Bibliographic information
GuidelineWHO consolidated guidelines for the management of common childhood illness: management of sickle-cell disease in children and adolescents
Year of Publication2026
Issuing InstitutionWorld Health Organization
Recommendation
New
In children and adolescents (aged 0–19 years) with sickle-cell disease (SCD) at risk of recurrent stroke (e.g. history of stroke, haemoglobin S >30% and haemoglobin <9 g/dL), regular blood transfusion with iron chelation therapy is suggested rather than hydroxyurea therapy alone for secondary stroke prevention.
Recommended in favor
Conditional
Certainty of evidence
Very low
Notes and Remarks
- This recommendation assumes that all children and adolescents with SCA aged 9 months and older are already receiving hydroxyurea therapy as standard care. Regular blood transfusion and iron chelation are additional interventions specifically for secondary stroke prevention.
- In practice, children at risk of recurrent stroke may continue to receive hydroxyurea alongside regular blood transfusion and chelation therapy, depending on the clinical judgement and resource availability.
- The decision to initiate or continue transfusion therapy should be based on shared decision-making, considering the risks of iron overload, alloimmunization and the burden of chronic transfusion, balanced against the high risk of recurrent stroke.