Transcranial Doppler imaging ultrasound assessment of cerebral blood flow velocity and abnormalities in steady-state sickle cell anaemia children, Southwest Nigeria
DOI:
https://doi.org/10.18203/2349-3291.ijcp20253475Keywords:
Abnormalities, Children, Cerebral blood flow, Sickle cell anaemia, VelocityAbstract
Background: Monitoring cerebral blood flow velocity in children with sickle cell anaemia is valuable and advocated and early detection of abnormal velocity affords appropriate management. This study assessed the blood flow velocities in the large intracranial arteries of the participants and determined abnormalities (risks for stroke).
Methods: The blood flow velocity in the middle and anterior cerebral arteries of the study participants (2–14 years) was assessed using a transcranial doppler (TCD) imaging ultrasound machine. The risk of stroke for each patient was determined by the greatest time-average mean maximum velocity (TAMMV) in centimeters/second (cm/s) in any of the insonated arteries. And using the Stroke Prevention Trial (STOP) criteria, the subjects were classified into having standard, conditional or high risk for stroke.
Results: Out of the 110 participants, males were 61 (55.5%) and females 49 (44.5%). The overall mean TAMMV was 135.50±28.62 cm/s and the 2‒5-year-old group presented the highest mean TAMMV (141.31±29.97). The overall mean TAMMVs for the middle and anterior cerebral arteries were 151.95±39.29 cm/s and 117.38±39.85 cm/s, respectively (t=8.583, p<0.001). According to the STOP criteria, fifty-four (49.1%), 40 (36.4%) and 16 (14.5%) of the subjects had standard, conditional and high risk for stroke, respectively. A comparison of the pattern of risk for stroke identified by Stop criteria (non-imaging) and the adjusted Stop criteria (imaging) revealed a statistically significant difference (p<0.001).
Conclusions: The prevalence (50.9%) of abnormal velocity (Stop criteria) in this study was high and therefore, regular measurement of the TAMMV in SCA patients is recommended.
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References
Chowdhury DeBaun MR, Frei-Jones M, Vichinsky E. Sickle cell disease. In: Kliegman RM, Stanton BF, St. Geme III JW, Schor NF, Behrman RE, ed. Nelson textbook of paediatrics. 20th ed. Philadelphia: Elsevier- Saunders. 2019: 2336-53.
Manwani D, Frenette P. Vaso-occlusion in sickle cell disease: pathophysiology and novel targeted therapies. Hematol. 2013;1:3892-8. DOI: https://doi.org/10.1182/blood-2013-05-498311
Beutler E. The sickle cell disease and related disorder. In: Beutler E, Lithman MA, Coller BS, Kipps TJ, Selighson U. ed. William Haematology. 6th ed. Minnesota: McGraw-Hill professional. 2011: 80-100.
World Health Organization. Management of birth defects and haemoglobin disorders: Reports of a Joint WHO-March of Dimes Meeting, Geneva; Switzerland, 2006. Available at https://iris.who.int/bitstream/handle/10665/43587/9789241594929_eng.pdf?sequence=1. Accessed on 10 June 2025
Ejiofor OS. Newborn screening for Sickle Cell Disease (SCD) in Akwa Southeast Nigeria. J Blood Discord Transfus. 2018;9:398.
Asbeutah AM, Almajran AA, Adekile A. Pattern of cerebral blood flow and interrelationship of vascular parameters of Transcranial Doppler Imaging in children with Sickle cell disease. J Clin Ultrasound. 2019;47(3):128-32. DOI: https://doi.org/10.1002/jcu.22663
Jauch CE. Guideline for the early management of patients with acute ischemic stroke: a guideline for health care professionals from the American Heart Association. Stroke. 2013;44:870-947. DOI: https://doi.org/10.1161/STR.0b013e318284056a
Jones AM. Comparison of transcranial color Doppler imaging (TCDI) and transcranial Doppler (TCD) in children with sickle-cell anemia. Pediatr Radiol. 2001;31:461-9. DOI: https://doi.org/10.1007/s002470100427
McCarville MB, Li C, Xiong X, Wang W. Comparison of transcranial Doppler sonography with and without imaging in the evaluation of children with sickle cell anemia. Am J Roentgenol. 2004;183:1117-22. DOI: https://doi.org/10.2214/ajr.183.4.1831117
Oloyede IP, Ahunanya CN, Uduma FU, Eduwem DU. Clinical Profile and middle cerebral artery velocity of children with sickle cell anaemia seen in UUTH, Uyo, Akwa Ibom state, Nigeria. Niger Med J. 2024;65(2):195-205.
