Journal
BLOOD
Volume 120, Issue 19, Pages 3891-3897Publisher
AMER SOC HEMATOLOGY
DOI: 10.1182/blood-2012-01-406314
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Funding
- North and Central Texas Clinical and Translational Science Initiative from the National Institutes of Health [KL2 RR024983]
- Doris Duke Charitable Foundation
- Perot Center for Brain and Nerve Injury at Children's Medical Center Dallas
- Children's Clinical Research Advisory Committee of Children's Medical Center Dallas
- First American Real Estate Information Services
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We hypothesized that the silent cerebral infarcts (SCI), which affect up to 40% of children with sickle cell disease (SCD), could occur in the setting of acute anemic events. In a prospective observational study of children with and without SCD hospitalized for an illness associated with acute anemia, we identified acute silent cerebral ischemic events (ASCIE) in 4 (18.2%) of 22 with SCD and in 2 (6.7%) of 30 without SCD, using diffusion-weighted magnetic resonance imaging. Children with ASCIE had lower hemoglobin concentration than those without (median 3.1 vs 4.4 g/dL, P = .003). The unique temporal features of stroke on diffusion-weighted magnetic resonance imaging permit estimation of incidence rates for ASCIE of 421 (95% confidence interval, 155-920) per 100 patient-years during acute anemic events for all patients. For children with SCD, the estimated incidence was 663 (95% confidence interval, 182-1707) which is much higher than previously reported. Acute anemic events are common in children with SCD and prevalence could partially account for the high SCI. Some ASCIE (1 of 4 in our study) may be reversible. Alterations in management may be warranted for children with severe anemia to identify unrecognized ischemic brain injury that may have permanent neurocognitive sequelae. (Blood. 2012;120(19):3891-3897)
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