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Silent cerebral infarcts occur despite regular blood transfusion therapy after first strokes in children with sickle cell disease. Blood 2011 Jan 20;117(3):772-9 PMID: 20940417 PMCID: PMC3035071

Pubmed ID

20940417

DOI

10.1182/blood-2010-01-261123

Abstract

Children with sickle cell disease (SCD) and strokes receive blood transfusion therapy for secondary stroke prevention; despite this, approximately 20% experience second overt strokes. Given this rate of second overt strokes and the clinical significance of silent cerebral infarcts, we tested the hypothesis that silent cerebral infarcts occur among children with SCD being transfused for secondary stroke prevention. A prospective cohort enrolled children with SCD and overt strokes at 7 academic centers. Magnetic resonance imaging and magnetic resonance angiography of the brain were scheduled approximately every 1 to 2 years; studies were reviewed by a panel of neuroradiologists. Eligibility criteria included regularly scheduled blood transfusion therapy. Forty children were included; mean pretransfusion hemoglobin S concentration was 29%. Progressive cerebral infarcts occurred in 45% (18 of 40 children) while receiving chronic blood transfusion therapy; 7 had second overt strokes and 11 had new silent cerebral infarcts. Worsening cerebral vasculopathy was associated with new cerebral infarction (overt or silent; relative risk = 12.7; 95% confidence interval, 2.65-60.5, P = .001). Children with SCD and overt strokes receiving regular blood transfusion therapy experience silent cerebral infarcts at a higher rate than previously recognized. Additional therapies are needed for secondary stroke prevention in children with SCD.

Author List

Hulbert ML, McKinstry RC, Lacey JL, Moran CJ, Panepinto JA, Thompson AA, Sarnaik SA, Woods GM, Casella JF, Inusa B, Howard J, Kirkham FJ, Anie KA, Mullin JE, Ichord R, Noetzel M, Yan Y, Rodeghier M, Debaun MR

Author

Julie A. Panepinto MD, MSPH Professor in the Pediatrics department at Medical College of Wisconsin




Scopus

2-s2.0-78751697297   117 Citations

MESH terms used to index this publication - Major topics in bold

Anemia, Sickle Cell
Blood Transfusion
Brain
Cerebral Infarction
Cerebral Revascularization
Child
Child, Preschool
Cohort Studies
Disease-Free Survival
Humans
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Stroke
Time Factors
jenkins-FCD Prod-310 bff9d975ec7f2d302586822146c2801dd4449aad