Haemoglobin oxygen saturation, leucocyte count and lactate dehydrogenase are predictors of elevated cerebral blood flow velocity in Nigerian children with sickle cell anaemia

Ojewunmi, Oyesola; Adeyemo, Titilope A.; Osuntoki, Akinniyi Adediran; Imaga, Ngozi Awa; Oyetunji, Ajoke Idayat

doi:10.1080/20469047.2017.1311087

Cited by 7 publications

(5 citation statements)

References 34 publications

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“…Apart from lower age, a non‐modifiable biological factor, other modifiable significant hematological abnormalities observed in the abnormal TCD group include elevated WBC count, suggesting enhanced leukocytosis and elevated MCV, which may be indicative of higher osmotic fragility risk. These findings confirm our previous work in which elevated LDH and WBC count were linked to chronic hypoxia 27 . Among Jamaican children with sickle cell anemia, Rankine‐Mullings et al 30 also established significant associations of lower oxygen saturation, higher MCV, and leukocytosis with abnormal TCD.…”

Section: Discussionsupporting

confidence: 88%

“…Non‐imaging TCD was measured for all the children according to the Stroke prevention trial (STOP) guidelines as previously described 27 and the time‐averaged mean of maximum velocities (TAMMV) were recorded. Children with TAMMV < 170 cm/s were defined as having normal TCD and represented a low stroke risk group, while children with TAMMV > 200 cm/s were defined as having abnormal TCD and represented high stroke risk group 27 …”

Section: Methodsmentioning

confidence: 99%

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Association of alpha‐thalassemia and Glucose‐6‐Phosphate Dehydrogenase deficiency with transcranial Doppler ultrasonography in Nigerian children with sickle cell anemia

Ojewunmi

Adeyemo

Oyetunji

et al. 2021

Clinical Laboratory Analysis

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Background Stroke is a devastating complication of sickle cell anemia (SCA) and can be predicted through abnormally high cerebral blood flow velocity using transcranial Doppler Ultrasonography (TCD). The evidence on the role of alpha‐thalassemia and glucose‐6‐phosphate dehydrogenase (G6PD) deficiency in the development of stroke in children with SCA is conflicting. Thus, this study investigated the association of alpha‐thalassemia and G6PD(A−) variant with abnormal TCD velocities among Nigerian children with SCA. Methods One hundred and forty‐one children with SCA were recruited: 72 children presented with normal TCD (defined as the time‐averaged mean of the maximum velocity: < 170 cm/s) and 69 children with abnormal TCD (TAMMV ≥ 200 cm/s). Alpha‐thalassemia (the α‐3.7 globin gene deletion) was determined by multiplex gap‐PCR, while G6PD polymorphisms (202G > A and 376A > G) were genotyped using restriction fragment length polymorphism—polymerase chain reaction. Results The frequency of α‐thalassemia trait in the children with normal TCD was higher than those with abnormal TCD: 38/72 (52.8%) [α‐/ α α: 41.7%, α ‐/ α ‐: 11.1%] versus 21/69 (30.4%) [α‐/ α α: 27.5%, α ‐/ α ‐: 2.9%], and the odds of abnormal TCD were reduced in the presence of the α‐thalassemia trait [Odds Ratio: 0.39, 95% confidence interval: 0.20–0.78, p = 0.007]. However, the frequencies of G6PDA− variant in children with abnormal and normal TCD were similar (11.6% vs. 15.3%, p = 0.522). Conclusion Our study reveals the protective role of α‐thalassemia against the risk of abnormal TCD in Nigerian children with SCA.

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Section: Discussionsupporting

confidence: 88%

Section: Methodsmentioning

confidence: 99%

Association of alpha‐thalassemia and Glucose‐6‐Phosphate Dehydrogenase deficiency with transcranial Doppler ultrasonography in Nigerian children with sickle cell anemia

Ojewunmi

Adeyemo

Oyetunji

et al. 2021

Clinical Laboratory Analysis

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“…This may be clinically signficant because it is related to the severity of anaemia [ 31 ] and to high 2,3-DPG levels, which increases deoxy-Hb S polymerization and sickling [ 32 ]. We and others have previously observed that low oxygen saturation is associated with increased cerebral blood flow velocity [ 33 , 34 ], and higher risk of neurological complications [ 35 , 36 ]. It was observed that there were low levels of red cell indices (MCV, MCH), which may be attributed in part to the high frequency of α-thalassaemia in this population (about 40% heterozygotes [ 37 ]): however, there is no a priori reason why this frequency should be any different in SCD versus non-SCD.…”

