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Soni Z, Maheta D, Agrawal S, Frishman WH, Aronow WS. Sickle Cell Trait and Vascular Health: Insights into Complications and Management. Cardiol Rev 2025:00045415-990000000-00417. [PMID: 39932271 DOI: 10.1097/crd.0000000000000857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2025]
Abstract
Sickle cell trait was once considered to benign hereditary condition, besides the association of renal medullary carcinoma, affecting red blood cells. The inherited disorder creates several health issues under various conditions, such as dehydration, hypoxia, or extreme physical exertion. Healthcare professionals and patients with the disorder should understand the importance of vascular complications in sickle cell traits. This article emphasizes the pathophysiology, epidemiology, and molecular basis of the sickle cell trait, which involves virtually every organ system and involves vascular endothelial dysfunction, cerebral vasculopathy, renal complications, cardiopulmonary manifestations, and splenic issues. Techniques of prevention and management strategies for quality-of-life improvement in the case of sickle cell trait are presented.
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Affiliation(s)
- Zeal Soni
- From the Department of Medicine, Smt. NHLMMC, Ahmedabad, India
| | | | - Siddharth Agrawal
- Department of Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI
| | | | - Wilbert S Aronow
- Departments of Cardiology and Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY
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Zayed AM, Al-Muhaimeed S, Al-Otaibi T, Ali EM, Saleh R, Ancheta SJ, Al-Harbi F, Waheed KB, Albahli Y, Alghamdi H. Moyamoya Syndrome in Children With Sickle Cell Disease in Saudi Arabia: A Single-Center Experience. Cureus 2023; 15:e49039. [PMID: 38024048 PMCID: PMC10657488 DOI: 10.7759/cureus.49039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Sickle cell disease (SCD) is relatively common in Saudi Arabia. Its neurologic complications such as stroke and Moyamoya syndrome (MMS) can be severe and devastating. Such complications can be minimized by modern investigative tools such as transcranial Doppler (TCD) ultrasound, which is unavailable in many high-risk places. Our aim is to investigate the prevalence and characteristics of these complications in children with SCD in our center where TCD is not available. Methods We conducted a retrospective record review of children with SCD admitted to the pediatric ward and visited the pediatric hematology outpatient clinic of King Fahad Military Medical Complex, Dhahran, Saudi Arabia, from January 2010 to December 2021. The target population was children aged six months to 14 years with SCD and a history of stroke or transient ischemic attacks (TIAs). Their magnetic resonance imaging/magnetic resonance angiography (MRI/MRA) of the brain radiographic features were reviewed. A descriptive analysis was used to summarize the demographic characteristics and clinical features of patients with and without MMS. Results Twenty-six children (out of 385 with sickle cell anemia, originating mainly from the southwestern and eastern provinces of Saudi Arabia) experienced an overt stroke with an overall prevalence of 6.7%. All patients with stroke were originally from the Southwestern province. Their genotype was SS, and the median age at the onset of the first stroke was six years (IQR: 5.5). The main presenting symptoms were seizures (57.7%), motor weakness (42.3%), headache (15.3%), cranial nerve palsies (11.5%), cognitive deficit (7.6%), and dysphasia (3.8%). The majority of strokes were ischemic (92.3%). MMS was detected in 61.5% and was seen at the onset of the first stroke in all patients with this MRA abnormality. Seven children with moyamoya (43.8%) had recurrent strokes. Conclusion In this study, the prevalence of overt stroke is 9% in children with SCD originating from the southwestern region of Saudi Arabia (26/286), and 61.5% of them (16/26) had MMS. It is absent in the children of Eastern origin (99 children). In places lacking TCD facilities, further studies are required to determine if MRA brain screenings of children with SCD may detect MMS before the onset of stroke and help start protective therapy.
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Affiliation(s)
- Abdalla M Zayed
- Pediatrics, King Fahad Military Medical Complex, Dhahran, SAU
| | | | - Turki Al-Otaibi
- Pediatrics, King Fahad Military Medical Complex, Dhahran, SAU
| | | | - Rashid Saleh
- Pediatrics, King Fahad Military Medical Complex, Dhahran, SAU
| | | | - Fahad Al-Harbi
- Pediatrics, King Fahad Military Medical Complex, Dhahran, SAU
| | | | - Yasir Albahli
- Pediatrics, King Fahad Military Medical Complex, Dhahran, SAU
| | - Hamid Alghamdi
- Pediatrics, King Fahad Military Medical Complex, Dhahran, SAU
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3
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Karkoska KA, Gollamudi J, Hyacinth HI. Molecular and environmental contributors to neurological complications in sickle cell disease. Exp Biol Med (Maywood) 2023; 248:1319-1332. [PMID: 37688519 PMCID: PMC10625341 DOI: 10.1177/15353702231187646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2023] Open
Abstract
Sickle cell disease (SCD) is an inherited hemoglobinopathy in which affected hemoglobin polymerizes under hypoxic conditions resulting in red cell distortion and chronic hemolytic anemia. SCD affects millions of people worldwide, primarily in Sub-Saharan Africa and the Indian subcontinent. Due to vaso-occlusion of sickled red cells within the microvasculature, SCD affects virtually every organ system and causes significant morbidity and early mortality. The neurological complications of SCD are particularly devastating and diverse, ranging from overt stroke to covert cerebral injury, including silent cerebral infarctions and blood vessel tortuosity. However, even individuals without evidence of neuroanatomical changes in brain imaging have evidence of cognitive deficits compared to matched healthy controls likely due to chronic cerebral hypoxemia and neuroinflammation. In this review, we first examined the biological contributors to SCD-related neurological complications and then discussed the equally important socioenvironmental contributors. We then discuss the evidence for neuroprotection from the two primary disease-modifying therapies, chronic monthly blood transfusions and hydroxyurea, and end with several experimental therapies designed to specifically target these complications.
