Monitoring
Patients require continuous monitoring for complications of sickle cell disease. The frequency at which the physician will see the patient is dependent on the frequency and severity of the patient's complications.
Patients treated with hydroxycarbamide require full blood count with differential and reticulocyte count monitored on a monthly basis.
Transcranial Doppler (TCD) screening of children with HbSS is recommended, starting at 2 years of age and continued annually if TCD is normal and every 4 to 6 months if TCD is marginal.[31] Children with abnormal results are tested again within 2 to 4 weeks.[32][33] Surveillance for cognitive impairment using simplified signalling questions is recommended, and screening with MRI brain without sedation may be considered to detect silent cerebral infarcts at least once in early-school-age children and adults with HbSS and Hb0 thalassaemia.[31]
Symptomatic adults should undergo an echocardiogram to evaluate for pulmonary hypertension.[141] The American Society of Hematology recommends against screening echocardiography, pulmonary function tests or sleep disordered breathing in the absence of symptoms.[141]
Patients require annual retinal examinations to screen for proliferative retinopathy, and annual screenings for the presence of increased urinary albumin excretion. Screening for retinopathy with a dilated eye exam beginning at age 10 years.[35] Annual liver, pulmonary, and renal function assessments are also recommended.
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