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2015, Number 4

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Rev Cubana Hematol Inmunol Hemoter 2015; 31 (4)

Transcranial doppler ultrasound in the prevention of cerebrovascular accident in children with sickle cell disease

Menéndez VA, Arencibia NA, Chaviano LM, Svarch E, Scherle MC, González OA, Machín GS, Serrano MJ, Gutiérrez DAI, Delgado VT, Valdés CF

Language: Spanish
References: 37
Page: 405-416
PDF size: 163.07 Kb.


ABSTRACT

Introduction: neurological complications and their sequelae are known almost since the first description of sickle cell disease, most commonly in sickle cell anemia. They vary with age, can be acute or chronic and produce high morbidity and mortality.
Aims: to determine the frequency of children with AD who have alterations in cerebral blood flow velocity, relate these changes to clinical events and laboratory data and assess the evolution over time of patients with abnormalities and their association with the use of hydroxyurea.
Methods: a prospective analytical study involving 50 patients with sickle cell disease, aged 5 to 18, was performed in at the Institute of Hematology and Immunology where they are assisted. Alterations in cerebral blood flow (CBF) and the association with other clinical and hematological elements were determined.
Results: the arteries that showed larger speed were right middle cerebral artery (121.6 cm/s) and left (115 cm/s). Patients with impaired CBF velocity in transcranial Doppler ultrasound were 11 ( 22%) with speeds greater higher than 170 cm/s, 6 patients (12%) with a flow between 170-199 cm/s, and five (10%) greater higher than 200 cm/s. There was an inverse correlation between CBF velocity with age and hemoglobin levels and directly with the platelet count. The cerebrovascular accident, blood transfusions and hospitalizations were the most frequent clinical events in patients with abnormal transcranial doppler ultrasound. FSC velocities were significantly decreased (31 cm/s; p = 0,034) in patients receiving treatment with hydroxyurea.
Conclusions: Patients with alterations in the transcranial Doppler ultrasound must be included in a program for primary prevention of cerebrovascular accident.


REFERENCES

  1. Kossorotoff M, Grevent D, de Montalembert M. Cerebral vasculopathy in pediatric sickle-cell anemia. Arch Pediatr. 2014 Apr;21(4):404-14. doi:10.1016/j.arcped.2014.01.005.

  2. Ballas SK, Lieff S, Benjamin LJ, Dampier CD, Heeney MM, Hoppe C, et al. Definitions of the phenotypic manifestations of sickle cell disease Am J Hematol. 2010;85:6–13.

  3. Majumdar S, Webb S, Norcross E, Mannam V, Ahmad N, Lirette S, et al. Stroke with intracranial stenosis is associated with increased platelet activation in sickle cell anemia. Pediatr Blood Cancer. 2013 Jul;60(7):1192-7. doi:10.1002/pbc.24473.

  4. Verlhac S, Balandra S, Cussenot I, Kasbi F, Vasile M, Kheniche A, et al. Extracranial carotid arteriopathy in stroke-free children with sickle cell anemia: detection by submandibular Doppler sonography. Pediatr Radiol. 2014 May;44(5):587-96. doi:10.1007/s00247-014-2880-9.

  5. Casella JF, King AA, Barton B, White DA, Noetzel MJ, Ichord RN, et al. Design of the silent cerebral infarct transfusion (SIT) trial. Pediatr Hematol Oncol. 2010 Mar;27(2):69-89. doi:10.3109/08880010903360367.

  6. Schatz J, Brown RT, Pascual JM, Hsu L, DeBaun MR. Poor school and cognitive functioning with silent cerebral infarcts and sickle cell disease. Neurology. 2001 Apr 24;56(8):1109-11.

  7. Schatz J, Finke R L., Kellett JM, Kramer JH. Cognitive functioning in children with sickle cell disease: A meta-analysis. J Pediatr Psychol. 2002 Dec;27(8):739-48.

  8. Sidenstricker VP, Mulherin WA, Houseal RW. Sickle cell anemia. Report of two cases in children with necropsy in one case. Am J Dis Child. 1923. 26:132-54.

