Pediatric Sickle Cell Disease and Stroke: A Literature Review

Overview of the Association Between the Pathophysiology, Types, and Management of Sickle Cell Disease and Stroke

Sickle cell disease (SCD) is a genetic blood disorder that affects hemoglobin and increases stroke risk, particularly in childhood. This review examines the pathophysiological association between SCD and stroke, the classification of stroke types, risk factors, diagnosis, management, prevention, and prognosis. A comprehensive literature search was conducted via PubMed, Scopus, and Cochrane databases. Relevant studies on SCD and stroke pathophysiology, classification, epidemiology, diagnosis, treatment, and prevention were identified. Sickle cell disease causes red blood cells to become rigid and sickle-shaped, obstructing blood vessels. Recurrent sickling alters cerebral blood flow and damages vessel walls, often leading to ischemic or hemorrhagic strokes (HS). These occur most frequently in childhood, with ischemic strokes (IS) being more common. Key risk factors include a prior transient ischemic attack (TIA), low hemoglobin, and a high leukocyte count. Neuroimaging is essential for diagnosis and determining stroke type. Primary prevention centers on blood transfusions and hydroxyurea for those at high risk. Acute treatment involves promptly restoring blood flow and managing complications. However, significant knowledge gaps remain regarding stroke mechanisms, optimizing screening protocols, and improving long-term outcomes. This review synthesizes current evidence on SCD and stroke to highlight opportunities for further research and standardizing care protocols across institutions. Ultimately, a holistic perspective is critical for mitigating the high risk of debilitating strokes in this vulnerable patient population.

Genetic literacy and experiential knowledge on sickle cell disease among Canadian- and foreign-born male and female Anglophone and Francophone youth in Canada

OBJECTIVES

Growing global human mobility raises concerns about impacts on global health, particularly on the prevalence of sickle cell disease. This research unveiled the level of genetic literacy on sickle cell disease of male and female Anglophone and Francophone youth living in Canada. The research responded to questions about whether the type of information about the disease has been more prevalent among the youth's family, friends, acquaintances and school circles, and the influence of such information on shaping the current youth level of genetic literacy on the disease.

METHODS

An online survey hosted by a Canadian university (2019/2020) platform was conducted with youth (n=87, aged 16-29) recruited in their natural, social environments in seven Canadian provinces. Data analysis used descriptive statistics and manual qualitative content analysis.

RESULTS

Youth, mostly Canadian-born, 71.42 % Francophones and 67.12 % Anglophones, descend from parents who had been born in countries at risk for the disease. Results indicated that experiential knowledge is due to the familiarity with the disease occurrence among family members and acquaintances. Participants did not comment about how academic-gained knowledge could influence their own decision on becoming a parent.

CONCLUSIONS

Independently of their country of birth, Canadian youth seem to have unmet information needs: a complex challenge requiring creativity and simplicity to deliver information through attractive media.

Moyamoya Syndrome in Children With Sickle Cell Disease in Saudi Arabia: A Single-Center Experience

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.

Pseudo-Thrombotic Thrombocytopenic Purpura Due to Severe Vitamin B12 Deficiency: A Case Report

Vitamin B12 deficiency is common in vegetarians, as meat is a common source of vitamin B12. In this case presentation, a patient presented to his primary care doctor with signs of severe vitamin B12 deficiency anemia. He had elevated lactate dehydrogenase levels, indirect bilirubin, and schistocytes on the blood smear, all pointing toward a hemolytic process. A severe vitamin B12 deficiency was deemed the cause of this hemolytic anemia after ruling out other causes. We highlight the importance of knowing more about this pathogenesis to avoid unnecessary workup and management for an elementary disorder that can result from severe B12 deficiency.