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Cerebral artery conditional blood velocity in sickle cell disease: a multicentre study and evidence for active
Emmanuel Modebe1, Charles Nonyelu2, Augustine Duru2
1Department of Radiation Medicine, University of Nigeria Teaching Hospital, Ituku Ozalla, Nigeria.
Insights
In Nigerian children with sickle cell disease (SCD), 15.5% had conditional cerebral artery blood velocity, a risk factor for stroke. This finding suggests regular monitoring and intervention may be necessary for these children.
Area of Science:
- Neurology
- Pediatrics
- Hematology
Background:
- Sickle cell disease (SCD) is a genetic blood disorder prevalent in Nigeria.
- Cerebral artery blood velocity abnormalities are a known risk factor for stroke in children with SCD.
- Limited multicentre data exists on cerebral blood flow in Nigerian children with SCD.
Purpose of the Study:
- To determine the prevalence of normal, high, and conditional (intermediate) cerebral artery blood velocity in Nigerian children with SCD.
- To provide multicentre data on cerebral blood flow parameters using transcranial Doppler (TCD) ultrasonography.
- To inform potential screening and intervention strategies for stroke prevention in this population.
Main Methods:
- A prospective observational study was conducted across five tertiary healthcare institutions in Nigeria.
- Transcranial Doppler (TCD) ultrasonography was used to measure cerebral artery peak systolic blood velocity (PSV) in 193 children and time-averaged mean of the maximum blood velocity (TAMMV) in 115 children with SCD.
- Data on normal, high, and conditional blood velocity were collected and analyzed.
Main Results:
- Among 193 children assessed for PSV, 77.7% had normal velocity, 3.6% had high velocity, and 18.7% had conditional velocity.
- In 115 children assessed for TAMMV, 84% had normal velocity, 6% had high velocity, and 10% had conditional velocity.
- Overall, 80% of the 308 children had normal cerebral artery blood velocity, 4.5% had high velocity, and 15.5% had conditional velocity.
Conclusions:
- A significant proportion (15.5%) of children with SCD in Nigeria exhibit conditional cerebral artery blood velocity.
- Conditional velocity is a precursor to high velocity and an indicator of increased stroke risk.
- These findings highlight the need to consider regular monitoring and proactive interventions for children with SCD and conditional cerebral artery blood velocity.
Objective:
To obtain multicentre data on the prevalence of normal, high or conditional (intermediate) blood velocity in the cerebral arteries among children with sickle cell disease (SCD) in Nigeria.
Design:
A prospective observational study in five tertiary healthcare institutions. By transcranial Doppler (TCD) ultrasonography, cerebral artery peak systolic blood velocity (PSV) was determined in 193 children with SCD and time averaged mean of the maximum blood velocity (TAMMV) in a different cohort of 115 children. This design was to make the findings relevant to hospitals with TCD equipment that measure either PSV or TAMMV.
Setting:
Nigeria.
Participants:
308 children (126 girls, 182 boys; age 2-16 years).
Main Outcome Measures:
Percentage of children with SCD who have normal, high or intermediate (often termed conditional) PSV or TAMMV.
Results:
In the cohort of 193 children, PSV was normal in 150 (77.7%), high in 7 (3.6%) and conditional in 36 (18.7%). In the cohort of 115 children, TAMMV was normal in 96 (84%), high in 7 (6%) and conditional in 12 (10%). There were no significant differences in gender or age distribution between the PSV and TAMMV cohorts. Altogether, cerebral artery blood velocity was normal in 246/308 children (80%), high in 14 (4.5%) and conditional in 48 (15.5%).
Conclusion:
Since conditional blood velocity in cerebral arteries can progress to high values and predispose to stroke, the proportion of children with SCD who are affected (15.5%) raises the question of whether regular monitoring and proactive intervention ought to be the standard of care.
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