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Affiliation(s)
- Kristine A Karkoska
- Division of Hematology & Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45219-0525, USA
| | - Jahnavi Gollamudi
- Division of Hematology & Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45219-0525, USA
| | - Hyacinth I Hyacinth
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0525, USA
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4
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Aldana PR, Hanel RA, Piatt J, Han SH, Bansal MM, Schultz C, Gauger C, Pederson JM, Iii JCW, Hulbert ML, Jordan LC, Qureshi A, Garrity K, Robert AP, Hatem A, Stein J, Beydler E, Adelson PD, Greene S, Grabb P, Johnston J, Lang SS, Leonard J, Magge SN, Scott A, Shah S, Smith ER, Smith J, Strahle J, Vadivelu S, Webb J, Wrubel D. Cerebral revascularization surgery reduces cerebrovascular events in children with sickle cell disease and moyamoya syndrome: Results of the stroke in sickle cell revascularization surgery retrospective study. Pediatr Blood Cancer 2023; 70:e30336. [PMID: 37057741 DOI: 10.1002/pbc.30336] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 03/01/2023] [Accepted: 03/04/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Recent studies suggest that cerebral revascularization surgery may be a safe and effective therapy to reduce stroke risk in patients with sickle cell disease and moyamoya syndrome (SCD-MMS). METHODS We performed a multicenter, retrospective study of children with SCD-MMS treated with conservative management alone (conservative group)-chronic blood transfusion and/or hydroxyurea-versus conservative management plus surgical revascularization (surgery group). We monitored cerebrovascular event (CVE) rates-a composite of strokes and transient ischemic attacks. Multivariable logistic regression was used to compare CVE occurrence and multivariable Poisson regression was used to compare incidence rates between groups. Covariates in multivariable models included age at treatment start, age at moyamoya diagnosis, antiplatelet use, CVE history, and the risk period length. RESULTS We identified 141 patients with SCD-MMS, 78 (55.3%) in the surgery group and 63 (44.7%) in the conservative group. Compared with the conservative group, preoperatively the surgery group had a younger age at moyamoya diagnosis, worse baseline modified Rankin scale scores, and increased prevalence of CVEs. Despite more severe pretreatment disease, the surgery group had reduced odds of new CVEs after surgery (odds ratio = 0.27, 95% confidence interval [CI] = 0.08-0.94, p = .040). Furthermore, comparing surgery group patients during presurgical versus postsurgical periods, CVEs odds were significantly reduced after surgery (odds ratio = 0.22, 95% CI = 0.08-0.58, p = .002). CONCLUSIONS When added to conservative management, cerebral revascularization surgery appears to reduce the risk of CVEs in patients with SCD-MMS. A prospective study will be needed to validate these findings.
