Children with sickle cell anemia with normal transcranial Doppler ultrasounds and without silent infarcts have a low incidence of new strokes

Lori C. Jordan, Dionna O. Roberts Williams, Mark J. Rodeghier, Brittany V. Covert Greene, Maria R. Ponisio, James F. Casella, Robert C. Mckinstry, Michael J. Noetzel, Fenella J. Kirkham, Emily R. Meier, Beng Fuh, Melissa Mcnaull, Sharada Sarnaik, Suvankar Majumdar, Timothy L. Mccavit, Michael R. Debaun

Research output: Contribution to journalArticle

Abstract

In a prospective cohort study, we tested the hypothesis that children with sickle cell anemia (SCA) with normal transcranial Doppler ultrasound (TCD) velocities and without silent cerebral infarcts (SCIs) would have a lower incidence rate of new neurological events (strokes, seizures or transient ischemic attacks) compared to children with normal TCD measurements and SCIs, not receiving regular blood transfusions. Nonrandomized participants from the silent cerebral infarct transfusion (SIT) Trial who had screening magnetic resonance imaging (MRI) of the brain and normal TCD measurements were included. Follow-up ended at the time of first neurological event (stroke, seizure or transient ischemic attack), start of regular blood transfusion, or loss to follow-up, whichever came first. The primary endpoint was a new neurological event. Of 421 participants included, 68 had suspected SCIs. Mean follow-up was 3.6 years. Incidence rates of new neurological events in nontransfused participants with normal TCD values with SCIs and without SCIs were 1.71 and 0.47 neurological events per 100 patient-years, respectively, P=.065. The absence of SCI(s) at baseline was associated with a decreased risk of a new neurological event (hazard ratio 0.231, 95% CI 0.062-0.858; P=.029). Local pediatric neurologists examined 67 of 68 participants with suspected SCIs and identified 2 with overt strokes classified as SCIs by local hematologists; subsequently one had a seizure and the other an ischemic stroke. Children with SCA, without SCIs, and normal TCD measurements have a significantly lower rate of new neurological events when compared to those with SCIs and normal TCD measurements. Pediatric neurology assessment may assist risk stratification.

Original languageEnglish (US)
JournalAmerican Journal of Hematology
DOIs
StateAccepted/In press - Jan 1 2018

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Doppler Ultrasonography
Sickle Cell Anemia
Stroke
Incidence
Seizures
Transient Ischemic Attack
Blood Transfusion
Pediatrics
Neurology
Cohort Studies
Magnetic Resonance Imaging
Prospective Studies
Brain

ASJC Scopus subject areas

  • Hematology

Cite this

Jordan, L. C., Roberts Williams, D. O., Rodeghier, M. J., Covert Greene, B. V., Ponisio, M. R., Casella, J. F., ... Debaun, M. R. (Accepted/In press). Children with sickle cell anemia with normal transcranial Doppler ultrasounds and without silent infarcts have a low incidence of new strokes. American Journal of Hematology. https://doi.org/10.1002/ajh.25085

Children with sickle cell anemia with normal transcranial Doppler ultrasounds and without silent infarcts have a low incidence of new strokes. / Jordan, Lori C.; Roberts Williams, Dionna O.; Rodeghier, Mark J.; Covert Greene, Brittany V.; Ponisio, Maria R.; Casella, James F.; Mckinstry, Robert C.; Noetzel, Michael J.; Kirkham, Fenella J.; Meier, Emily R.; Fuh, Beng; Mcnaull, Melissa; Sarnaik, Sharada; Majumdar, Suvankar; Mccavit, Timothy L.; Debaun, Michael R.

In: American Journal of Hematology, 01.01.2018.

