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Transcranial doppler as screening method for sickling crises in children with sickle cell anemia: a latin America
Gabriel Pinheiro Modolo1, Gustavo José Luvizutto2, Pedro Tadao Hamamoto Filho1
1Departmento de Neurologia, Psicologia e Psiquiatria, Universidade Estadual Paulista (UNESP), Botucatu, Brasil.
Insights
Altered cerebral blood flow velocities, measured by transcranial Doppler (TCD), are linked to vaso-occlusive crises in children with sickle cell anemia (SCA). These TCD findings, including MCA PSV and EDV, can predict crisis risk in pediatric SCA patients.
Area of Science:
- Neurology
- Hematology
- Pediatrics
Background:
- Sickle cell anemia (SCA) is a primary cause of stroke in children.
- Cerebral blood flow alterations are implicated in SCA complications.
Purpose of the Study:
- To investigate the association between cerebral flow velocities measured by transcranial Doppler (TCD) and vaso-occlusive complications in pediatric SCA patients.
- To determine if TCD can predict sickling crises beyond stroke.
Main Methods:
- Evaluated 37 pediatric SCA patients (aged 2-16 years) using TCD between 2012 and 2018.
- Collected genotypic, demographic data, and monitored for sickling crises.
- Employed survival analyses with simple frailty models to assess predictor variables.
Main Results:
- Peak systolic velocity (PSV) and end-diastolic velocity (EDV) in the middle cerebral artery (MCA) were associated with increased risk of sickling crises.
- Time average mean maximum velocity (TAMMV) in the basilar artery (BA) also correlated with higher crisis occurrence.
- Hemoglobin, hematocrit, leukocyte counts, platelet counts, and reticulocyte numbers were also identified as significant variables.
Conclusions:
- PSV and EDV in the MCA, along with TAMMV in the BA, serve as crucial markers for predicting sickling crises in SCA.
- TCD measurements offer valuable insights into the risk of vaso-occlusive events in pediatric SCA.
Background:
Sickle cell anemia (SCA) is the leading cause of childhood stroke. We aimed to evaluate whether altered cerebral flow velocities, as measured by transcranial Doppler (TCD), are associated with vaso-occlusive complications in addition to stroke in pediatric SCA patients.
Methods:
We evaluated 37 children aged between 2 and 16 years with SCA who underwent screening for TCD between January 2012 and October 2018. Genotypic profiles and demographic data were collected, TCD examinations were performed during follow-up, and the presence of sickling crises was compared. Survival analyses were performed using simple frailty models, in which each predictor variable was analyzed separately in relation to the occurrence of a sickling crisis.
Results:
The variables related to sickle cell crises in the univariate analysis were peak systolic velocity (PSV) in the middle cerebral artery (MCA), hazard ratio (HR) 1.01 (1.00-1.02) p = 0.04; end-diastolic velocity (EDV) in the MCA, HR 1.02 (1.01-1.04) p = 0.01; time average mean maximum velocity (TAMMV) in the basilar artery (BA), HR 1.02 (1.00-1.04) p = 0.04; hemoglobin, HR 0.49 (0.38-0.65) p < 0.001; hematocrit, HR 0.78 (0.71-0.85) p < 0.001; leukocyte counts, HR 1.1 (1.05-1.15) p < 0.001; platelets counts, HR 0.997 (0.994-0.999) p = 0.02; and reticulocyte numbers, HR 1.14 (1.06-1.23) p < 0.001.
Conclusions:
Our results indicate PSV and EDV in the MCA and TAMMV in the BA as markers of risk for the occurrence of sickling crises in SCA.
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