Condition/comorbidity | Screening test(s) used | Age at which screening is started | Action(s) to take if screening is abnormal |
General pediatric issues that may require special attention in patients with SCD (assess at all routine visits) |
Asthma | - Symptom screening by ROS
- History of recurrent wheezing and/or recurrent ACS
| Infancy | - Referral to an asthma specialist for spirometry and to optimize asthma management
|
Depression and other mental health issues | - Screening questions or questionnaires
| Once old enough to answer screening questions, typically by school age | - Referral to mental health provider
|
Growth failure and delayed puberty | - Measurement of height, weight, and assessment of pubertal stage
| Infancy | - Referral to endocrinologist
|
Hypertension | - Manual or automated blood pressure measurement
| Infancy | |
OSA | - Screening questions regarding frequency of OSA symptoms
| Age 2 years | - Refer to pulmonary/sleep medicine specialist for PSG
- If PSG confirms OSA, refer to otolaryngologist for possible adenotonsillectomy
|
SCD-specific issues (assess at least annually) |
Nephropathy | - Measurement of urinary protein (eg, urinalysis or urine protein-to-creatinine ratio)
- Serum creatinine
| By age 10 years* | |
Pulmonary hypertension | | Once between age 8 to 18 years¶ | |
Retinopathy | | 10 years | - Referral to ophthalmology
|
Stroke | - TCD (patients with Hb SS or Hb S-beta0 thalassemia only)
- Assess for neurocognitive or other neurologic deficits (eg, developmental delay, marked decline in school performance, frequent headaches)
| 2 yearsΔ | - Obtain MRI/MRA if TCD is abnormal or if there are clinical concerns
- Referral to neurology for patients with confirmed stroke
- Follow-up abnormal TCD results with repeat testingΔ
- For persistently abnormal flow velocity on TCD, primary prophylaxis with chronic transfusion is generally indicatedΔ
|