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Affiliation(s)
- Philipp R Aldana
- Department of Neurosurgery, University of Florida College of Medicine - Jacksonville and Wolfson Children's Hospital, Jacksonville, Florida, USA
| | - Ricardo A Hanel
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Joseph Piatt
- Division of Neurosurgery, Nemours Neuroscience Center, A.I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Sabrina H Han
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Manisha M Bansal
- Department of Pediatric Hematology/Oncology, Nemours Children's Health System and Wolfson Children's Hospital, Jacksonville, Florida, USA
| | - Corinna Schultz
- Department of Pediatrics, Nemours Center for Cancer and Blood Disorders, Nemours Children's Hospital, Wilmington, Delaware, USA
| | - Cynthia Gauger
- Department of Pediatric Hematology/Oncology, Nemours Children's Health System and Wolfson Children's Hospital, Jacksonville, Florida, USA
| | - John M Pederson
- Superior Medical Experts, St. Paul, Minnesota, USA
- Nested Knowledge, St. Paul, Minnesota, USA
| | - John C Wellons Iii
- Division of Pediatric Neurological Surgery, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Monica L Hulbert
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lori C Jordan
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adnan Qureshi
- Department of Neurology, Zeenat Qureshi Stroke Institute, University of Missouri, Columbia, Missouri, USA
| | - Kelsey Garrity
- Department of Neurosurgery, University of Florida College of Medicine - Jacksonville and Wolfson Children's Hospital, Jacksonville, Florida, USA
| | - Adam P Robert
- Department of Neurosurgery, University of Florida College of Medicine - Jacksonville and Wolfson Children's Hospital, Jacksonville, Florida, USA
| | - Asmaa Hatem
- Department of Neurosurgery, University of Florida College of Medicine - Jacksonville and Wolfson Children's Hospital, Jacksonville, Florida, USA
| | - Jennifer Stein
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Emily Beydler
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - P David Adelson
- Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Stephanie Greene
- Department of Neurosurgery, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Paul Grabb
- Department of Neurosurgery, Children's Mercy Hospital, Kansas, Missouri, USA
| | - James Johnston
- Department of Neurosurgery, Children's Hospital of Alabama, Birmingham, Alabama, USA
| | - Shih-Shan Lang
- Department of Neurosurgery and Pediatric Neurosurgery, University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeffrey Leonard
- Department of Neurosurgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Suresh N Magge
- Department of Neurosurgery, CHOC Neuroscience Institute, Children's Health of Orange County, Orange, California, USA
| | - Alex Scott
- Department of Neurosurgery, Washington University School of Medicine, Washington University in Saint Louis, St Louis, Missouri, USA
| | - Sanjay Shah
- Department of Pediatric Hematology/Oncology, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Edward R Smith
- Department of Neurosurgery, Children's Hospital Boston, and Harvard Medical School, Boston, Massachusetts, USA
| | - Jodi Smith
- Department of Pediatric Neurosurgery, Goodman Campbell Brain and Spine, Peyton Manning Children's Hospital, Indianapolis, Indiana, USA
| | - Jennifer Strahle
- Department of Neurosurgery, Washington University School of Medicine, Washington University in Saint Louis, St Louis, Missouri, USA
| | - Sudhakar Vadivelu
- Division of Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer Webb
- Department of Hematology/Oncology, Children's National Hospital, Washington, District of Columbia, USA
| | - David Wrubel
- Department of Neurosurgery, Children's Healthcare of Atlanta, Egleston Hospital, Atlanta, Georgia, USA
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Krementz NA, Gardener HE, Torres L, Alkhalifah M, Campo-Bustillo I, Campo N, Koch S, Alvarez O, Rundek T, Romano JG. Accuracy of transcranial Doppler in detecting intracranial stenosis in patients with sickle cell anemia when compared to magnetic resonance angiography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:480-486. [PMID: 35244950 DOI: 10.1002/jcu.23182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 12/06/2021] [Accepted: 12/16/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Stroke, the most devastating consequence of sickle cell anemia (SCA), is associated with endothelial damage and intracranial artery stenosis. We aimed to assess transcranial Doppler (TCD) ultrasound accuracy in detecting intracranial stenosis when compared to magnetic resonance angiography (MRA). METHODS Children with SCA and at least one TCD and MRA within 1 month were identified from a retrospectively collected database. Sensitivity and specificity were obtained to assess the overall accuracy of TCD mean flow velocity (mFV) ≥200 cm/s in detecting vessel stenosis of ≥50%. Multivariate analysis identified independent factors associated with MRA stenosis. RESULTS Among 157 patients in the database, 64 had a TCD and MRA within 1 month (age 11.8 ± 5.3 years, 56% female, 20% with cerebral infarcts on MRI, 8 or 13% had mFV ≥200 cm/s and 20% or 21%, had intracranial stenosis ≥50% on MRA). TCD mFV ≥200 cm/s had a high specificity (95%) but low sensitivity (29%) to detecting intracranial stenosis. As a continuous variable, TCD mFV of 137.5 cm/s had maximal specificity (77%) and sensitivity (72%). After adjustment for age, hemoglobin level, transfusion status, hydroxyurea treatment, and vessel, for every increase in cm/sec on TCD, there was a 2% increase in the odds of ≥50% stenosis on MRA (p < 0.001). CONCLUSION Our study reports TCD mFV is a positive predictor of MRA stenosis in SCA, independent of patient characteristics, including hemoglobin. A mFV ≥200 cm/s is highly specific but less sensitive in detecting stenosis ≥50%. Lower mFV cut points may be needed for the early detection of intracranial stenosis.
