Elevated Systolic Blood Pressure and Low Fetal Hemoglobin Are Risk Factors for Silent Cerebral Infarcts in Children with Sickle Cell Anemia.

• DOI: 10.1182/blood.v114.22.262.262
• Publication Date: 2019-10-09T21:07:54Z
• Authors: Sharada A. Sarnaik; James F. Casella; Bruce A Barton; Michele Afif; Gladstone Airewele; Brian W. Berman; Francoise Bernaudin; Thomas Coates; Beng Fuh; Helge Hartung; Mark E. Heiny; Thomas H. Howard; Baba Inusa; Rathi V. Iyer; Karen Kalinyak; Allison King; Melanie Kirby-Allen; Fenella J Kirkham; Janet L Kwiatkowski; Scott T. Miller; Julie A. Panepinto; Charles T. Quinn; Rupa Redding-Lall...; Melissa M. Rhodes; Hernan Sabio; Suzanne Saccente; Charles Scher; Paul Telfer; Alexis A Thompson; Gerald M Woods; Michael R. DeBaun
• Keywords: 03 medical and health sciences; 0302 clinical medicine; 3. Good health

Abstract Abstract 262

Introduction: The most common cause of neurological injury in sickle cell anemia is silent cerebral infarcts (SCI). In the Silent Cerebral Infarct Multi-Center Clinical Trial (SIT Trial) cohort, we sought to identify risk factors associated with SCI.

Patients and Methods: In this cross-sectional study, we evaluated the clinical history, baseline laboratory values and performed magnetic resonance imaging of the brain. For those children with SCI-like lesions, a pediatric neurologist examined the child and neuroradiology and neurology committees adjudicated the presence of SCI. Children between the ages of 5 and 15 years with hemoglobin SS or S-beta° thalassemia and no history of overt strokes or seizure were evaluated.

Results: A total of 542 children were evaluated; 173 (31.9%) had SCI. The mean age of the children was 9.3 years, with 280 males (51.7%). In a multivariate logistic analysis, two covariates were significant: a single systolic blood pressure (SBP) obtained during a baseline well-visit, p = 0.015 and hemoglobin F (Hgb F) level obtained after three years of age, p = 0.038. Higher values of SBP and lower values of Hgb F increased the odds of SCI; Figure. Baseline values of white blood cell count, hemoglobin level, oxygen saturation, reticulocytes, pain, or ACS event rates were not associated with SCI.

Conclusion: SBP and Hgb F level are two previously unidentified risk factors for SCI in children with sickle cell disease. Modulation of SBP and Hgb F levels might decrease the risk of SCI.

Disclosures: No relevant conflicts of interest to declare.