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Silent cerebral ischemia common in anemia, sickle cell disease
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Acute silent cerebral ischemic events occurred in nearly 20% of children with sickle cell disease who were hospitalized for anemia, according to results of a prospective observational study.
Silent cerebral infarcts — which have been observed in up to 40% of children with sickle cell disease — may occur in the setting of acute anemic events, according to the researchers.
The current investigation included children who were hospitalized for a complaint associated with acute anemia. Children with or without sickle cell disease were eligible.
Acute silent cerebral ischemic events occurred in four of 22 (18.2%) children in the sickle cell cohort and two of 30 (6.7%) children without sickle cell disease. These results were obtained using diffusion-weighted MRI.
Children with an event had a median hemoglobin concentration of 3.1 g/dL vs. a concentration of 4.4 g/dL among children who did not have an event (P=.003).
Features of diffusion-weighted MRI allowed the researchers to estimate an event incidence rate of 421 per 100 patient-years (95% CI, 155-920) during acute anemic events for the entire cohort. Sickle cell disease was linked to an incidence of 663 per 100 patient-years (95% CI, 182-1,707), which the researchers noted was higher that previous estimates.
As many as one-quarter of acute silent cerebral ischemic events may be reversible, according to the researchers.
“Alterations in management may be warranted for children with severe anemia to identify unrecognized ischemic brain injury that may have permanent neurocognitive sequelae,” they concluded.
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