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Affiliation(s)
- Nastajjia A Krementz
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Hannah E Gardener
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Luis Torres
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Moayd Alkhalifah
- Department of Neurology, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Iszet Campo-Bustillo
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Nelly Campo
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Sebastian Koch
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ofelia Alvarez
- Department of Pediatrics, Division of Pediatric Hematology, University of Miami, Miami, Florida, USA
| | - Tatjana Rundek
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Jose G Romano
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
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Al-Jefri A, Siddiqui K, Al-Oraibi A, Al-Seraihy A, Al Ahmari A, Ghemlas I, Al Anazi A, Al Saedi H, Ayas M. Hematopoietic Stem Cell Transplantation Stabilizes Cerebral Vasculopathy in High-Risk Pediatric Sickle Cell Disease Patients: Evidence From a Referral Transplant Center. J Hematol 2022; 11:8-14. [PMID: 35356638 PMCID: PMC8929199 DOI: 10.14740/jh949] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/28/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Severe sickle cell disease (SCD) can present with different vaso-occlusive manifestations with cerebral vasculopathy (CV) as one of the most serious complications. Hematopoietic stem cell transplant (HSCT) is the ultimate therapy for this complication. The aim of this study was to assess the outcome and impact of HSCT on severe SCD patients with CV complications. METHODS Twenty-five consecutive transplants-naive pediatric SCD patients with CV complications underwent HSCT at our institution between 1993 and 2015, using bone marrow as stem cells source from fully match related donors were included. Neurologic evaluation was done both clinically and radiologically before transplantation and regularly following the HSCT. RESULTS With a median follow-up of 52.2 ± 5.8 months, the cumulative probability of overall survival (OS) at 3 years was 92.0% and event-free survival (EFS) was 88%. Significant neurologic improvements were observed in most of the patients clinically. Different neurologic complications were assessed. The neurologic manifestations before and after HSCT were hemiparesis (11, 1), seizures (13, 8), focal neurologic deficit (4, 2), loss of conscious (2, 1) headache (6, 1), and psychological symptoms (5, 2). Post-HSCT radiological imaging was done in 15 patients, which showed stabilization of CV among all. CONCLUSIONS Allogeneic HSCT in patients with severe SCD presenting with CV complications including moyamoya vasculopathy showed favorable outcome with significant clinical neurologic improvement and stabilization of the disease. None of the patients with severe vasculopathy underwent neurological vascular by-pass surgery prior to HSCT.
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Affiliation(s)
- Abdullah Al-Jefri
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Khawar Siddiqui
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Amira Al-Oraibi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Amal Al-Seraihy
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ali Al Ahmari
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ibrahim Ghemlas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Awatif Al Anazi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hawazen Al Saedi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Abstract
Intracranial vascular abnormalities rarely are encountered in primary care. Many of the pathologies are occult and prognosis varies widely between inconsequential variants of anatomy to acutely life-threatening conditions. Consequently, there often is a great deal of anxiety associated with any potential diagnosis. This article reviews anatomic intracranial vascular lesions, including vascular malformations (arteriovenous malformations/arteriovenous fistulae and cavernous malformations), structural arteriopathies (aneurysms and moyamoya), and common developmental anomalies of the vasculature. The focus includes a general overview of anatomy, pathology, epidemiology, and key aspects of evaluation for the primary care provider and a review of common questions encountered in practice.
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Giustini AJ, Stone SA, Ramamoorthy C. Moyamoya disease in children and its anesthetic implications: A review. Paediatr Anaesth 2020; 30:1191-1198. [PMID: 33463884 DOI: 10.1111/pan.14001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023]
Abstract
Moyamoya disease is a rare, progressive cerebral vasculopathy which most commonly presents in the first and fourth decades of life. The mainstay of treatment is surgical revascularization; without treatment, most patients experience ischemic or hemorrhagic strokes. This report reviews moyamoya disease, its associated conditions, surgical treatment techniques, and anesthetic management of patients with moyamoya disease.
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Affiliation(s)
- Andrew J Giustini
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, California, USA
| | - Sarah A Stone
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, California, USA
| | - Chandra Ramamoorthy
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, California, USA
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Yamani M, Obaid EF, Hemida AH. Moyamoya Syndrome in a 32-Year-Old Male With Sickle Cell Anemia. Cureus 2020; 12:e10001. [PMID: 32983699 PMCID: PMC7515146 DOI: 10.7759/cureus.10001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/24/2020] [Indexed: 11/25/2022] Open
Abstract
Moyamoya disease (MMD) is an unusual vasculopathy in which the blood vessels of the brain are occluded, resulting in thrombosis. When MMD occurs in association with an underlying pathology, it is known as moyamoya syndrome. The association of moyamoya syndrome with sickle cell disease is uncommon. Herein, we report a case of moyamoya syndrome in a 32-year-old male adult patient.
