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Floch A, Viret S, Malard L, Pakdaman S, Jouard A, Habibi A, Galacteros F, François A, Pirenne F. Eleven years of alloimmunization in 6496 patients with sickle cell disease in France who received transfusion. Blood Adv 2023; 7:7608-7620. [PMID: 37699002 PMCID: PMC10790094 DOI: 10.1182/bloodadvances.2022009328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 07/27/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023] Open
Abstract
ABSTRACT Red blood cell (RBC) transfusion is a major therapy for sickle cell disease (SCD). Patients are at risk of forming antibodies to RBC antigens, which can result in the impossibility to find compatible units and can cause hemolytic transfusion reactions. This retrospective study investigates the evolution of RBC consumption and the frequencies, specificities, and chronology of the appearance of antibodies in a population of patients consistently receiving RH (C, D, E, c, e) and K-matched RBC units (RBCus) from a predominantly European donor population. Over the 11-year period in the Paris area, 6496 patients received transfusion at least once for a total of 239 944 units. Antibodies were made by 1742 patients. The first antibodies of a patient were predictive of subsequent immunization. By the 17th RBCu transfused (by the 20th, excluding warm autoantibodies), 75% of the patients who would make antibodies had made their first. By the 16th, 90% who would make antibodies to a high frequency antigen had made their first antibody to these antigens. Females made their first antibodies slightly earlier than males. Patients who received multiple transfusions (>50 units) had a higher immunization prevalence than those who rarely received transfusion (<12 units) but fewer clinically significant antibodies. Patients with SCD and prophylactic RH-K matching not immunized by the 20th RBCu are likely to have a low alloimmunization risk (to antigens other than RH-K), that is, be low responders, especially relative to the most clinically significant antibodies. This number of 20 units is a point before which close monitoring of patients is most important but remains open to future adjustment.
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Affiliation(s)
- Aline Floch
- Etablissement Français du Sang Ile-de-France, Créteil, France
- INSERM U955, Equipe Transfusion et Maladies du Globule Rouge, Université Paris-Est Creteil, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - Sophie Viret
- Etablissement Français du Sang Ile-de-France, Créteil, France
| | | | - Sadaf Pakdaman
- Etablissement Français du Sang Ile-de-France, Créteil, France
- INSERM U955, Equipe Transfusion et Maladies du Globule Rouge, Université Paris-Est Creteil, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - Alicia Jouard
- Etablissement Français du Sang Ile-de-France, Créteil, France
- INSERM U955, Equipe Transfusion et Maladies du Globule Rouge, Université Paris-Est Creteil, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - Anoosha Habibi
- Referral Center for Sickle Cell Disease, Henri Mondor Hospital, Créteil, France
| | - Frédéric Galacteros
- Referral Center for Sickle Cell Disease, Henri Mondor Hospital, Créteil, France
| | | | - France Pirenne
- Etablissement Français du Sang Ile-de-France, Créteil, France
- INSERM U955, Equipe Transfusion et Maladies du Globule Rouge, Université Paris-Est Creteil, Institut Mondor de Recherche Biomédicale, Créteil, France
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Reggiani G, Boaro MP, Colombatti R. Prevention of neurovascular complications in children with Sickle Cell Disease in the real-world setting: What adult medicine physicians should know. Presse Med 2023; 52:104201. [PMID: 37939876 DOI: 10.1016/j.lpm.2023.104201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/05/2023] [Indexed: 11/10/2023] Open
Abstract
Neurovascular complications represent one of the most detrimental manifestations of Sickle Cell Disease (SCD), affecting many patients since infancy. They include overt stroke, silent cerebral infarcts and neurocognitive disorders. In fact, neurodevelopment can be impaired in children resulting in cognitive dysfunction in adults with SCD. This review is meant to resume the most recent guidelines about the prevention of SCD neurovascular complications and to highlight the open challenges in their implementation. Transcranial Doppler, Magnetic Resonance Imaging/Angiography and neurocognitive test are useful screening tools. Chronic transfusion regimen, hematopoietic stem cell transplantation and neurocognitive rehabilitation find indications in the context of primary and secondary prevention of neurovascular complications of SCD. However, international guidelines are often difficult to bring into the real world due to the lack of appropriate instruments and trained personnel. Many challenges have still to be faced to guarantee the best possible neurocognitive function to each child affected by SCD.
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Affiliation(s)
- Giulia Reggiani
- Department of Women's and Children's Health, University of Padua, Via Giustiniani, 3, 35128 Padua, Italy.
| | - Maria Paola Boaro
- Department of Women's and Children's Health, University of Padua, Via Giustiniani, 3, 35128 Padua, Italy
| | - Raffaella Colombatti
- Department of Women's and Children's Health, University of Padua, Via Giustiniani, 3, 35128 Padua, Italy
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Jacob SA, Talati R, Kanter J. The evolving treatment landscape for children with sickle cell disease. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:797-808. [PMID: 37858508 DOI: 10.1016/s2352-4642(23)00201-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 10/21/2023]
Abstract
Sickle cell disease is the most common inherited pathological haemoglobinopathy. Over the past 30 years, disease-related morbidity and mortality have improved in high-income countries due to advances in preventive care and treatments. Established disease-modifying therapies, such as hydroxyurea (hydrocarbamide), are continuing to have an important role in the treatment of sickle cell disease, and newer agents also show promise. In the past 5 years, the US Food and Drug Administration approved three additional sickle cell disease-modifying medications, and new gene therapies have been developed as an alternative curative treatment to haematopoietic stem-cell transplantation. In this Review, we discuss the current treatment landscape for paediatric sickle cell disease and emerging innovations in care. We also review the need for close, long-term management for children receiving newer therapies and the importance of ongoing investment in people with sickle cell disease in low-income and middle-income countries.
