How long would you continue chronic transfusion therapy for adult sickle cell patients who have had a stroke?

There is no high-level evidence to inform the decision of how long to continue chronic transfusion in this scenario. Decisions on whether to continue indefinitely are affected by multiple factors like the presence of RBC alloimmunization, whether the patient was on hydroxyurea at MTD or not at the time of the stroke, history of port infection or thrombosis, accessibility/convenience/cost of exchange transfusion. In the absence of guidelines, my preference is for secondary prevention with exchang...

Management of stroke in adults is not informed by the data that is available for children. Assuming that this was not a hemorrhagic stroke and that there was no moya-moya, I would continue transfusions indefinitely. To slow iron accumulation, I would use an exchange transfusion aiming for an HbS level of 30% or less prior to the next scheduled transfusion. If transfusion is impossible, I would be sure he is on a maximally tolerated dose of hydroxyurea. If hematopoietic stem and progenitor cell t...