Associations Between Transcranial Doppler Flow Velocities, Laboratory Parameters, and Clinical Features in Turkish Children With Sickle Cell Disease

Objective: Stroke is one of the major complications of sickle cell disease (SCD). Stroke features either occlusion of, or stenosis at, the origin of one of the large intracerebral arteries, the internal carotid artery (ICA), and/or the middle cerebral artery (MCA). Purpose: We sought correlations between cerebral blood flow velocities and the laboratory and clinical findings of patients with SCD. Materials and Methods: Fifty-three pediatric SCD patients (39 with HbSS, 14 with HbS beta(0)) were analyzed. The mean patient age was 12.9 +/- 3.9 years. The control group contained 24 healthy individuals. The time-averaged maximum mean velocity (TAMMV) and resistive index (RI) of the MCA, the TAMMVs of the ICA and vertebral artery (VA), and the diameter of the VA were estimated through transcranial Doppler ultrasonography using a 2.5 MHz transducer, in accordance with the Stroke Prevention Trial in Sickle Cell Anemia (STOP) protocol. We evaluated the relationships between the TAMMVs, laboratory parameters, and clinical findings. Results: The mean +/- SD MCA TAMMV was 161.2 +/- 35.4 cm/s in patients with HbSS and 185.8 +/- 62.9 cm/s in patients with HbS beta(0). The mean MCA TAMMV, RI, ICA TAMMV, VA TAMMV, and VA diameter were 168.5 +/- 43.9 cm/s, 0.63 +/- 0.06, 116.8 +/- 25.5 cm/s, 69.2 +/- 18.5 cm/s, and 3.5 +/- 0.61 mm for all SCD patients, respectively. In the control group, the mean MCA TAMMV, RI, ICA TAMMV, VA TAMMV, and VA diameter were 103.8 +/- 28.8 cm/s, 0.53 +/- 0.04, 96.4 +/- 27.8 cm/s, 40.3 +/- 12.1 cm/s, and 3.4 +/- 0.6 mm, respectively. Although the differences were not significant, TAMMVs were higher in HbS beta(0) patients taking hydroxyurea; those with hemoglobin levels <8 g/dL, ferritin levels >1000 ng/dL, mean platelet volume >12 fL, or red cell distribution width >18%; or required chelation, or were below the third percentiles of weight and height. The TAMMV was significantly higher only in SCD patients who complained of headache. Conclusions: High ferritin and low hemoglobin levels, a high mean platelet volume, a high red cell distribution width, low weight (below the third percentile), and a short height (below the third percentile) may be associated with elevated cerebral blood flow velocities and an increased stroke risk in children with SCD. Children with such features should be closely followed-up through transcranial Doppler ultrasonography examination.