  9. De Montalembert M, Wang W. Cerebrovascular complications in children with sickle cell disease Handb Clin Neurol. 2013;113:1937-43. doi: 10.1016/B978-0- 444-59565-2.00064-2.

  10. Arkuszewski M, Krejza J, Chen R, Ichord R, Kwiatkowski JL, Bilello M, et al. Sickle cell anemia: intracranial stenosis and silent cerebral infarcts in children with low risk of stroke. Adv Med Sci. 2014 Mar;59(1):108-13. doi: 10.1016/j.advms.2013.09.001.

  11. Venkataraman A, Adams RJ. Neurologic complications of sickle cell disease. Handb Clin Neurol. 2014;120:1015-25. doi:10.1016/B978-0-7020-4087-0.00068-1.

  12. Hussain S, Nichols F, Bowman L, Xu H, Neunert C. Implementation of transcranial Doppler ultrasonography screening and primary stroke prevention in urban and rural sickle cell disease populations. Pediatr Blood Cancer. 2014 Nov 8. doi: 10. 1002/pbc. 25306.

  13. Scherle CE, Fernández L, Alvarado JD, Svarch E, González A. Riesgo de ictus isquémico en niños con Sβ talsemia. Estudio con Doppler transcraneal. Rev Cubana Hematol. Inmunol Hemoter. 2012;28(2):169-76.

  14. Quinn CT, Variste J, Dowling M. Haemoglobin oxygen saturation is a determinant of cerebral artery blood flow velocity in children with sickle cell anemia. Br J Haematol. 2009 May;145(4):500-5. doi: 10.1111/j.1365- 2141.2009.07652.x.

  15. Helton KJ, Adams RJ, Kesler KL, Lockhart A, Aygun B, Driscoll C, Heeney MM, et al. Magnetic resonance imaging/angiography and transcranial Doppler velocities in sickle cell anemia: results from the SWITCH trial. Blood. 2014 Aug 7;124(6):891-8. doi: 10.1182/blood-2013-12-545186.

  16. Svarch E. Programa cubano de atención integral al paciente con drepanocitosis. Rev Cubana Hematol Inmunol Hemoter. 2011 Jun;27(2):165-7.

  17. Vargas-Díaz J, Puga-Gómez R, Seijo-Hernández JL, Quevedo-Sotolongo L, Corona-Rodríguez PI, Izaguirre-Corrales A. Infartos cerebrales de repetición y anemia drepanocítica en un niño:revisión de la literatura médica. Rev Cubana Pediatr [revista en la Internet]. 2009 Dic;81(4): 98-109. (citado ene 28, 2015). Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034- 75312009000400011&lng=es&nrm=iso&tlng=es

  18. Sheehan VA, Hansbury EN, Smeltzer MP, Fortner G, McCarville MB, Aygun B. Transcranial Doppler velocity and brain MRI/MRA changes in children with sickle cell anemia on chronic transfusions to prevent primary stroke. Pediatr Blood Cancer. 2013 Sep;60(9):1499-502. doi: 10.1002/pbc.24569.

  19. Pavlakis SG, Rees RC, Huang X, Brown RC, Casella JF, Iyer RV, et al. Transcranial Doppler Ultrasonography (TCD) in Infants With Sickle Cell Anemia: Baseline Data From the BABY HUG Trial. Pediatr Blood Cancer. 2010;54(2):256 – 9.

  20. Jordan LC, Caslla JF, De Baun MR). Prospects for primary stroke prevention in children with sickle cell anaemia. Br J Hematol. 2012;10:1365-2141.

  21. Roach ES, Golomb MR, Adams R. Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke. 2008;39:2644–91.

  22. Svarch E, Marcheco B, Machín-García S, Menéndez-Veitía A, Nordet-Carrera I, Arencibia-Núñez A. La drepanocitosis en Cuba. Estudio en niños. Rev Cubana Hematol Inmunol Hemoter. 2011;27(1):51-67.

