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Transcranial doppler ultrasound in the prevention of cerebrovascular accident in children with sickle cell disease

Abstract:

Introduction: neurological complications and their sequelae are known almost since the first description of sickle cell disease, most commonly in sickle cell anemia. They vary with age, can be acute or chronic and produce high morbidity and mortality. Aims: to determine the frequency of children with AD who have alterations in cerebral blood flow velocity, relate these changes to clinical events and laboratory data and assess the evolution over time of patients with abnormalities and their association with the use of hydroxyurea. Methods: a prospective analytical study involving 50 patients with sickle cell disease, aged 5 to 18, was performed in at the Institute of Hematology and Immunology where they are assisted. Alterations in cerebral blood flow (CBF) and the association with other clinical and hematological elements were determined. Results: the arteries that showed larger speed were right middle cerebral artery (121.6 cm/s) and left (115 cm/s). Patients with impaired CBF velocity in transcranial Doppler ultrasound were 11 (22%) with speeds greater higher than 170 cm/s, 6 patients (12%) with a flow between 170-199 cm/s, and five (10%) greater higher than 200 cm/s. There was an inverse correlation between Cbf velocity with age and hemoglobin levels and directly with the platelet count. The cerebrovascular accident, blood transfusions and hospitalizations were the most frequent clinical events in patients with abnormal transcranial doppler ultrasound. FSC velocities were significantly decreased (31 cm /s; p = 0,034) in patients receiving treatment with hydroxyurea. Conclusions: Patients with alterations in the transcranial Doppler ultrasound must be included in a program for primary prevention of cerebrovascular accident.