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Affiliation(s)
| | - Elaf F Obaid
- Internal Medicine, Al Noor Specialist Hospital, Mecca, SAU
| | - Amr H Hemida
- Internal Medicine, Al Noor Specialist Hospital, Mecca, SAU
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10
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Age-dependent characterization of carotid and cerebral artery geometries in a transgenic mouse model of sickle cell anemia using ultrasound and microcomputed tomography. Blood Cells Mol Dis 2020; 85:102486. [PMID: 32841841 DOI: 10.1016/j.bcmd.2020.102486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/23/2022]
Abstract
To define morphological changes in carotid and cerebral arteries in sickle cell transgenic mice (SS) as they age, a combination of ultrasound and microcomputed tomography of plastinated arteries was used to quantify arterial dimensions and changes in mice 4, 12, and 24 weeks of age. 12-week SS mice had significantly larger common carotid artery diameters than AS mice, which continued through to the extracranial and intracranial portions of the internal carotid artery (ICA). There were also side specific differences in diameters between the left and right vessels. Significant ICA tapering along its length occurred by 12- and 24-weeks in SS mice, decreasing by as much as 70%. Significant narrowing along the length was also measured in SS anterior cerebral arteries at 12- and 24-weeks, but not AS. Collectively, these findings indicate that sickle cell anemia induces arterial remodeling in 12- and 24-weeks old mice. Catalog of measurements are also provided for the common carotid, internal carotid, anterior cerebral, and middle cerebral arteries for AS and SS genotypes, as a reference for other investigators using mathematical and computational models of age-dependent arterial complications caused by sickle cell anemia.
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Abstract
Vascular injury is increasingly recognized as an important cause of mortality and morbidity in children (29 days to 18 years of age). Since vascular brain injury in children appears to be less common than in adults, the index of suspicion for vascular brain injury is usually lower. In this review article, we describe frequent and rare conditions underlying pediatric stroke including cardioembolic, viral, autoimmune, post-traumatic, and genetic etiologies. Furthermore, we provide a neuroimaging correlate for clinical mimics of pediatric stroke. This review highlights the role of multimodal noninvasive neuroimaging in the early diagnosis of pediatric stroke, providing a problem-solving approach to the differential diagnosis for the neuroradiologist, emergency room physician, and neurologist.
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Amlie-Lefond C, Flanagan J, Kanter J, Dobyns WB. The Genetic Landscape of Cerebral Steno-Occlusive Arteriopathy and Stroke in Sickle Cell Anemia. J Stroke Cerebrovasc Dis 2018; 27:2897-2904. [PMID: 30076115 DOI: 10.1016/j.jstrokecerebrovasdis.2018.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/28/2018] [Accepted: 06/02/2018] [Indexed: 11/24/2022] Open
Abstract
Sickle cell disease (SCD) is one of the most common autosomal recessive diseases in humans, occurring at a frequency of 1 in 365 African-American and 1 in 50 sub-Saharan African births. Despite progress in managing complications of SCD, these remain a major health burden worldwide. Stroke is a common and serious complication of SCD, most often associated with steno-occlusive cerebral arteriopathy, but little is known about its pathogenesis. Transcranial Doppler ultrasonography is currently the only predictive test for future development of stroke in patients with sickle cell anemia and is used to guide preventative treatment. However, transcranial Doppler ultrasonography does not identify all patients at increased risk for stroke, and progressive arteriopathy may occur despite preventative treatment. While sibling studies have shown a strong genetic contribution to the development of steno-occlusive arteriopathy (SOA) in SCD, the only genome-wide association study compared a relatively small cohort of 177 patients with stroke to 335 patients with no history of stroke. This single study detected variants in only 2 genes, ENPP1 and GOLGB1, and only one of these was confirmed in a subsequent independent study. Thus, the underlying genes and pathogenesis of SOA in SCD remain poorly understood, greatly limiting the ability to develop more effective preventive therapies. Dissecting the molecular causes of stroke in SCD will provide valuable information that can be used to better prevent stroke, stratify risk of SOA, and optimize personalized medicine approaches.
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Affiliation(s)
- Catherine Amlie-Lefond
- Departments of Neurology, University of Washington, Seattle, Washington; Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington.
| | - Jonathan Flanagan
- Division of Hematology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Julie Kanter
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - William B Dobyns
- Departments of Neurology, University of Washington, Seattle, Washington; Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington
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Castilhos LG, Adefegha SA, Doleski PH, Bertoldo TM, Moritz CEJ, Casali EA, Leal DB. NTPDase, 5'-nucleotidase and adenosine deaminase activities and purine levels in serum of sickle cell anemia patients. J Appl Biomed 2018. [DOI: 10.1016/j.jab.2017.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Olatunya OS, Oke OJ, Kuti BP, Ajayi IA, Olajuyin O, Omotosho-Olagoke O, Taiwo AB, Faboya OA, Ajibola A. Factors Influencing the Academic Performance of Children with Sickle Cell Anaemia in Ekiti, South West Nigeria. J Trop Pediatr 2018; 64:67-74. [PMID: 28549163 DOI: 10.1093/tropej/fmx034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is a paucity of information on factors that influence the school performance of children with sickle cell anaemia (SCA) in Nigeria, despite her huge burden of the disease. METHODS In total, 101 children with SCA were recruited at a paediatric clinic in Nigeria. Their socio-demographic-matched classmates were the controls. Academic performance and cognitive functioning were obtained from school reports and Ziler's Draw-a-Person Test, respectively. Factors influencing the academic performance were determined. RESULTS Children with SCA had higher rates of school absence and lower haemoglobin concentration (p < 0.05). There was no difference in overall school performance between children with SCA and controls (59.0 vs. 60.6%; p = 0.256). School absenteeism > 1 week independently predicts poor school performance among the study participants (odds ratio = 15.71; 95% confidence interval = 5.93-41.66; p =0.000). Most SCA children with poor performance were absent from school for > 1 week. CONCLUSION There is need to address causes of school absenteeism among children with SCA.
