Related Experiment Video
Updated: Oct 21, 2025
Point of Care Transcranial Color-Coded Duplex Ultrasound of the Middle Cerebral Artery
Published on: August 9, 2024
Associations Between Transcranial Doppler Flow Velocities, Laboratory Parameters, and Clinical Features in Turkish
Sultan Aydin1, Hakan Yeral2, Gönül Oktay3
1Departments of Pediatric Hematology and Oncology.
Insights
Children with sickle cell disease (SCD) and specific lab values like high ferritin or low hemoglobin may have increased stroke risk. Close monitoring with transcranial Doppler ultrasonography is recommended for these children.
Area of Science:
- Neurology
- Hematology
- Pediatrics
Background:
- Stroke is a significant complication in sickle cell disease (SCD).
- SCD-related strokes often involve large intracerebral arteries like the internal carotid artery (ICA) and middle cerebral artery (MCA).
Purpose of the Study:
- To investigate correlations between cerebral blood flow velocities and clinical/laboratory findings in pediatric SCD patients.
- To identify potential markers for increased stroke risk in children with SCD.
Main Methods:
- Transcranial Doppler ultrasonography was used to measure time-averaged maximum mean velocity (TAMMV) and resistive index (RI) in MCA, ICA, and vertebral artery (VA) in 53 pediatric SCD patients and 24 controls.
- Evaluated relationships between TAMMVs, laboratory parameters (hemoglobin, ferritin, platelet volume, red cell distribution width), and clinical data.
Main Results:
- SCD patients exhibited higher mean TAMMVs and RI compared to controls.
- Elevated TAMMVs were observed in patients with HbSβ0, those on hydroxyurea, and those with low hemoglobin (<8 g/dL), high ferritin (>1000 ng/dL), high mean platelet volume (>12 fL), high red cell distribution width (>18%), or those requiring chelation.
- Significantly higher TAMMV was noted in SCD patients reporting headaches.
Conclusions:
- High ferritin, low hemoglobin, elevated mean platelet volume, high red cell distribution width, and low weight/height percentiles may indicate increased stroke risk in pediatric SCD.
- Children with SCD exhibiting these features warrant close follow-up using transcranial Doppler ultrasonography to monitor cerebral blood flow velocities.
Objective:
Stroke is one of the major complications of sickle cell disease (SCD). Stroke features either occlusion of, or stenosis at, the origin of one of the large intracerebral arteries, the internal carotid artery (ICA), and/or the middle cerebral artery (MCA).
Purpose:
We sought correlations between cerebral blood flow velocities and the laboratory and clinical findings of patients with SCD.
Materials And Methods:
Fifty-three pediatric SCD patients (39 with HbSS, 14 with HbSβ0) were analyzed. The mean patient age was 12.9±3.9 years. The control group contained 24 healthy individuals. The time-averaged maximum mean velocity (TAMMV) and resistive index (RI) of the MCA, the TAMMVs of the ICA and vertebral artery (VA), and the diameter of the VA were estimated through transcranial Doppler ultrasonography using a 2.5 MHz transducer, in accordance with the Stroke Prevention Trial in Sickle Cell Anemia (STOP) protocol. We evaluated the relationships between the TAMMVs, laboratory parameters, and clinical findings.
Results:
The mean±SD MCA TAMMV was 161.2±35.4 cm/s in patients with HbSS and 185.8±62.9 cm/s in patients with HbSβ0. The mean MCA TAMMV, RI, ICA TAMMV, VA TAMMV, and VA diameter were 168.5±43.9 cm/s, 0.63±0.06, 116.8±25.5 cm/s, 69.2±18.5 cm/s, and 3.5±0.61 mm for all SCD patients, respectively. In the control group, the mean MCA TAMMV, RI, ICA TAMMV, VA TAMMV, and VA diameter were 103.8±28.8 cm/s, 0.53±0.04, 96.4±27.8 cm/s, 40.3±12.1 cm/s, and 3.4±0.6 mm, respectively. Although the differences were not significant, TAMMVs were higher in HbSβ0 patients taking hydroxyurea; those with hemoglobin levels <8 g/dL, ferritin levels >1000 ng/dL, mean platelet volume >12 fL, or red cell distribution width >18%; or required chelation, or were below the third percentiles of weight and height. The TAMMV was significantly higher only in SCD patients who complained of headache.
Conclusions:
High ferritin and low hemoglobin levels, a high mean platelet volume, a high red cell distribution width, low weight (below the third percentile), and a short height (below the third percentile) may be associated with elevated cerebral blood flow velocities and an increased stroke risk in children with SCD. Children with such features should be closely followed-up through transcranial Doppler ultrasonography examination.