Research output: Contribution to journalArticle

Jordan, LC, Roberts Williams, DO, Rodeghier, MJ, Covert Greene, BV, Ponisio, MR, Casella, JF, Mckinstry, RC, Noetzel, MJ, Kirkham, FJ, Meier, ER, Fuh, B, Mcnaull, M, Sarnaik, S, Majumdar, S, Mccavit, TL & Debaun, MR 2018, 'Children with sickle cell anemia with normal transcranial Doppler ultrasounds and without silent infarcts have a low incidence of new strokes', American Journal of Hematology. https://doi.org/10.1002/ajh.25085
Jordan, Lori C. ; Roberts Williams, Dionna O. ; Rodeghier, Mark J. ; Covert Greene, Brittany V. ; Ponisio, Maria R. ; Casella, James F. ; Mckinstry, Robert C. ; Noetzel, Michael J. ; Kirkham, Fenella J. ; Meier, Emily R. ; Fuh, Beng ; Mcnaull, Melissa ; Sarnaik, Sharada ; Majumdar, Suvankar ; Mccavit, Timothy L. ; Debaun, Michael R. / Children with sickle cell anemia with normal transcranial Doppler ultrasounds and without silent infarcts have a low incidence of new strokes. In: American Journal of Hematology. 2018.
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abstract = "In a prospective cohort study, we tested the hypothesis that children with sickle cell anemia (SCA) with normal transcranial Doppler ultrasound (TCD) velocities and without silent cerebral infarcts (SCIs) would have a lower incidence rate of new neurological events (strokes, seizures or transient ischemic attacks) compared to children with normal TCD measurements and SCIs, not receiving regular blood transfusions. Nonrandomized participants from the silent cerebral infarct transfusion (SIT) Trial who had screening magnetic resonance imaging (MRI) of the brain and normal TCD measurements were included. Follow-up ended at the time of first neurological event (stroke, seizure or transient ischemic attack), start of regular blood transfusion, or loss to follow-up, whichever came first. The primary endpoint was a new neurological event. Of 421 participants included, 68 had suspected SCIs. Mean follow-up was 3.6 years. Incidence rates of new neurological events in nontransfused participants with normal TCD values with SCIs and without SCIs were 1.71 and 0.47 neurological events per 100 patient-years, respectively, P=.065. The absence of SCI(s) at baseline was associated with a decreased risk of a new neurological event (hazard ratio 0.231, 95{\%} CI 0.062-0.858; P=.029). Local pediatric neurologists examined 67 of 68 participants with suspected SCIs and identified 2 with overt strokes classified as SCIs by local hematologists; subsequently one had a seizure and the other an ischemic stroke. Children with SCA, without SCIs, and normal TCD measurements have a significantly lower rate of new neurological events when compared to those with SCIs and normal TCD measurements. Pediatric neurology assessment may assist risk stratification.",
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T1 - Children with sickle cell anemia with normal transcranial Doppler ultrasounds and without silent infarcts have a low incidence of new strokes

AU - Jordan, Lori C.

AU - Roberts Williams, Dionna O.

AU - Rodeghier, Mark J.

AU - Covert Greene, Brittany V.

AU - Ponisio, Maria R.

AU - Casella, James F.

AU - Mckinstry, Robert C.

AU - Noetzel, Michael J.

AU - Kirkham, Fenella J.

AU - Meier, Emily R.

AU - Fuh, Beng

AU - Mcnaull, Melissa

AU - Sarnaik, Sharada

AU - Majumdar, Suvankar

AU - Mccavit, Timothy L.

AU - Debaun, Michael R.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - In a prospective cohort study, we tested the hypothesis that children with sickle cell anemia (SCA) with normal transcranial Doppler ultrasound (TCD) velocities and without silent cerebral infarcts (SCIs) would have a lower incidence rate of new neurological events (strokes, seizures or transient ischemic attacks) compared to children with normal TCD measurements and SCIs, not receiving regular blood transfusions. Nonrandomized participants from the silent cerebral infarct transfusion (SIT) Trial who had screening magnetic resonance imaging (MRI) of the brain and normal TCD measurements were included. Follow-up ended at the time of first neurological event (stroke, seizure or transient ischemic attack), start of regular blood transfusion, or loss to follow-up, whichever came first. The primary endpoint was a new neurological event. Of 421 participants included, 68 had suspected SCIs. Mean follow-up was 3.6 years. Incidence rates of new neurological events in nontransfused participants with normal TCD values with SCIs and without SCIs were 1.71 and 0.47 neurological events per 100 patient-years, respectively, P=.065. The absence of SCI(s) at baseline was associated with a decreased risk of a new neurological event (hazard ratio 0.231, 95% CI 0.062-0.858; P=.029). Local pediatric neurologists examined 67 of 68 participants with suspected SCIs and identified 2 with overt strokes classified as SCIs by local hematologists; subsequently one had a seizure and the other an ischemic stroke. Children with SCA, without SCIs, and normal TCD measurements have a significantly lower rate of new neurological events when compared to those with SCIs and normal TCD measurements. Pediatric neurology assessment may assist risk stratification.

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