Furie LK, Kasner SE, Adams RJ, Albers GW, Bush LB. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association. Stroke. 2011;42:227-76. DOI: https://doi.org/10.1161/STR.0b013e3181f7d043
Lagunju I, Sodeinde O, Telfer P. Prevalence of Transcranial Doppler abnormalities in Nigerian children with sickle cell disease. J Hematol. 2012;87:544-7. DOI: https://doi.org/10.1002/ajh.23152
Kwiatkowski JL, Zimmerman R, Greenbaum B, Ohene-Frempong K. Stroke and Elevated Blood Flow Velocity in the Anterior Cerebral Artery in Sickle Cell Disease. J Pediatric Hematol Oncol. 2004;26(5):323-6. DOI: https://doi.org/10.1097/00043426-200405000-00014
Buchanan ID, James-Herry A, Osuukwo I. The other side of abnormal: a case series of low transcranial Doppler velocities associated with stroke in children with sickle cell disease. J Pediatr Hematol Oncol. 2013;35(7):543-6. DOI: https://doi.org/10.1097/MPH.0b013e318279caae
Grosse SD, Odame I, Atrash HK, Amendah DD, Piel FB, William T. A Sickle cell disease in Africa: a neglected cause of early childhood mortality. Am J Prev Med. 2011;41:398-405. DOI: https://doi.org/10.1016/j.amepre.2011.09.013
Lagunju I, Sodeinde O, Brown B, Akinbami F, Adedokun B. Transcranial Doppler ultrasonography in children with sickle cell anaemia: Clinical and laboratory correlates for elevated blood flow velocities. J Clin ultrasound. 2014;42:89-95. DOI: https://doi.org/10.1002/jcu.22099
Ezeuko LC, Odunvbun ME, Ikejiaku UP, Ike II. Cerebral Artery Blood Flow Velocities in Children with Sickle Cell Anaemia at the Federal Teaching Hospital, Owerri. Nigerian J Paediatr. 2024;51(4):348-55. DOI: https://doi.org/10.4314/njp.v51i4.04
Oniyangi O, Akano AO, Oyesakin AB, Wakama TT. Transcranial Doppler ultrasound studies for primary prevention of strokes among children with sickle cell disease in Nigeria-a single tertiary centre experience. Res. 2014;1:825. DOI: https://doi.org/10.13070/rs.en.1.825
Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol. 2013;35:121-6 DOI: https://doi.org/10.4103/0253-7176.116232
Adams RJ. The use of transcranial ultrasonography to predict stroke in sickle cell disease. N Engl J Med. 1992;326(9):605-10. DOI: https://doi.org/10.1056/NEJM199202273260905
Adams RJ. Long term stroke risk in children with sickle cell disease screened with transcranial doppler. Ann Neurol. 1997;42:67-74. DOI: https://doi.org/10.1002/ana.410420505
Jibir BW, Wudil JU, Muuta I, Adeodu OO. Assessment of the risk of stroke in children with sickle cell anemia using transcranial doppler ultrasound with imaging in Northwestern Nigeria. Niger J Paediatr. 2022;49(4):290-7. DOI: https://doi.org/10.4314/njp.v49i4.3
Adekunle MO, Animasahun AB, Dialu-Akinwumi IN, Njokama OF. Pattern of cerebral blood flow velocity using Transcranial Doppler ultrasonography in children with sickle cell disorder in Lagos state Nigeria. J Hematol. 2017;9:2056. DOI: https://doi.org/10.4084/mjhid.2017.050
Rees DC, Williams TN. Gladwin TM. Sickle-cell disease. Lancet. 2010;376:2018-31. DOI: https://doi.org/10.1016/S0140-6736(10)61029-X
Adekile AD, Yacoub F, Gupta R, Sinan T, Heider MZ, Habeeb Y. Silent brain infarcts are rare in Kuwaiti children with Sickle cell disease and high HbF. Am J Hematol. 2002;70:228-31. DOI: https://doi.org/10.1002/ajh.10143
Bernaudin F. Impact of early Transcranial Doppler Screening and intensive therapy on cerebral vasculopathy outcome in a newborn sickle cell anaemia cohort. Blood. 2011;117:1130-40. DOI: https://doi.org/10.1182/blood-2010-06-293514
Riebel T, Kebelmann-Betzing C, Gotze R, Overburg U. Transcranial Doppler Ultrasonography in neurologically asymptomatic children and young adults with sickle cell disease. Eur Radiol. 2003;13:563-70. DOI: https://doi.org/10.1007/s00330-002-1481-4
Meschia FJ, Bushnell C, Boden-Albala B, Braun LT. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association. Stroke. 2014;45:3754-832. DOI: https://doi.org/10.1161/STR.0000000000000046
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