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Affiliation(s)
- Seethal A Jacob
- Division of Pediatric Hematology Oncology, Riley Hospital for Children, Indianapolis, IN, USA
| | - Ravi Talati
- Division of Pediatric Hematology, Oncology & Blood/Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Julie Kanter
- Lifespan Comprehensive Sickle Cell Center, University of Alabama, Birmingham, AL, USA.
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4
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d'Humières T, Saba J, Savale L, Dupuy M, Boyer L, Guillet H, Alassaad L, de Luna G, Iles S, Pham Hung d'Alexandry d'Orengiani AL, Zaouali Y, Boukour N, Pelinski Y, Messonnier L, Audureau E, Derbel H, Habibi A, Lellouche N, Derumeaux G, Bartolucci P. Determinants of ventricular arrhythmias in sickle cell anemia: toward better prevention of sudden cardiac death. Blood 2023; 142:409-420. [PMID: 37216685 DOI: 10.1182/blood.2022019571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/24/2023] Open
Abstract
Sudden death is 1 of the leading causes of death in adults with sickle cell anemia (SCA) but its etiology remains mostly unknown. Ventricular arrhythmia (VA) carries an increased risk of sudden death; however, its prevalence and determinants in SCA are poorly studied. This study aimed to identify the prevalence and predictors of VA in patients with SCA. From 2019 to 2022, 100 patients with SCA were referred to the physiology department to specifically analyze cardiac function and prospectively included in the DREPACOEUR registry. They underwent a 24-hour electrocardiogram monitoring (24h-Holter), transthoracic echocardiography, and laboratory tests on the same day. The primary end point was the occurrence of VA, defined as sustained or nonsustained ventricular tachycardia (VT), >500 premature ventricular contractions (PVCs) on 24h-Holter, or a recent history of VT ablation. The mean patient age was 46 ± 13 years, and 48% of the patients were male. Overall, VA was observed in 22 (22%) patients. Male sex (81% vs 34%; P = .02), impaired global longitudinal strain (GLS): -16% ± 1.9% vs -18.3% ± 2.7%; P = .02), and decreased platelet count (226 ± 96 giga per liter [G/L] vs 316 ± 130 G/L) were independently associated with VA. GLS correlated with PVC load every 24 hours (r = 0.39; P < .001) and a cutoff of -17.5% could predict VA with a sensitivity of 82% and a specificity of 63%. VAs are common in patients with SCA, especially in men. This pilot study uncovered GLS as a valuable parameter for improving rhythmic risk stratification.
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MESH Headings
- Adult
- Humans
- Male
- Middle Aged
- Female
- Pilot Projects
- Arrhythmias, Cardiac/etiology
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/etiology
- Anemia, Sickle Cell/complications
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Affiliation(s)
- Thomas d'Humières
- Department of Physiology, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, INSERM IMRB U955, Université Paris Est, Créteil, France
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Joseph Saba
- Department of Physiology, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, INSERM IMRB U955, Université Paris Est, Créteil, France
| | - Laurent Savale
- Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 Pulmonary Hypertension, Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Marie Dupuy
- Department of Physiology, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, INSERM IMRB U955, Université Paris Est, Créteil, France
| | - Laurent Boyer
- Department of Physiology, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, INSERM IMRB U955, Université Paris Est, Créteil, France
| | - Henri Guillet
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
- Department of Internal Medicine, Henri-Mondor University Hospital-UPEC, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Lara Alassaad
- Department of Physiology, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, INSERM IMRB U955, Université Paris Est, Créteil, France
| | - Gonzalo de Luna
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
- Department of Internal Medicine, Henri-Mondor University Hospital-UPEC, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Sihem Iles
- Department of Physiology, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, INSERM IMRB U955, Université Paris Est, Créteil, France
| | - Anne L Pham Hung d'Alexandry d'Orengiani
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Yosr Zaouali
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Nouhaila Boukour
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Yanis Pelinski
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Laurent Messonnier
- Inter-university Laboratory of Human Movement Sciences EA 7424, Université Savoie Mont Blanc, Chambéry, France
| | - Etienne Audureau
- Department of Biostatistics, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, CEpiA IMRB U955, FHU SENEC, Université Paris Est, Créteil, France
| | - Haytham Derbel
- Department of Radiology, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Est, Créteil, France
| | - Anoosha Habibi
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
- Department of Internal Medicine, Henri-Mondor University Hospital-UPEC, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Nicolas Lellouche
- Department of Cardiology, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Est, Créteil, France
| | - Geneviève Derumeaux
- Department of Physiology, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, INSERM IMRB U955, Université Paris Est, Créteil, France
| | - Pablo Bartolucci
- Sickle Cell Referral Center - UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, Université Paris Est, FHU SENEC, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
- Department of Internal Medicine, Henri-Mondor University Hospital-UPEC, Assistance Publique-Hôpitaux de Paris, Créteil, France
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Martino S, Turki RC, Zouiti F, Fort R, Pakdaman S, Forté S, Menouche D, Calvet D, Rupp T, Pirenne F, Bartolucci P. Near-Infrared Spectroscopy Demonstrates the Benefit of Erythracytapheresis in Sickle Cell Disease Adult Patients with Cerebral Vasculopathy. J Clin Med 2023; 12:jcm12041256. [PMID: 36835792 PMCID: PMC9966188 DOI: 10.3390/jcm12041256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Cerebral vasculopathy can induce chronic cerebral hypoperfusion leading to stroke in patients with sickle cell disease (SCD) and is treated by blood exchange transfusion (BET). However, no prospective clinical study has demonstrated the benefit of BET in adults with SCD and cerebral vasculopathy. Near Infrared Spectroscopy (NIRS) is a recent non-invasive method complementary to Magnetic Resonance Imaging (MRI). We evaluated cerebral perfusion using NIRS during erythracytapheresis in patients with SCD with and without steno-occlusive arterial disease. METHODS We conducted a monocentric, prospective study in 16 adults with SCD undergoing erythracytapheresis in 2014. Among them, 10 had cerebral steno-occlusive arterial disease. NIRS measured the relative amounts of oxyhemoglobin (OxyHb), deoxyhemoglobin (DeoxyHb) and total hemoglobin (Total Hb) in brain tissue and in muscle. RESULTS In cerebral hemispheres associated with steno-occlusive arterial disease, we observed a significant increase of OxyHb and Total Hb during BET, without modification of DeoxyHb. CONCLUSION Using NIRS during BET showed that BET improves cerebral perfusion in adult patients with SCD with cerebral vasculopathy.