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Affiliation(s)
| | | | - Bankole Peter Kuti
- Department of Paediatrics, Obafemi Awolowo University, 220282 Ile-Ife, Nigeria
| | | | - Oyebanji Olajuyin
- Department of Otolaryngology, Ekiti State University, 360101 Ado Ekiti, Nigeria
| | | | - Adekunle Bamidele Taiwo
- Department of Paediatrics, Ekiti State University Teaching Hospital, 360101 Ado Ekiti, Nigeria
| | - Opeyemi Ayodeji Faboya
- Department of Paediatrics, Ekiti State University Teaching Hospital, 360101 Ado Ekiti, Nigeria
| | - Ayodeji Ajibola
- Department of Paediatrics, Ekiti State University Teaching Hospital, 360101 Ado Ekiti, Nigeria
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15
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Chou ST, Westhoff CM. Application of genomics for transfusion therapy in sickle cell anemia. Blood Cells Mol Dis 2017; 67:148-154. [DOI: 10.1016/j.bcmd.2017.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 08/07/2017] [Indexed: 12/23/2022]
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16
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Buckley EM, Platt MO, Lam WA. Novel in vivo and in vitro techniques to image and model the cerebral vasculature in sickle cell disease. Blood Cells Mol Dis 2017; 67:114-119. [PMID: 28822622 DOI: 10.1016/j.bcmd.2017.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 08/07/2017] [Indexed: 01/20/2023]
Affiliation(s)
- Erin M Buckley
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, United States; Department of Pediatrics, Emory University, United States.
| | - Manu O Platt
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, United States.
| | - Wilbur A Lam
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, United States; Department of Pediatrics, Emory University, United States; Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, United States.
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17
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Weaver MD, Dayoub H, Damuth E, Kavi T. Diffuse cerebral oedema from sickle cell vaso-occlusive crisis. BMJ Case Rep 2017; 2017:bcr-2017-221345. [PMID: 28798247 DOI: 10.1136/bcr-2017-221345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Martin D Weaver
- Department of Internal Medicine, Cooper University Hospital, Camden, New Jersey, USA.,Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine / Jackson Memorial Hospital, Miami, Florida, USA
| | - Hayan Dayoub
- Department of Neurosurgery, Cooper University Hospital, Camden, New Jersey, USA
| | - Emily Damuth
- Department of Critical Care, Cooper University Hospital, Camden, New Jersey, USA
| | - Tapan Kavi
- Department of Neurology and Neurosurgery, Cooper University Hospital, Camden, New Jersey, USA
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18
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Brewin J, Kaya B, Chakravorty S. How I manage sickle cell patients with high transcranial doppler results. Br J Haematol 2017; 179:377-388. [DOI: 10.1111/bjh.14850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- John Brewin
- Department of Haematology; King's College London; London UK
| | - Banu Kaya
- Department of Haematology; Royal London Hospital; London UK
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19
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Simões BP, Pieroni F, Costa T, Barros GN, Darrigo G, Grecco CS, Bernardes JE, Moraes D, Stracieri ABL, Cunha R, Rodrigues MC. Allogenic bone narrow transplantation in sickle-cell diseases. Rev Assoc Med Bras (1992) 2017; 62 Suppl 1:16-22. [PMID: 27982320 DOI: 10.1590/1806-9282.62.suppl1.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Sickle-cell diseases are the most common inherited hemoglobinopathies worldwide. Improvement in survival has been seen in the last decades with the introduction of careful screening and prevention of complications and the introduction of hydroxyurea. Stem-cell transplantation is currently the only curative option for these patients and has been indicated for patients with neurological events, repeated vaso-occlusive crisis, any organ damage or presence of red blood cell antibodies. Related bone-marrow or cord-blood transplant has shown an overall survival of more than 90% with a disease-free survival of 90% in 1,000 patients transplanted in the last decades. The use of unrelated donors unfortunately has not shown the same good results, but better typing methods and improved support may improve the outcome with this source of stem cells in the future. In Brazil, only recently stem cell transplant from related donors has been included in the procedures performed in the public health system. The use of related bone marrow or cord blood and a myeloablative conditioning regimen are considered standard of care for patients with sickle-cell diseases. Transplants with non-myeloablative regimens, unrelated donors or haploidentical donors should be performed only in controlled clinical trials.
