Partial Red Cell Exchange in the Secondary Prevention of Stroke in Sickle Cell Disease: A Prospective Study
In brief
11 of 12 neurologic events after red cell exchange came within four years
In this 29-patient prospective study, partial red cell exchange lowered average sickle hemoglobin from 40% to 21%, but 8 patients had treatment failure. Eleven of 12 recurrent neurologic events occurred within the first four years, and moyamoya vasculopathy predicted failure. The findings support ongoing prevention while highlighting the need for close monitoring, especially early in treatment.
- Journal
- European journal of haematology (Q1)
- Published
- 19 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Mellouli Fethi, Bouzidi Leyla, Ksouri Habib, Ben Fraj Ilhem, Rekaya Samya, Ben Khaled Monia, et al.
- PMID
- 42895074
- DOI
- 10.1111/ejh.70338
Why clinicians should know about it
- Picked for Hematology (paper of the day, 21 October 2026): Partial red cell exchange prevents stroke recurrence in SCD
Abstract
INTRODUCTION: Stroke is a severe complication associated with sickle cell disease (SCD). The risk of recurrence is extremely high. The present study aimed to assess the clinical and biological efficacy of Partial Red Cell Exchange (PRE) in secondary stroke prevention among a cohort of Tunisian patients with SCD. PATIENTS AND METHODS: We conducted a prospective study over a 15-year period (January 1, 2010-December 31, 2024). A total of 29 patients with sickle cell syndromes complicated by one or more strokes were enrolled. They underwent 1732 PRE. RESULTS: The median age was 99 months (75-133). The median follow-up duration was 78 months (49-126). The mean HbS decreased from 40.1% ± 14.1% to 21.1% ± 11.1% post-exchange (p < 0.0001). Treatment failure was observed in 8 of 29 patients (27.5%), with a total of 12 neurological events over a cumulative treatment duration of 1570 months. 11 of 12 recurrences (91.7%) occurred within the first 4 years of the exchange program. The presence of moyamoya vasculopathy was predictive of therapeutic failure. CONCLUSIONS: PRE remains an effective modality for secondary stroke prevention in patients with sickle cell disease. Stroke recurrences occur predominantly within the first 4 years of treatment and are more frequent in the context of severe cerebrovascular disease.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.