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Affiliation(s)
- Suella Martino
- Sickle Cell Referral Center, Department of Internal Medicine, Henri Mondor University Hospital, UPEC, APHP, 94000 Creteil, France
| | - Rym Chouk Turki
- Etablissement Français du Sang, Île-de-France Mondor, 94000 Creteil, France
| | - Fouzia Zouiti
- Etablissement Français du Sang, Île-de-France Mondor, 94000 Creteil, France
| | - Romain Fort
- Department of Internal Medicine, Edouard Herriot University Hospital, 69003 Lyon, France
| | - Sadaf Pakdaman
- Etablissement Français du Sang, Île-de-France Mondor, 94000 Creteil, France
| | - Stéphanie Forté
- Division of Hematology and Oncology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 3E4, Canada
| | - Dehbia Menouche
- Department of Apheresis, Henri Mondor University Hospital, UPEC, APHP, 94000 Creteil, France
| | - David Calvet
- Department of Neurology, Sainte-Anne Hospital, 75014 Paris, France
| | - Thomas Rupp
- Interuniversity Laboratory of Human Movement Biology, University Savoie Mont Blanc, 73000 Chambery, France
| | - France Pirenne
- Etablissement Français du Sang, Île-de-France Mondor, 94000 Creteil, France
- Laboratoire D’Excellence, GRex, Institut Mondor, INSERM U955 Equipe 2, 94000 Creteil, France
| | - Pablo Bartolucci
- Sickle Cell Referral Center, Department of Internal Medicine, Henri Mondor University Hospital, UPEC, APHP, 94000 Creteil, France
- Laboratoire D’Excellence, GRex, Institut Mondor, INSERM U955 Equipe 2, 94000 Creteil, France
- Correspondence:
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6
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Chronic Pain. Hematol Oncol Clin North Am 2022; 36:1151-1165. [DOI: 10.1016/j.hoc.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Miller R, Klyde DM, Unda SR, Fluss R, Altschul DJ. Classical Risk Factors for Ischemic Stroke are not Associated with Inpatient Post-Stroke Mortality in Sickle Cell Disease. J Stroke Cerebrovasc Dis 2021; 30:106089. [PMID: 34551382 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/22/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES Sickle cell disease is a common haemoglobinopathy that significantly increases the risk of ischemic stroke. Because the risk factors for ischemic stroke onset and mortality in non-sickle cell disease patients have been largely elucidated, this paper aims to analyze risk factors for ischemic stroke mortality in sickle cell disease patients, which remain largely unknown. MATERIALS/METHODS The National Inpatient Sample database (2016-2017) was used to develop a multivariable regression model for risk quantification of known ischemic stroke risk factors for in-hospital mortality in ischemic stroke patients with and without sickle cell disease. RESULTS Classical risk factors for ischemic stroke onset, including ischemic heart disease, carotid artery disease, lipidemias, hypertension, obesity, tobacco use, atrial fibrillation, personal or family history of stroke, congenital heart defects, congestive heart failure, cardiac valve disorder, peripheral vascular disease, and diabetes mellitus are associated with in-hospital mortality in non-sickle cell patients (p < 0.05). However, no significant association was found between these stroke risk factors and in-hospital mortality in sickle cell disease patients presenting with ischemic stroke (p > 0.05). CONCLUSIONS While the classical risk factors for stroke onset are associated with in-hospital mortality in non-sickle cell stroke patients, they are not associated with in-hospital mortality in sickle cell stroke patients.
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Affiliation(s)
- Raphael Miller
- Albert Einstein College of Medicine, Bronx, NY 10461***, USA
| | - Daniel M Klyde
- Albert Einstein College of Medicine, Bronx, NY 10461***, USA.
| | | | - Rose Fluss
- Montefiore Medical Center, Bronx, NY 10467, USA
| | - David J Altschul
- Leo M. Davidoff Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Ave., Bronx, NY 10467, USA
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8
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Edjlali M, Gobin‐Metteil M, Mélé N, Maïer B, Habibi A, Kauv P, Hosseini H, Mas J, Oppenheim C, Galactéros F, Bartolucci P, Calvet D. Transcranial color-coded duplex sonography reliably identifies intracranial vasculopathy in adult patients with sickle cell disease. Am J Hematol 2021; 96:961-967. [PMID: 33971039 DOI: 10.1002/ajh.26215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/28/2021] [Accepted: 05/01/2021] [Indexed: 11/08/2022]
Abstract
In order to prevent stroke, screening for disease-related intracranial vasculopathy using Doppler ultrasound is recommended in sickle-cell disease (SCD) children. How to screen such vasculopathy in adults remains largely unknown. The objective of this study was to assess whether transcranial color-coded duplex sonography (TCCD) is sensitive and specific enough to identify SCD adult patients with vasculopathy, compared with magnetic resonance angiography (MRA). Sickle cell disease adults followed in referral centers at high risk of vasculopathy were included in this study. Transcranial color-coded duplex sonography examination and 3-D time-of-flight MRA were performed on the same day. On MRA, vasculopathy was defined by the presence of at least one ≥50% arterial stenosis. On TCCD, vasculopathy was defined by a time-averaged mean of the maximum velocity (TAMx) stenotic/prestenotic ratio ≥ 3, an occlusion, or a Moyamoya pattern. Vasculopathy was also considered as present when TAMx ratio could not be calculated because of the presence of severe cervical lesions. Among 80 included patients, quality of MRA was insufficient in three patients. Among the 38 patients with vasculopathy on MRA, 37 had a vasculopathy according to TCCD criteria: TAMx ratio ≥ 3 or intracranial occlusion in 33 patients and cervical lesion in four patients. A Moyamoya pattern was identified with TCCD in all 17 patients with Moyamoya on MRA. Sensitivity and specificity of TCCD to identify patients with ≥50% vasculopathy on MRA were (n = 37/38) 97% and (n = 28/34) 82%, respectively. Positive and negative predictive values were (n = 37/43) 86% and (n = 28/29) 97%, respectively. Note, TCCD may be used to identify SCD adult patients with vasculopathy.