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Affiliation(s)
| | - Fabiano Pieroni
- Transplantation Unit of Hospital das Clínicas, FMRP, USP, Brasil
| | - Thalita Costa
- Transplantation Unit of Hospital das Clínicas, FMRP, USP, Brasil
| | | | | | | | | | - Daniela Moraes
- Transplantation Unit of Hospital das Clínicas, FMRP, USP, Brasil
| | | | - Renato Cunha
- Transplantation Unit of Hospital das Clínicas, FMRP, USP, Brasil
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20
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Jorgensen DR, Rosano C, Novelli EM. Can Neuroimaging Markers of Vascular Pathology Explain Cognitive Performance in Adults With Sickle Cell Anemia? A review of the Literature. Hemoglobin 2017; 40:381-387. [PMID: 27689914 DOI: 10.1080/03630269.2016.1242493] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Adults with homozygous sickle cell anemia have, on average, lower cognitive function than unaffected controls. The mechanisms underlying cognitive deterioration in this population are poorly understood, but cerebral small vessel disease (CSVD) is likely to be implicated. We conducted a systematic review using the Prisma Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of articles that included both measures of cognitive function and magnetic resonance imaging (MRI) neuroimaging markers of small vessel disease. While all five studies we identified reported small vessel disease by MRI, only two of them found a significant relationship between structural changes and cognitive performance. Differences in methodologies and small sample sizes likely accounted for the discrepancies between the studies. We conclude that while MRI is a valuable tool to identify markers of CSVD in this population, larger studies are needed to definitely establish a link between MRI-detectable abnormalities and cognitive function in sickle cell anemia.
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Affiliation(s)
- Dana R Jorgensen
- a Department of Epidemiology , University of Pittsburgh School of Public Health , Pittsburgh , PA , USA
| | - Caterina Rosano
- a Department of Epidemiology , University of Pittsburgh School of Public Health , Pittsburgh , PA , USA
| | - Enrico M Novelli
- b Adult Sickle Cell Program, Division of Hematology/Oncology , University of Pittsburgh , Pittsburgh , PA , USA
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21
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Fasano RM, Chou ST. Red Blood Cell Antigen Genotyping for Sickle Cell Disease, Thalassemia, and Other Transfusion Complications. Transfus Med Rev 2016; 30:197-201. [DOI: 10.1016/j.tmrv.2016.05.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 01/19/2023]
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22
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Kaushal M, Byrnes C, Khademian Z, Duncan N, Luban NLC, Miller JL, Fasano RM, Meier ER. Examination of Reticulocytosis among Chronically Transfused Children with Sickle Cell Anemia. PLoS One 2016; 11:e0153244. [PMID: 27116614 PMCID: PMC4845996 DOI: 10.1371/journal.pone.0153244] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/27/2016] [Indexed: 11/21/2022] Open
Abstract
Sickle cell anemia (SCA) is an inherited hemolytic anemia with compensatory reticulocytosis. Recent studies have shown that increased levels of reticulocytosis during infancy are associated with increased hospitalizations for SCA sequelae as well as cerebrovascular pathologies. In this study, absolute reticulocyte counts (ARC) measured prior to transfusion were analysed among a cohort of 29 pediatric SCA patients receiving chronic transfusion therapy (CTT) for primary and secondary stroke prevention. A cross-sectional flow cytometric analysis of the reticulocyte phenotype was also performed. Mean duration of CTT was 3.1 ± 2.6 years. Fifteen subjects with magnetic resonance angiography (MRA) -vasculopathy had significantly higher mean ARC prior to initiating CTT compared to 14 subjects without MRA-vasculopathy (427.6 ± 109.0 K/μl vs. 324.8 ± 109.2 K/μl, p<0.05). No significant differences in hemoglobin or percentage sickle hemoglobin (HbS) were noted between the two groups at baseline. Reticulocyte phenotyping further demonstrated that the percentages of circulating immature [CD36(+), CD71(+)] reticulocytes positively correlated with ARC in both groups. During the first year of CTT, neither group had significant reductions in ARC. Among this group of children with SCA, cerebrovasculopathy on MRA at initiation of CTT was associated with increased reticulocytosis, which was not reduced after 12 months of transfusions.
