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Updated: Jul 5, 2025
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Factors Associated with Overt Stroke in Children and Adolescents with Sickle Cell Disease: A Retrospective Cohort
Wolney de Oliveira Taques1,2,3, Gabriele Curvo Bett2, Bárbara Lucia Barbosa de Moraes2
1Júlio Müller University Hospital/EBSERH, Teaching and Research Management, Federal University of Mato Grosso - UFMT, Cuiabá, Brazil.
Insights
Children with sickle cell disease (SCD) experiencing frequent dactylitis or acute chest syndrome (ACS)/pneumonia may face higher stroke risks. Increased reticulocyte count and red blood cell distribution width (RDW) also correlate with stroke occurrence in pediatric SCD patients.
Area of Science:
- Pediatric Hematology
- Neurology
- Vascular Medicine
Background:
- Sickle cell disease (SCD) is a genetic blood disorder characterized by vaso-occlusive phenomena, leading to significant complications, notably stroke.
- Overt stroke is a devastating complication in children and adolescents with SCD, necessitating identification of predictive factors for early intervention.
Purpose of the Study:
- To investigate the clinical and laboratory characteristics of pediatric patients with SCD.
- To identify factors associated with the incidence of overt stroke in this cohort.
Main Methods:
- Retrospective cohort study involving 120 children and adolescents with SCD.
- Data collected from patient medical records, including demographic, clinical, and laboratory parameters.
- Survival analysis used to compare characteristics between patients with and without overt stroke.
Main Results:
- The incidence density of overt stroke was 0.94 cases per 100 patient-years.
- A history of two or more dactylitis episodes and three or more acute chest syndrome (ACS)/pneumonia episodes were associated with overt stroke.
- Increased reticulocyte count and red blood cell distribution width (RDW) were also linked to overt stroke occurrence.
Conclusions:
- Frequent dactylitis, ACS/pneumonia, elevated RDW, and reticulocytosis are associated with overt stroke in pediatric SCD patients.
- These findings highlight potential biomarkers for stroke risk stratification in children and adolescents with SCD.
- Further research with larger cohorts and higher stroke incidence is recommended to validate these associations.
Abstract:
Sickle cell disease (SCD) is associated with a high occurrence of complications due to vaso-occlusive phenomenon such as stroke. This retrospective cohort study aimed to examine the clinical and laboratory characteristics of 120 children and adolescents with SCD and analyze the factors associated with overt stroke incidence. All relevant data were obtained from patient medical records. Survival analysis was used to compare the demographic, clinical, and laboratory characteristics between patients with and those without overt stroke. The patients were 52.5% female with a mean (SD) age of 11.2 (4.3) years. The incidence of overt stroke in this cohort was nine out of 956.7 patient-years, resulting in an incidence density of 0.94 cases/100 patient-years. Reports of greater than or equal to two previous attacks of dactylitis and greater than or equal to three episodes of acute chest syndrome (ACS)/pneumonia were associated with overt stroke and an increase in reticulocyte count and red blood cell distribution width (RDW). In conclusion, a history of a high number of dactylitis, ACS/pneumonia, increased RDW, and reticulocytosis was associated with overt stroke occurrence in children and adolescents with SCD. Future studies with a higher stroke incidence in the evaluated sample are necessary to confirm this hypothesis.
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