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Affiliation(s)
- Myriam Edjlali
- Service d'Imagerie, GHU Paris Psychiatrie et Neurosciences (Sainte‐Anne) Université de Paris Paris France
- INSERM 1266 Institut de Psychiatrie et Neurosciences de Paris ‐ FHU Neurovasc—Paris Sorbonne Paris France
| | - Marie‐Pierre Gobin‐Metteil
- Service d'Imagerie, GHU Paris Psychiatrie et Neurosciences (Sainte‐Anne) Université de Paris Paris France
- INSERM 1266 Institut de Psychiatrie et Neurosciences de Paris ‐ FHU Neurovasc—Paris Sorbonne Paris France
| | - Nicolas Mélé
- INSERM 1266 Institut de Psychiatrie et Neurosciences de Paris ‐ FHU Neurovasc—Paris Sorbonne Paris France
- Service de Neurologie et Unité Neurovasculaire, GHU Paris Psychiatrie et Neurosciences (Sainte‐Anne) Université de Paris Paris France
| | - Benjamin Maïer
- INSERM 1266 Institut de Psychiatrie et Neurosciences de Paris ‐ FHU Neurovasc—Paris Sorbonne Paris France
- Service de Neurologie et Unité Neurovasculaire, GHU Paris Psychiatrie et Neurosciences (Sainte‐Anne) Université de Paris Paris France
| | - Anoosha Habibi
- Sickle Cell Referral Center, Médecine Interne, Hôpital Henri‐Mondor, UPEC Créteil France
- INSERM U955, team 2, Laboratoire d'Excellence GRex Créteil France
| | - Paul Kauv
- Department of Imaging Henri‐Mondor Hospital, UPEC, Assistance Publique‐Hopitaux de Paris, Creteil Créteil France
| | - Hassan Hosseini
- Department of Neurology Henri‐Mondor Hospital, UPEC, Assistance Publique‐Hopitaux de Paris, Creteil Créteil France
| | - Jean‐Louis Mas
- INSERM 1266 Institut de Psychiatrie et Neurosciences de Paris ‐ FHU Neurovasc—Paris Sorbonne Paris France
- Service de Neurologie et Unité Neurovasculaire, GHU Paris Psychiatrie et Neurosciences (Sainte‐Anne) Université de Paris Paris France
| | - Catherine Oppenheim
- Service d'Imagerie, GHU Paris Psychiatrie et Neurosciences (Sainte‐Anne) Université de Paris Paris France
- INSERM 1266 Institut de Psychiatrie et Neurosciences de Paris ‐ FHU Neurovasc—Paris Sorbonne Paris France
| | - Frédéric Galactéros
- Sickle Cell Referral Center, Médecine Interne, Hôpital Henri‐Mondor, UPEC Créteil France
- INSERM U955, team 2, Laboratoire d'Excellence GRex Créteil France
| | - Pablo Bartolucci
- Sickle Cell Referral Center, Médecine Interne, Hôpital Henri‐Mondor, UPEC Créteil France
- INSERM U955, team 2, Laboratoire d'Excellence GRex Créteil France
| | - David Calvet
- INSERM 1266 Institut de Psychiatrie et Neurosciences de Paris ‐ FHU Neurovasc—Paris Sorbonne Paris France
- Service de Neurologie et Unité Neurovasculaire, GHU Paris Psychiatrie et Neurosciences (Sainte‐Anne) Université de Paris Paris France
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9
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Robertson RL, Palasis S, Rivkin MJ, Pruthi S, Bartel TB, Desai NK, Kadom N, Kulkarni AV, Lam HFS, Maheshwari M, Milla SS, Mirsky DM, Myseros JS, Partap S, Radhakrishnan R, Soares BP, Trout AT, Udayasankar UK, Whitehead MT, Karmazyn B. ACR Appropriateness Criteria® Cerebrovascular Disease-Child. J Am Coll Radiol 2020; 17:S36-S54. [PMID: 32370977 DOI: 10.1016/j.jacr.2020.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 10/24/2022]
Abstract
Stroke is an uncommon but an important and under-recognized cause of morbidity and mortality in children. Strokes may be due to either brain ischemia or intracranial hemorrhage. Common symptoms of pediatric acute stroke include headache, vomiting, focal weakness, numbness, visual disturbance, seizures, and altered consciousness. Most children presenting with an acute neurologic deficit do not have an acute stroke, but have symptoms due to stroke mimics which include complicated migraine, seizures with postictal paralysis, and Bell palsy. Because of frequency of stroke mimics, in children and the common lack of specificity in symptoms, the diagnosis of a true stroke may be delayed. There are a relatively large number of potential causes of stroke mimic and true stroke. Consequently, imaging plays a critical role in the assessment of children with possible stroke and especially in children who present with acute onset of stroke symptoms. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Susan Palasis
- Panel Chair, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Michael J Rivkin
- Boston Children's Hospital, Boston, Massachusetts; American Academy of Neurology
| | - Sumit Pruthi
- Panel Vice Chair, Vanderbilt Children's Hospital, Nashville, Tennessee
| | | | | | - Nadja Kadom
- Emory University and Children's of Atlanta (Egleston), Atlanta, Georgia
| | - Abhaya V Kulkarni
- Hospital for Sick Children, Toronto, Ontario, Canada; Neurosurgery expert
| | - H F Samuel Lam
- Sutter Medical Center, Sacramento, California; American College of Emergency Physicians
| | | | - Sarah S Milla
- Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | - John S Myseros
- Children's National Health System, Washington, District of Columbia; Neurosurgery expert
| | - Sonia Partap
- Stanford University, Stanford, California; American Academy of Pediatrics
| | | | - Bruno P Soares
- The University of Vermont Medical Center, Burlington, Vermont
| | - Andrew T Trout
