Acute silent cerebral ischemia and infarction during acute anemia in children with and without sickle cell disease
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. We conducted 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 4/22 (18.2%) with SCD and in 2/30 (6.7%) without SCD, using diffusion-weighted magnetic resonance imaging (DWI). Children with ASCIE had lower hemoglobin concentration than those without (median 3.1 vs 4.4 g/dl, p=0.003). The unique temporal features of cerebral infarction on DWI permit estimation of incidence rates for ASCIE of 421 (95% C.I. 155-920) per 100 patient years during acute anemic events for all patients. For children with SCD, the estimated incidence was 663 (95% C.I. 182-1707) which is much higher than reported in longitudinal studies of silent or overt strokes in SCD. Acute anemic events are common in children with SCD and therefore could partially account for the high SCI prevalence. Some ASCIE (1/4 in our study) may be reversible. Alterations in management may be warranted for all children with severe anemia to identify unrecognized ischemic brain injury that may have permanent neurocognitive sequelae.
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