Sickle cell, silent strokes, and galvanizing nurses

Some children already suffering sickle cell disease may find themselves at risk for yet another malady: “silent strokes.” Researchers found those children with a combination of sickle cell, high blood pressure, and the anemia inherent with sickle cell were more vulnerable to this dangerous, symptomless neurologic condition, according to findings published in the November 2011 issue of Blood.

Part of an international, multicenter trial funded by the National Institutes of Health, the study surveyed 814 patients ages five to 15. (None had reported or showed signs of previous strokes.) Using MRIs, researchers found 31% of those children had experienced a silent stroke. Though both anemia and high blood pressure on their own were found to increase the risk of stroke, patients with both were nearly four times as likely to have a silent stroke, when compared to the children with the lowest blood pressure and highest hemoglobin numbers.

While strokes are far more common among children with sickle cell than those without, silent strokes do not exhibit the telltale signs nurses and other practitioners may be accustomed to, such as paralysis and loss of speech or vision. Rather, silent strokes can cause brain damage and further hinder a child’s development. By targeting anemia and high blood pressure, nurses can help mitigate the risk of silent strokes in children with sickle cell through early awareness and preventive care.

Children with sickle cells also need extra fluids: at least five cups of water or other liquids for children up to 30 pounds, with one added cup for every additional five pounds. “We can all be a part of this process if we share the importance of hydration, hydration,” says Donna Edwards, M.S.N., R.N., a nurse with 25 years experience in medical/surgical, critical care/interventional radiology nursing, and education fields. With a grandson living with the disease, Edwards says the top five things nurses need to know about sickle cell include the following:

  1. Red blood cells break down every 14 days.
  2. Patients may exhibit acute abdominal pain (gallstones, constipation, dehydration).
  3. Bone pain can be part of the disease but can also be osteomyelitis.
  4. Patients may develop increased respirations with a moist cough/impending infection.
  5. Patients should dress appropriately for cold and warm temperatures.

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