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Boaz Karmazyn
- Specialty Chair, Riley Hospital for Children Indiana University, Indianapolis, Indiana
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10
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Song H, Keegan PM, Anbazhakan S, Rivera CP, Feng Y, Omojola VO, Clark AA, Cai S, Selma J, Gleason RL, Botchwey EA, Huo Y, Tan W, Platt MO. Sickle Cell Anemia Mediates Carotid Artery Expansive Remodeling That Can Be Prevented by Inhibition of JNK (c-Jun N-Terminal Kinase). Arterioscler Thromb Vasc Biol 2020; 40:1220-1230. [PMID: 32160775 DOI: 10.1161/atvbaha.120.314045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Sickle cell anemia (SCA) causes chronic inflammation and multiorgan damage. Less understood are the arterial complications, most evident by increased strokes among children. Proteolytic mechanisms, biomechanical consequences, and pharmaceutical inhibitory strategies were studied in a mouse model to provide a platform for mechanistic and intervention studies of large artery damage due to sickle cell disease. Approach and Results: Townes humanized transgenic mouse model of SCA was used to test the hypothesis that elastic lamina and structural damage in carotid arteries increased with age and was accelerated in mice homozygous for SCA (sickle cell anemia homozygous genotype [SS]) due to inflammatory signaling pathways activating proteolytic enzymes. Elastic lamina fragmentation observed by 1 month in SS mice compared with heterozygous littermate controls (sickle cell trait heterozygous genotype [AS]). Positive immunostaining for cathepsin K, a powerful collagenase and elastase, confirmed accelerated proteolytic activity in SS carotids. Larger cross-sectional areas were quantified by magnetic resonance angiography and increased arterial compliance in SS carotids were also measured. Inhibiting JNK (c-jun N-terminal kinase) signaling with SP600125 significantly reduced cathepsin K expression, elastin fragmentation, and carotid artery perimeters in SS mice. By 5 months of age, continued medial thinning and collagen degradation was mitigated by treatment of SS mice with JNK inhibitor. CONCLUSIONS Arterial remodeling due to SCA is mediated by JNK signaling, cathepsin proteolytic upregulation, and degradation of elastin and collagen. Demonstration in Townes mice establishes their utility for mechanistic studies of arterial vasculopathy, related complications, and therapeutic interventions for large artery damage due to SCA.
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Affiliation(s)
- Hannah Song
- From the Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta (H.S., P.M.K., S.A., C.P.R., V.O.O., A.A.C., S.C., J.S., R.L.G., E.A.B., M.O.P.)
| | - Philip M Keegan
- From the Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta (H.S., P.M.K., S.A., C.P.R., V.O.O., A.A.C., S.C., J.S., R.L.G., E.A.B., M.O.P.)
| | - Suhaas Anbazhakan
- From the Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta (H.S., P.M.K., S.A., C.P.R., V.O.O., A.A.C., S.C., J.S., R.L.G., E.A.B., M.O.P.)
| | - Christian P Rivera
- From the Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta (H.S., P.M.K., S.A., C.P.R., V.O.O., A.A.C., S.C., J.S., R.L.G., E.A.B., M.O.P.).,Department of Mechanics and Engineering Science at Peking University, Beijing, China (C.P.R., Y.F., Y.H., W.T.)
| | - Yundi Feng
- Department of Mechanics and Engineering Science at Peking University, Beijing, China (C.P.R., Y.F., Y.H., W.T.)
| | - Victor O Omojola
- From the Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta (H.S., P.M.K., S.A., C.P.R., V.O.O., A.A.C., S.C., J.S., R.L.G., E.A.B., M.O.P.)
| | - Alexus A Clark
- From the Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta (H.S., P.M.K., S.A., C.P.R., V.O.O., A.A.C., S.C., J.S., R.L.G., E.A.B., M.O.P.)
| | - Shuangyi Cai
- From the Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta (H.S., P.M.K., S.A., C.P.R., V.O.O., A.A.C., S.C., J.S., R.L.G., E.A.B., M.O.P.)
| | - Jada Selma
- From the Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta (H.S., P.M.K., S.A., C.P.R., V.O.O., A.A.C., S.C., J.S., R.L.G., E.A.B., M.O.P.)
| | - Rudolph L Gleason
- From the Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta (H.S., P.M.K., S.A., C.P.R., V.O.O., A.A.C., S.C., J.S., R.L.G., E.A.B., M.O.P.).,Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta (R.L.G., E.A.B., M.O.P.)
| | - Edward A Botchwey
- From the Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta (H.S., P.M.K., S.A., C.P.R., V.O.O., A.A.C., S.C., J.S., R.L.G., E.A.B., M.O.P.).,Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta (R.L.G., E.A.B., M.O.P.)
| | - Yunlong Huo
- Department of Mechanics and Engineering Science at Peking University, Beijing, China (C.P.R., Y.F., Y.H., W.T.)
| | - Wenchang Tan
- Department of Mechanics and Engineering Science at Peking University, Beijing, China (C.P.R., Y.F., Y.H., W.T.)
| | - Manu O Platt
- From the Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta (H.S., P.M.K., S.A., C.P.R., V.O.O., A.A.C., S.C., J.S., R.L.G., E.A.B., M.O.P.).,Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta (R.L.G., E.A.B., M.O.P.)
