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Discontinuing prophylactic transfusions increases the risk of silent brain infarction in children with sickle cell

Miguel R Abboud1, Eunsil Yim, Khaled M Musallam

  • 1American University of Beirut Medical Center, Beirut, Lebanon. abboudm@aub.edu.lb

Blood
|June 3, 2011
PubMed

Insights

Discontinuing blood transfusions in children with sickle cell disease (SCD) and abnormal TCD scans increased the risk of silent brain infarcts. Transfusions are crucial for preventing these brain injuries in high-risk children.

Area of Science:

  • Pediatric Neurology
  • Hematology
  • Radiology

Background:

  • Sickle cell disease (SCD) poses a significant risk for cerebrovascular complications, including silent brain infarcts.
  • Transcranial Doppler (TCD) ultrasonography is used to identify children with SCD at high risk for stroke.
  • Prophylactic blood transfusions are a standard intervention for preventing stroke in these children.

Purpose of the Study:

  • To investigate the impact of discontinuing prophylactic transfusions on the development and progression of silent brain infarcts detected by magnetic resonance imaging (MRI) in children with SCD.
  • To analyze data from the STOP II trial to assess the relationship between transfusion status and MRI-detected brain lesions.

Main Methods:

  • Analysis of data from the STOP II trial, including baseline and end-of-study MRI scans.
  • Comparison of new brain MRI lesions and changes in lesion counts between children who continued transfusions and those who halted them.
  • Assessment of baseline characteristics to ensure comparability between study groups.

Main Results:

  • At study entry, 27% of patients had evidence of silent infarcts on MRI.
  • New brain MRI lesions developed in 8.1% of patients in the continued-transfusion group versus 27.5% in the transfusion-halted group (P = .03).
  • The number of lesions increased significantly in the transfusion-halted group (from 27 to 45) but remained stable in the continued-transfusion group (from 25 to 24).

Conclusions:

  • Discontinuation of prophylactic transfusions in children with SCD and abnormal TCD velocities, even if they revert to low-risk, increases the risk of developing silent brain infarcts.
  • These findings, along with data from the STOP trial, confirm that transfusions effectively prevent silent infarcts in SCD patients with abnormal TCD but normal MRA.
  • Maintaining prophylactic transfusions is essential for preventing cerebrovascular complications in high-risk children with SCD.

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