Section: Discussionmentioning

confidence: 99%

A ten year review of the sickle cell program in Muhimbili National Hospital, Tanzania

et al. 2018

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BackgroundAfrica has the highest burden of Sickle cell disease (SCD) but there are few large, systematic studies providing reliable descriptions of the disease spectrum. Tanzania, with 11,000 SCD births annually, established the Muhimbili Sickle Cell program aiming to improve understanding of SCD in Africa. We report the profile of SCD seen in the first 10 years at Muhimbili National Hospital (MNH).MethodsIndividuals seen at MNH known or suspected to have SCD were enrolled at clinic and laboratory testing for SCD, haematological and biochemical analyses done. Ethnicity was self-reported. Clinical and laboratory features of SCD were documented. Comparison was made with non-SCD population as well as within 3 different age groups (< 5, 5–17 and ≥ 18 years) within the SCD population.ResultsFrom 2004 to 2013, 6397 individuals, 3751 (58.6%) SCD patients, were enrolled, the majority (47.4%) in age group 5–17 years. There was variation in the geographical distribution of SCD. Individuals with SCD compared to non-SCD, had significantly lower blood pressure and peripheral oxygen saturation (SpO2). SCD patients had higher prevalence of severe anemia, jaundice and desaturation (SpO2 < 95%) as well as higher levels of reticulocytes, white blood cells, platelets and fetal hemoglobin. The main causes of hospitalization for SCD within a 12-month period preceding enrolment were pain (adults), and fever and severe anemia (children). When clinical and laboratory features were compared in SCD within 3 age groups, there was a progressive decrease in the prevalence of splenic enlargement and an increase in prevalence of jaundice. Furthermore, there were significant differences with monotonic trends across age groups in SpO2, hematological and biochemical parameters.ConclusionThis report confirms that the wide spectrum of clinical expression of SCD observed elsewhere is also present in Tanzania, with non-uniform geographical distribution across the country. Age-specific analysis is consistent with different disease-patterns across the lifespan.

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“…In Nigeria, the country that has the largest population of people with SCD (3 million) and the highest SCD birth rate of 150 000 per year,15–18 previous studies of the percentage who have conditional blood velocity in the cerebral arteries have been in single healthcare institutions and yielded variable results 19–24. The objective of this study is to obtain multicentre data to represent the general situation in the country and so facilitate the development of policy on the care of children with SCD who have conditional blood velocity in the cerebral arteries.…”

Section: Introductionmentioning

confidence: 99%

Cerebral artery conditional blood velocity in sickle cell disease: a multicentre study and evidence for active treatment

et al. 2023

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ObjectiveTo obtain multicentre data on the prevalence of normal, high or conditional (intermediate) blood velocity in the cerebral arteries among children with sickle cell disease (SCD) in Nigeria.DesignA prospective observational study in five tertiary healthcare institutions. By transcranial Doppler (TCD) ultrasonography, cerebral artery peak systolic blood velocity (PSV) was determined in 193 children with SCD and time averaged mean of the maximum blood velocity (TAMMV) in a different cohort of 115 children. This design was to make the findings relevant to hospitals with TCD equipment that measure either PSV or TAMMV.SettingNigeria.Participants308 children (126 girls, 182 boys; age 2–16 years).Main outcome measuresPercentage of children with SCD who have normal, high or intermediate (often termed conditional) PSV or TAMMV.ResultsIn the cohort of 193 children, PSV was normal in 150 (77.7%), high in 7 (3.6%) and conditional in 36 (18.7%). In the cohort of 115 children, TAMMV was normal in 96 (84%), high in 7 (6%) and conditional in 12 (10%). There were no significant differences in gender or age distribution between the PSV and TAMMV cohorts. Altogether, cerebral artery blood velocity was normal in 246/308 children (80%), high in 14 (4.5%) and conditional in 48 (15.5%).ConclusionSince conditional blood velocity in cerebral arteries can progress to high values and predispose to stroke, the proportion of children with SCD who are affected (15.5%) raises the question of whether regular monitoring and proactive intervention ought to be the standard of care.

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Haemoglobin oxygen saturation, leucocyte count and lactate dehydrogenase are predictors of elevated cerebral blood flow velocity in Nigerian children with sickle cell anaemia

Cited by 7 publications

References 34 publications

Association of alpha‐thalassemia and Glucose‐6‐Phosphate Dehydrogenase deficiency with transcranial Doppler ultrasonography in Nigerian children with sickle cell anemia

Association of alpha‐thalassemia and Glucose‐6‐Phosphate Dehydrogenase deficiency with transcranial Doppler ultrasonography in Nigerian children with sickle cell anemia

A ten year review of the sickle cell program in Muhimbili National Hospital, Tanzania

Cerebral artery conditional blood velocity in sickle cell disease: a multicentre study and evidence for active treatment

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