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11
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Schlemmer F, Gellen-Dautremer J, Carette MF, de Prost N, Spagnolo S, Deux JF, Fartoukh M, Naccache JM, Habibi A, Mahevas M, Bartolucci P, Mekontso Dessap A, Maitre B. Systemo-pulmonary shunting and acute chest syndrome in a patient with SC sickle-cell disease. Respir Med Res 2020; 77:21-23. [PMID: 32036282 DOI: 10.1016/j.resmer.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/10/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
Affiliation(s)
- F Schlemmer
- Pneumology, DHU A-TVB, CHU Henri Mondor, Assistance publique-hôpitaux de Paris, 51, avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France; Université Paris Est Créteil, 94010 Créteil, France.
| | - J Gellen-Dautremer
- Unité des maladies génétiques du globule rouge, Sickle cell center, CHU Henri Mondor, Assistance publique-hôpitaux de Paris, 51, avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - M F Carette
- Radiology, hôpital Tenon, Assistance publique-hôpitaux de Paris, 4, rue de la Chine, 75970 Paris, France; Université Pierre et Marie Curie Paris, 75252 Paris, France
| | - N de Prost
- Université Paris Est Créteil, 94010 Créteil, France; Intensive Care Unit, DHU A-TVB, CHU Henri Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - S Spagnolo
- Intensive Care Unit, DHU A-TVB, CHU Henri Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - J F Deux
- Université Paris Est Créteil, 94010 Créteil, France; Radiology, CHU Henri Mondor, Assistance publique-hôpitaux de Paris, 4, rue de la Chine, 75970 Paris, France
| | - M Fartoukh
- Intensive Care Unit, hôpital Tenon, Assistance publique-hôpitaux de Paris, 4, rue de la Chine, 75970 Paris, France; Université Pierre et Marie Curie Paris, 75252 Paris, France
| | - J M Naccache
- Université Pierre et Marie Curie Paris, 75252 Paris, France; Pneumology, hôpital Tenon, Assistance publique-hôpitaux de Paris, 4, rue de la Chine, 75970 Paris, France
| | - A Habibi
- Unité des maladies génétiques du globule rouge, Sickle cell center, CHU Henri Mondor, Assistance publique-hôpitaux de Paris, 51, avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - M Mahevas
- Université Paris Est Créteil, 94010 Créteil, France; Centre de référence des cytopénies auto-immunes de l'adulte, CHU Henri Mondor, Assistance publique-hôpitaux de Paris, 51, avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - P Bartolucci
- Université Paris Est Créteil, 94010 Créteil, France; Unité des maladies génétiques du globule rouge, Sickle cell center, CHU Henri Mondor, Assistance publique-hôpitaux de Paris, 51, avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - A Mekontso Dessap
- Université Paris Est Créteil, 94010 Créteil, France; Intensive Care Unit, DHU A-TVB, CHU Henri Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - B Maitre
- Pneumology, DHU A-TVB, CHU Henri Mondor, Assistance publique-hôpitaux de Paris, 51, avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France; Université Paris Est Créteil, 94010 Créteil, France
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12
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Spontaneous Epidural Hemorrhage in Sickle Cell Disease, Are They All the Same? A Case Report and Comprehensive Review of the Literature. Case Rep Hematol 2019; 2019:8974580. [PMID: 31346480 PMCID: PMC6617879 DOI: 10.1155/2019/8974580] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/30/2019] [Indexed: 11/18/2022] Open
Abstract
Trauma to the skull causing injury to the middle meningeal artery, middle meningeal vein, or dural venous sinuses is responsible for most cases of epidural hemorrhage (EDH). Spontaneous EDH is a rare entity in clinical practice. Common causes include sinusitis, coagulation abnormalities, dural metastasis, and Langerhans cell histiocytosis. Isolated nontraumatic EDH is an exceedingly rare complication of sickle cell disease (SCD). We report a case of spontaneous EDH in a patient with SCD and review the world literature regarding this rare entity. A 20-year-old African American female with sickle cell disease presented with vaso-occlusive crisis. About 24 hours after hospital admission, the patient had sudden deterioration of her mental status. An emergent CT scan of the head revealed a large right-sided frontoparietal epidural hematoma with midline shift, subfalcine, and uncal herniation. The patient underwent emergent hematoma evacuation but died 24 hours after surgery.
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13
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The Genetic Landscape of Cerebral Steno-Occlusive Arteriopathy and Stroke in Sickle Cell Anemia. J Stroke Cerebrovasc Dis 2018; 27:2897-2904. [PMID: 30076115 DOI: 10.1016/j.jstrokecerebrovasdis.2018.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/28/2018] [Accepted: 06/02/2018] [Indexed: 11/24/2022] Open
Abstract
Sickle cell disease (SCD) is one of the most common autosomal recessive diseases in humans, occurring at a frequency of 1 in 365 African-American and 1 in 50 sub-Saharan African births. Despite progress in managing complications of SCD, these remain a major health burden worldwide. Stroke is a common and serious complication of SCD, most often associated with steno-occlusive cerebral arteriopathy, but little is known about its pathogenesis. Transcranial Doppler ultrasonography is currently the only predictive test for future development of stroke in patients with sickle cell anemia and is used to guide preventative treatment. However, transcranial Doppler ultrasonography does not identify all patients at increased risk for stroke, and progressive arteriopathy may occur despite preventative treatment. While sibling studies have shown a strong genetic contribution to the development of steno-occlusive arteriopathy (SOA) in SCD, the only genome-wide association study compared a relatively small cohort of 177 patients with stroke to 335 patients with no history of stroke. This single study detected variants in only 2 genes, ENPP1 and GOLGB1, and only one of these was confirmed in a subsequent independent study. Thus, the underlying genes and pathogenesis of SOA in SCD remain poorly understood, greatly limiting the ability to develop more effective preventive therapies. Dissecting the molecular causes of stroke in SCD will provide valuable information that can be used to better prevent stroke, stratify risk of SOA, and optimize personalized medicine approaches.
