Silent cerebral infarcts occur despite regular blood transfusion therapy after first strokes in children with sickle cell disease

Blood - Tập 117 - Trang 772-779 - 2011
Monica L. Hulbert1, Robert C. McKinstry2,3, JoAnne L. Lacey2, Christopher J. Moran2, Julie A. Panepinto4, Alexis A. Thompson5, Sharada A. Sarnaik6, Gerald M. Woods7, James F. Casella8, Baba Inusa9, Jo Howard9, Fenella J. Kirkham10, Kofi A. Anie11, Jonathan E. Mullin12, Rebecca Ichord13, Michael Noetzel3,14, Yan Yan3, Mark Rodeghier15, Michael R. DeBaun16
1Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
2Department of Radiology, Washington University School of Medicine, St Louis, MO
3Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
4Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
5Department of Pediatrics, Northwestern University School of Medicine, Chicago, IL;
6Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI
7Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO
8Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
9Guy's and St Thomas's National Health Service Foundation Trust, London, United Kingdom;
10University College Institute of Child Health, London, United Kingdom;
11Imperial College School of Medicine, Central Middlesex Hospital, London, United Kingdom;
12Case Western Reserve University School of Medicine, Cleveland, OH
13Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA
14Department of Neurology, Washington University School of Medicine, St. Louis, MO
15Statistical Collaborator, Chicago, IL; and
16Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN

Tóm tắt

Abstract

Children with sickle cell disease (SCD) and strokes receive blood transfusion therapy for secondary stroke prevention; despite this, approximately 20% experience second overt strokes. Given this rate of second overt strokes and the clinical significance of silent cerebral infarcts, we tested the hypothesis that silent cerebral infarcts occur among children with SCD being transfused for secondary stroke prevention. A prospective cohort enrolled children with SCD and overt strokes at 7 academic centers. Magnetic resonance imaging and magnetic resonance angiography of the brain were scheduled approximately every 1 to 2 years; studies were reviewed by a panel of neuroradiologists. Eligibility criteria included regularly scheduled blood transfusion therapy. Forty children were included; mean pretransfusion hemoglobin S concentration was 29%. Progressive cerebral infarcts occurred in 45% (18 of 40 children) while receiving chronic blood transfusion therapy; 7 had second overt strokes and 11 had new silent cerebral infarcts. Worsening cerebral vasculopathy was associated with new cerebral infarction (overt or silent; relative risk = 12.7; 95% confidence interval, 2.65-60.5, P = .001). Children with SCD and overt strokes receiving regular blood transfusion therapy experience silent cerebral infarcts at a higher rate than previously recognized. Additional therapies are needed for secondary stroke prevention in children with SCD.


Tài liệu tham khảo

Ohene-Frempong, 1998, Cerebrovascular accidents in sickle cell disease: rates and risk factors., Blood, 91, 288 Scothorn, 2002, Risk of recurrent stroke in children with sickle cell disease receiving blood transfusion therapy for at least five years after initial stroke., J Pediatr, 140, 48, 10.1067/mpd.2002.122498 Powars, 1978, The natural history of stroke in sickle cell disease., Am J Med, 65, 461, 10.1016/0002-9343(78)90772-6 Hindmarsh, 1987, Incidence of overt and covert neurological damage in children with sickle cell disease., Postgrad Med J, 63, 751, 10.1136/pgmj.63.743.751 Pavlakis, 1988, Brain infarction in sickle cell anemia: magnetic resonance imaging correlates., Ann Neurol, 23, 125, 10.1002/ana.410230204 Glauser, 1995, Accuracy of neurologic examination and history in detecting evidence of MRI-diagnosed cerebral infarctions in children with sickle cell hemoglobinopathy., J Child Neurol, 10, 88, 10.1177/088307389501000203 Vendt, 2009, Silent Cerebral Infarction Transfusion (SIT) Trial Imaging Core: application of novel imaging information technology for rapid and central review of MRI of the brain., J Digit Imaging, 22, 326, 10.1007/s10278-008-9114-3 Pegelow, 2002, Longitudinal changes in brain magnetic resonance imaging findings in children with sickle cell disease., Blood, 99, 3014, 10.1182/blood.V99.8.3014 Miller, 2001, Silent infarction as a risk factor for overt stroke in children with sickle cell anemia: a report from the Cooperative Study of Sickle Cell Disease., J Pediatr, 139, 385, 10.1067/mpd.2001.117580 Schatz, 2002, Lesion burden and cognitive morbidity in children with sickle cell disease., J Child Neurol, 17, 891, 10.1177/08830738020170122401 Dobson, 2002, Moyamoya syndrome in childhood sickle cell disease: a predictive factor for recurrent cerebrovascular events., Blood, 99, 3144, 10.1182/blood.V99.9.3144 O'Shaughnessy, 2005, Development of a de novo cerebral arteriovenous malformation in a child with sickle cell disease and moyamoya arteriopathy: case report., J Neurosurg, 102, 238, 10.3171/jns.2005.102.2.0238 Schatz, 2001, Poor school and cognitive functioning with silent cerebral infarcts and sickle cell disease., Neurology, 56, 1109, 10.1212/WNL.56.8.1109 Armstrong, 1996, Cognitive functioning and brain magnetic resonance imaging in children with sickle cell disease., Pediatrics, 97, 864 Russell, 1984, Effect of transfusion therapy on arteriographic abnormalities and on recurrence of stroke in sickle cell disease., Blood, 63, 162, 10.1182/blood.V63.1.162.bloodjournal631162 Brousse, 2009, Does regular blood transfusion prevent progression of cerebrovascular lesions in children with sickle cell disease?, Ann Hematol, 88, 785, 10.1007/s00277-008-0670-x Bader-Meunier, 2009, Effect of transfusion therapy on cerebral vasculopathy in children with sickle-cell anemia., Haematologica, 94, 123, 10.3324/haematol.13610 Morris, 1997, Practical Neuroangiography, ed 1 Ganesan, 2006, Clinical and radiological recurrence after childhood arterial ischemic stroke., Circulation, 114, 2170, 10.1161/CIRCULATIONAHA.105.583690 Scott, 2009, Moyamoya disease and moyamoya syndrome., N Engl J Med, 360, 1226, 10.1056/NEJMra0804622 Casella, 2010, Design of the silent cerebral infarct transfusion (SIT) trial., Pediatr Hematol Oncol, 27, 69, 10.3109/08880010903360367
Thông tin
Thông tin xuất bản

Blood

Tập 117

772-779

Thông tin tác giả