  23. Bernaudin S, Verlhac F, Fréard F, Roudot-Thoraval M, Benkerrou I, Thuret, et al. Multicenter Prospective Study of Children With Sickle Cell Disease: Radiographic and Psychometric Correlation. J Child Neurol. 2000;15(5):333-43.

  24. Adams RJ, Brambilla DJ, Granger S, Gallagher D, Vichinsky E, Abboud MR, et al. Stroke and conversion to high risk in children screened with transcranial Doppler ultrasound during the STOP study. Blood. 2004 May 15;103(10):3689-94.

  25. Arkuszewski M, Krejza J, Chen R, Ichord R, Kwiatkowski JL, Bilello M, et al. Sickle cell anemia: intracranial stenosis and silent cerebral infarcts in children with low risk of stroke. Adv Med Sci. 2014 Mar;59(1):108-13. doi:10.1016/j.advms.2013.09.001.

  26. Hokazono M, Silva GS, Silva EMK, Braga JAP. Results from transcranial Doppler examination on children and adolescents with sickle cell disease and correlation between the time-averaged maximum mean velocity and hematological characteristics: a cross-sectional analytical study. Sao Paulo Med J. 2011;129(3):134-8.

  27. Galadonci NA, Abdullahi SU, Taboni MA, Abubakar S, Belon wu R, Salihu A, et al. Primary stroke in Nigerian children with sickle cell disease (SPIN). Challenges of conducting a feasibility trial. Pediatr Blood Cancer 2014 Nov 14 doi:10. 1002/pbc. 25289.

  28. Melo HA, Barreto-Filho JAS, Prado RC, Cipolotti R. Doppler transcraniano em portadores de anemia falciforme: estudo dos parâmetros de fluxo sangüíneo cerebral em crianças de Aracaju, Sergipe. Arq Neuropsiquiatr. 2008;66(2b):360-4

  29. Majumdar S, Webb S, Norcross E, Mannam V, Ahmad N, Lirette S, et al. Stroke with intracranial stenosis is associated with increased platelet activation in sickle cell anemia. Pediatr Blood Cancer. 2013 Jul;60(7):1192-7. doi: 10.1002/pbc.24473.

  30. Matsui NM, Varki A, Embury SH. Heparin inhibits the flow adhesion of sickle red blood cell to P-selectin. Blood. 2002;100:3790-6.

  31. Switzer JA, Hess DC, Nichols FT, Adams RJ. Pathophysiology and treatment of stroke in sickle cell disease: present and future. Lancet Neurol. 2006;5(6):501-12.

  32. Kato GJ, Gladwin MT, Steinberg MH. Deconstructing sickle cell disease: Reappraisal of the role of hemolisis in the development of clinical subphenotypes. Blood Rev. 2007;21:37-47.

  33. Svarch Eva. Fisiopatología de la drepanocitosis. Rev Cubana Hematol Inmunol Hemoter [revista en la Internet]. 2009 Abr [citado 2015 Ene 27] ;25(1):. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864- 02892009000100003&lng=es&nrm=iso&tlng=es

  34. Wong TE, Brandow AM, Lim W, Lottenberg R. Update on the use of hydroxyurea therapy in sickle cell disease. Blood. 2014 Dec 18;124(26):3850-7;quiz 4004. doi:10.1182/blood-2014-08-435768.

  35. Zimmerman SA, Schultz WH, Burgett S, Mortier NA, Ware RE. Hydroxiurea therapy lowers transcraneal Doppler flow velocities in children with sickle cell anemia. Blood. 2007;110:1043-47.

  36. Adams RJ, Brambilla D. Optimizing primary stroke prevention in sickle cell anemia (STOP II) trial investigator. Discontinuing prophylactic transfusion used to prevent stroke in sickle cell disease. N Engl J Med. 2005;353:2769-78.

  37. Wang WC, Dwan K. Blood transfusion prevent and secondary stroke in people with sickle cell disease. Crochrane Database Syt Rev. 2013 Nov 14;11:CD003146. doi: 10.1002/14651858.CD003146.pub2.




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