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14
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Dattani A, Jackson A. The cause of the stroke: a diagnostic uncertainty. BMJ Case Rep 2017. [PMID: 28645902 DOI: 10.1136/bcr-2016-218358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 39-year-old man with a history of sickle cell disease (SCD) presented with left leg weakness. He had a normal CT head and CT angiogram, but MRI head showed multiple acute bilateral cortical infarcts including in the right precentral gyrus. The MRI findings were more in keeping with an embolic source rather than stroke related to SCD, although it could not be ruled out. He also had an echocardiogram which revealed a patent foramen ovale. He was treated with antiplatelet therapy and also had red blood cell exchange transfusion. His symptoms improved significantly and he was discharged with follow-up as an outpatient and a cardiology review.
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Affiliation(s)
| | - Ava Jackson
- Stroke and Geriatric Medicine, Barts Health NHS Trust, London, UK
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15
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Adams-Graves P, Bronte-Jordan L. Recent treatment guidelines for managing adult patients with sickle cell disease: challenges in access to care, social issues, and adherence. Expert Rev Hematol 2016; 9:541-52. [DOI: 10.1080/17474086.2016.1180242] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Central nervous system complications and management in sickle cell disease. Blood 2016; 127:829-38. [DOI: 10.1182/blood-2015-09-618579] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/25/2015] [Indexed: 02/07/2023] Open
Abstract
Abstract
With advances in brain imaging and completion of randomized clinical trials (RCTs) for primary and secondary stroke prevention, the natural history of central nervous system (CNS) complications in sickle cell disease (SCD) is evolving. In order of current prevalence, the primary CNS complications include silent cerebral infarcts (39% by 18 years), headache (both acute and chronic: 36% in children with sickle cell anemia [SCA]), ischemic stroke (as low as 1% in children with SCA with effective screening and prophylaxis, but ∼11% in children with SCA without screening), and hemorrhagic stroke in children and adults with SCA (3% and 10%, respectively). In high-income countries, RCTs (Stroke Prevention in Sickle Cell Anemia [STOP], STOP II) have demonstrated that regular blood transfusion therapy (typically monthly) achieves primary stroke prevention in children with SCA and high transcranial Doppler (TCD) velocities; after at least a year, hydroxycarbamide may be substituted (TCD With Transfusions Changing to Hydroxyurea [TWiTCH]). Also in high-income countries, RCTs have demonstrated that regular blood transfusion is the optimal current therapy for secondary prevention of infarcts for children with SCA and strokes (Stroke With Transfusions Changing to Hydroxyurea [SWiTCH]) or silent cerebral infarcts (Silent Infarct Transfusion [SIT] Trial). For adults with SCD, CNS complications continue to be a major cause of morbidity and mortality, with no evidence-based strategy for prevention.
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17
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Qureshi AI, Malik AA, Adil MM, Suri MFK. Oral contraceptive use and incident stroke in women with sickle cell disease. Thromb Res 2015; 136:315-8. [DOI: 10.1016/j.thromres.2015.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 03/31/2015] [Accepted: 04/07/2015] [Indexed: 01/09/2023]
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18
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Calvet D, Bernaudin F, Gueguen A, Hosseini H, Habibi A, Galactéros F, Bartolucci P. First Ischemic Stroke in Sickle-Cell Disease: Are There Any Adult Specificities? Stroke 2015; 46:2315-7. [PMID: 26173728 DOI: 10.1161/strokeaha.115.010153] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 06/12/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE There is little evidence about characteristics of ischemic stroke (IS) occurring in adults with sickle-cell disease (SCD). The objective of this study was to assess characteristics of first-ever IS in adults with SCD and to assess whether they differ from those occurring in child patients with SCD. METHODS Adult and child individuals with SCD who had a first-ever IS were identified from cohorts of patients followed up in an adult and a child sickle cell referral center. Mechanisms of IS were determined by consensus meeting from all available explorations using the following predefined classification: Vasculopathy, cardioembolism, other defined cause, and undetermined. Treatment and stroke recurrences were recorded from prospective follow-up performed in the referral centers. RESULTS Twenty-nine adults and 26 children had a first-ever IS; mean age (SD) was 7.1 (4.3) and 32.3 (11.6), respectively. With regard to IS mechanism, vasculopathy was less often the cause of IS in adults (12/29, 41%) than in children (24/26, 92%; P<0.001). Other causes of IS in adults were cardioembolism in 7, antiphospholipid syndrome in 1, toxic (cocaine) in 1, and undetermined in 8. Adults with SCD had a higher risk of recurrent stroke (23.1% [7.0-39.2] at 5 years) compared with children (1 recurrence only; P log rank=0.046) despite exchange-blood transfusion in patients with vasculopathy. CONCLUSIONS First-ever IS occurring in adults with SCD has specificities that justify further studies conducted in adults with SCD to improve understanding and management.
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Affiliation(s)
- David Calvet
- From the Department of Neurology Hôpital Sainte-Anne, Université Paris-Descartes, INSERM 894, DHU Neurovasc-Paris Sorbonne, Paris, France (D.C.); Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Créteil, France (F.B.); Fondation Ophtalmologique A. de Rothschild, Paris, France (A.G.); Service de Neurologie, Hôpital Henri-Mondor, UPEC, Créteil, France (H.H.); Department of Neurology Sickle cell referral center, médecine interne, Hôpital Henri-Mondor, UPEC, Créteil, France (A.H, F.G., P.B.); and INSERM U955, team 2, Laboratoire d'Excellence Grex, Créteil, France (A.H, F.G., P.B.)
| | - Françoise Bernaudin
- From the Department of Neurology Hôpital Sainte-Anne, Université Paris-Descartes, INSERM 894, DHU Neurovasc-Paris Sorbonne, Paris, France (D.C.); Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Créteil, France (F.B.); Fondation Ophtalmologique A. de Rothschild, Paris, France (A.G.); Service de Neurologie, Hôpital Henri-Mondor, UPEC, Créteil, France (H.H.); Department of Neurology Sickle cell referral center, médecine interne, Hôpital Henri-Mondor, UPEC, Créteil, France (A.H, F.G., P.B.); and INSERM U955, team 2, Laboratoire d'Excellence Grex, Créteil, France (A.H, F.G., P.B.)
