Faculty mentor/PI email address
jim010@aol.com
Is your research Teaching and Learning based?
1
Keywords
Acute Ischemic Stroke in Hemoglobin SC Sickle Disease, acute ischemic stroke, hemoglobin SC sickle disease, complications of sickle cell disease, emergent exchange transfusion
Date of Presentation
5-6-2026 12:00 AM
Poster Abstract
Acute ischemic stroke is a well-recognized complication of sickle cell disease (SCD), with historical estimates suggesting that up to 11% of patients experience an overt stroke by early adulthood. Stroke represents a hematologic and neurologic emergency requiring rapid reduction of the circulating hemoglobin S (HbS) fraction to prevent infarct progression. The American Society of Hematology recommends emergent exchange transfusion within two hours of presentation for patients with acute neurologic deficits [1,3].
Management is particularly nuanced in hemoglobin SC (HbSC) disease. Compared with hemoglobin SS disease, patients with HbSC typically have higher baseline hemoglobin concentrations, increasing blood viscosity and the risk of hyperviscosity if treated with simple transfusion alone. We present a case of acute ischemic stroke in a patient with HbSC disease who had recent direct oral anticoagulant use (apixaban), which made the patient ineligible for intravenous thrombolysis. Although exchange transfusion capability existed at the presenting institution, anticipated delays in mobilizing the necessary resources prompted emergent transfer to ensure timely exchange transfusion. This case highlights the complex management of acute ischemic stroke in HbSC disease when thrombolytic therapy is contraindicated, and timely exchange transfusion requires rapid multidisciplinary coordination and interfacility transfer to prevent infarct progression.
Disciplines
Congenital, Hereditary, and Neonatal Diseases and Abnormalities | Hemic and Lymphatic Diseases | Medicine and Health Sciences
Included in
Congenital, Hereditary, and Neonatal Diseases and Abnormalities Commons, Hemic and Lymphatic Diseases Commons
Acute Ischemic Stroke in Hemoglobin SC Sickle Disease Requiring Emergent Exchange Transfusion and Neurocritical Transfer
Acute ischemic stroke is a well-recognized complication of sickle cell disease (SCD), with historical estimates suggesting that up to 11% of patients experience an overt stroke by early adulthood. Stroke represents a hematologic and neurologic emergency requiring rapid reduction of the circulating hemoglobin S (HbS) fraction to prevent infarct progression. The American Society of Hematology recommends emergent exchange transfusion within two hours of presentation for patients with acute neurologic deficits [1,3].
Management is particularly nuanced in hemoglobin SC (HbSC) disease. Compared with hemoglobin SS disease, patients with HbSC typically have higher baseline hemoglobin concentrations, increasing blood viscosity and the risk of hyperviscosity if treated with simple transfusion alone. We present a case of acute ischemic stroke in a patient with HbSC disease who had recent direct oral anticoagulant use (apixaban), which made the patient ineligible for intravenous thrombolysis. Although exchange transfusion capability existed at the presenting institution, anticipated delays in mobilizing the necessary resources prompted emergent transfer to ensure timely exchange transfusion. This case highlights the complex management of acute ischemic stroke in HbSC disease when thrombolytic therapy is contraindicated, and timely exchange transfusion requires rapid multidisciplinary coordination and interfacility transfer to prevent infarct progression.