 papers, 25 studies were included. The results of the research give the first evidence that HU is effective in the treatment of cerebrovascular problems in children with SCD. However, it is unclear under what circumstances HU may prevent a second stroke. It can be concluded that children with SCA can effectively avoid primary strokes through chronic blood transfusions and HU.

Keywords: blood transfusion; children; hydroxyurea; prevention; sickle cell anemia; stroke.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA flow diagram of the inclusion and exclusion process of the studies in the systematic review
PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2. Forest plot summarizing the analysis of the effects of transfusion on stroke incidences in children with sickle cell anemia.
Included studies are Aygun et al. [29], Brousse et al. [30], Mirre et al. [31], Moreira Franco et al. [32], and Wood et al. [33].
Figure 3
Figure 3. Funnel plot representing publication bias of the included and analyzed studies
Figure 4
Figure 4. Forest plot summarizing the analysis of the effects of hydroxyurea on stroke incidences in children with sickle cell anemia
Included studies are DeBaun et al. [34], Mulaku et al. [36], Montalembert et al. [37], Sumoza et al. [39], and Bortolusso Ali et al. [40].
Figure 5
Figure 5. Funnel plot representing publication bias of the included and analyzed studies
Figure 6
Figure 6. Forest plot summarizing the analysis of the effects of both transfusion and hydroxyurea on stroke incidences in children with sickle cell anemia
Included studies are Ware et al. [4] and Bernaudin et al. [22].
Figure 7
Figure 7. Funnel plot representing publication bias of the included and analyzed studies
See this image and copyright information in PMC

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