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Affiliation(s)
- Megha Kaushal
- Molecular Medicine Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
- Center for Cancer and Blood Disorders, Children’s National Health System, Washington, D.C., United States of America
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States of America
| | - Colleen Byrnes
- Molecular Medicine Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Zarir Khademian
- Division of Diagnostic Imaging and Radiology, Children’s National Health System, Washington, D.C., United States of America
| | - Natalie Duncan
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, United States of America
| | - Naomi L. C. Luban
- Center for Cancer and Blood Disorders, Children’s National Health System, Washington, D.C., United States of America
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States of America
| | - Jeffery L. Miller
- Molecular Medicine Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Ross M. Fasano
- Center for Cancer and Blood Disorders, Children’s National Health System, Washington, D.C., United States of America
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States of America
| | - Emily Riehm Meier
- Molecular Medicine Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
- Center for Cancer and Blood Disorders, Children’s National Health System, Washington, D.C., United States of America
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States of America
- * E-mail:
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23
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Rivera CP, Veneziani A, Ware RE, Platt MO. Original Research: Sickle cell anemia and pediatric strokes: Computational fluid dynamics analysis in the middle cerebral artery. Exp Biol Med (Maywood) 2016; 241:755-65. [PMID: 26946534 DOI: 10.1177/1535370216636722] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Children with sickle cell anemia (SCA) have a high incidence of strokes, and transcranial Doppler (TCD) identifies at-risk patients by measuring blood velocities in large intracerebral arteries; time-averaged mean velocities greater than 200 cm/s confer high stroke risk and warrant therapeutic intervention with blood transfusions. Our objective was to use computational fluid dynamics to alter fluid and artery wall properties, to simulate scenarios causative of significantly elevated arterial blood velocities. Two-dimensional simulations were created and increasing percent stenoses were created in silico, with their locations varied among middle cerebral artery (MCA), internal carotid artery (ICA), and anterior cerebral artery (ACA). Stenoses placed in the MCA, ICA, or ACA generated local increases in velocity, but not sufficient to reach magnitudes > 200 cm/s, even up to 75% stenosis. Three-dimensional reconstructions of the MCA, ICA, and ACA from children with SCA were generated from magnetic resonance angiograms. Using finite element method, blood flow was simulated with realistic velocity waveforms to the ICA inlet. Three-dimensional reconstructions revealed an uneven, internal arterial wall surface in children with SCA and higher mean velocities in the MCA up to 145 cm/s compared to non-SCA reconstructions. There were also greater areas of flow recirculation and larger regions of low wall shear stress. Taken together, these bumps on the internal wall of the cerebral arteries could create local flow disturbances that, in aggregate, could elevate blood velocities in SCA. Identifying cellular causes of these microstructures as adhered blood cells or luminal narrowing due to endothelial hyperplasia induced by disturbed flow would provide new targets to treat children with SCA. The preliminary qualitative results provided here point out the critical role of 3D reconstruction of patient-specific vascular geometries and provide qualitative insight to complex interplay between vascular geometry and rheological properties possibly altered by SCA.
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Affiliation(s)
- Christian P Rivera
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30332, USA
| | - Alessandro Veneziani
- Department of Math and Computer Science at Emory University, Atlanta, GA 30322, USA
| | - Russell E Ware
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Manu O Platt
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30332, USA
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24
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Meier ER, Fasano RM, Estrada M, He J, Luban NLC, McCarter R. Early Reticulocytosis and Anemia Are Associated with Abnormal and Conditional Transcranial Doppler Velocities in Children with Sickle Cell Anemia. J Pediatr 2016; 169:227-31.e1. [PMID: 26593107 DOI: 10.1016/j.jpeds.2015.10.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 08/28/2015] [Accepted: 10/08/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To improve prediction of sickle cell anemia severity at an early age, we evaluated whether absolute reticulocyte count (ARC) or hemoglobin (Hb) levels during early infancy (2-6 months of age) in patients with sickle cell anemia predict the risk of later developing an abnormal (abTCD) or conditional (cdTCD) Transcranial Doppler (TCD). STUDY DESIGN We used chart review to identify 121 consecutive patients who underwent TCD screening and had steady state ARC and Hb levels recorded between 2 and 6 months of age. Cox regression analysis was used to determine the relationship between ARC, Hb levels, and risk of developing cdTCD/abTCD over time. RESULTS Mean ARC in early infancy was highest and mean Hb lowest in those children with abTCDs and cdTCDs. Cox regression analysis revealed that those subjects with an ARC ≥200 K/μL in early infancy had nearly 3 times the risk of having an abTCD/cdTCD than the group with an ARC <200 K/μL, and patients with a Hb <8.5 g/dL had 2.7 times the risk of having an abTCD/cdTCD. CONCLUSIONS These data suggest that both elevated ARC and low baseline Hb during early infancy are associated with an increased risk of developing a cdTCD or abTCD later in childhood.
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Affiliation(s)
- Emily Riehm Meier
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Ross M Fasano
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Monica Estrada
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC
| | - Jianping He
- Division of Biostatistics and Study Methodology, Children's National Medical Center, Washington, DC
| | - Naomi L C Luban
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Robert McCarter
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC; Division of Biostatistics and Study Methodology, Children's National Medical Center, Washington, DC
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