| | - Antoine Gueguen
- From the Department of Neurology Hôpital Sainte-Anne, Université Paris-Descartes, INSERM 894, DHU Neurovasc-Paris Sorbonne, Paris, France (D.C.); Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Créteil, France (F.B.); Fondation Ophtalmologique A. de Rothschild, Paris, France (A.G.); Service de Neurologie, Hôpital Henri-Mondor, UPEC, Créteil, France (H.H.); Department of Neurology Sickle cell referral center, médecine interne, Hôpital Henri-Mondor, UPEC, Créteil, France (A.H, F.G., P.B.); and INSERM U955, team 2, Laboratoire d'Excellence Grex, Créteil, France (A.H, F.G., P.B.)
| | - Hassan Hosseini
- From the Department of Neurology Hôpital Sainte-Anne, Université Paris-Descartes, INSERM 894, DHU Neurovasc-Paris Sorbonne, Paris, France (D.C.); Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Créteil, France (F.B.); Fondation Ophtalmologique A. de Rothschild, Paris, France (A.G.); Service de Neurologie, Hôpital Henri-Mondor, UPEC, Créteil, France (H.H.); Department of Neurology Sickle cell referral center, médecine interne, Hôpital Henri-Mondor, UPEC, Créteil, France (A.H, F.G., P.B.); and INSERM U955, team 2, Laboratoire d'Excellence Grex, Créteil, France (A.H, F.G., P.B.)
| | - Anoosha Habibi
- From the Department of Neurology Hôpital Sainte-Anne, Université Paris-Descartes, INSERM 894, DHU Neurovasc-Paris Sorbonne, Paris, France (D.C.); Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Créteil, France (F.B.); Fondation Ophtalmologique A. de Rothschild, Paris, France (A.G.); Service de Neurologie, Hôpital Henri-Mondor, UPEC, Créteil, France (H.H.); Department of Neurology Sickle cell referral center, médecine interne, Hôpital Henri-Mondor, UPEC, Créteil, France (A.H, F.G., P.B.); and INSERM U955, team 2, Laboratoire d'Excellence Grex, Créteil, France (A.H, F.G., P.B.)
| | - Frédéric Galactéros
- From the Department of Neurology Hôpital Sainte-Anne, Université Paris-Descartes, INSERM 894, DHU Neurovasc-Paris Sorbonne, Paris, France (D.C.); Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Créteil, France (F.B.); Fondation Ophtalmologique A. de Rothschild, Paris, France (A.G.); Service de Neurologie, Hôpital Henri-Mondor, UPEC, Créteil, France (H.H.); Department of Neurology Sickle cell referral center, médecine interne, Hôpital Henri-Mondor, UPEC, Créteil, France (A.H, F.G., P.B.); and INSERM U955, team 2, Laboratoire d'Excellence Grex, Créteil, France (A.H, F.G., P.B.)
| | - Pablo Bartolucci
- From the Department of Neurology Hôpital Sainte-Anne, Université Paris-Descartes, INSERM 894, DHU Neurovasc-Paris Sorbonne, Paris, France (D.C.); Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Créteil, France (F.B.); Fondation Ophtalmologique A. de Rothschild, Paris, France (A.G.); Service de Neurologie, Hôpital Henri-Mondor, UPEC, Créteil, France (H.H.); Department of Neurology Sickle cell referral center, médecine interne, Hôpital Henri-Mondor, UPEC, Créteil, France (A.H, F.G., P.B.); and INSERM U955, team 2, Laboratoire d'Excellence Grex, Créteil, France (A.H, F.G., P.B.).
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19
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How I treat and manage strokes in sickle cell disease. Blood 2015; 125:3401-10. [PMID: 25824688 DOI: 10.1182/blood-2014-09-551564] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 02/26/2015] [Indexed: 12/11/2022] Open
Abstract
Neurologic complications are a major cause of morbidity and mortality in sickle cell disease (SCD). In children with sickle cell anemia, routine use of transcranial Doppler screening, coupled with regular blood transfusion therapy, has decreased the prevalence of overt stroke from ∼11% to 1%. Limited evidence is available to guide acute and chronic management of individuals with SCD and strokes. Current management strategies are based primarily on single arm clinical trials and observational studies, coupled with principles of neurology and hematology. Initial management of a focal neurologic deficit includes evaluation by a multidisciplinary team (a hematologist, neurologist, neuroradiologist, and transfusion medicine specialist); prompt neuro-imaging and an initial blood transfusion (simple followed immediately by an exchange transfusion or only exchange transfusion) is recommended if the hemoglobin is >4 gm/dL and <10 gm/dL. Standard therapy for secondary prevention of strokes and silent cerebral infarcts includes regular blood transfusion therapy and in selected cases, hematopoietic stem cell transplantation. A critical component of the medical care following an infarct is cognitive and physical rehabilitation. We will discuss our strategy of acute and long-term management of strokes in SCD.
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20
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Clinical biomarkers in sickle cell disease. Saudi J Biol Sci 2014; 22:24-31. [PMID: 25561879 PMCID: PMC4281636 DOI: 10.1016/j.sjbs.2014.09.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/10/2014] [Accepted: 09/10/2014] [Indexed: 01/01/2023] Open
Abstract
Sickle cell disease (SCD) is a hereditary blood disorder caused by a single gene. Various blood and urine biomarkers have been identified in SCD which are associated with laboratory and medical history. Biomarkers have been proven helpful in identifying different interconnected disease-causing mechanisms of SCD, including hypercoagulability, hemolysis, inflammation, oxidative stress, vasculopathy, reperfusion injury and reduced vasodilatory responses in endothelium, to name just a few. However, there exists a need to establish a panel of validated blood and urine biomarkers in SCD. This paper reviews the current contribution of biochemical markers associated with clinical manifestation and identification of sub-phenotypes in SCD.
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