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Transcranial doppler (<jats:styled-content style=\"fixed-case\">TCD<\/jats:styled-content>) is an accurate and non\u2010invasive method to determine stroke risk. Randomised controlled trials have demonstrated the efficacy of chronic transfusion therapy in stroke prevention based on risk stratification determined by <jats:styled-content style=\"fixed-case\">TCD<\/jats:styled-content> velocities. This has led to the regular use of <jats:styled-content style=\"fixed-case\">TCD<\/jats:styled-content> monitoring for children with <jats:styled-content style=\"fixed-case\">SCA<\/jats:styled-content> in order to determine stroke risk. Significant resource allocation is necessary to facilitate training, quality assurance and failsafe arrangements for non\u2010attenders. In a subgroup of patients, chronic transfusions for primary stroke prevention can be replaced by hydroxycarbamide therapy, provided careful monitoring is undertaken; including repeat <jats:styled-content style=\"fixed-case\">TCD<\/jats:styled-content> studies at frequent intervals. The authors propose an evidence\u2010based algorithm for the management of abnormal <jats:styled-content style=\"fixed-case\">TCD<\/jats:styled-content> velocities and discuss the role of this test in other clinical contexts, such as in Haemoglobin <jats:styled-content style=\"fixed-case\">SC<\/jats:styled-content> disease.<\/jats:p>","DOI":"10.1111\/bjh.14850","type":"journal-article","created":{"date-parts":[[2017,8,3]],"date-time":"2017-08-03T19:30:10Z","timestamp":1501788610000},"page":"377-388","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["How I manage sickle cell patients with high transcranial doppler results"],"prefix":"10.1111","volume":"179","author":[{"given":"John","family":"Brewin","sequence":"first","affiliation":[{"name":"Department of Haematology King's College London London 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