Google
Trusted Resources: Evidence & Education
Scientific literature and patient education texts
Increased prevalence of potential right-to-left shunting in children with sickle cell anaemia and stroke
source: British Journal of Haematology
year: 2017
authors: Dowling MM, Quinn CT, Ramaciotti C, Kanter J, Osunkwo I, Inusa B, Iyer R, Kwiatkowski JL, Johnson C, Rhodes M, Owen W, Strouse JJ, Panepinto JA, Neumayr L, Sarnaik S, Plumb PA, Dlamini N, Kirkham F, Hynan LS
summary/abstract:Paradoxical’ embolization via intracardiac or intrapulmonary right-to-left shunts (RLS) is an established cause of stroke. Hypercoagulable states and increased right heart pressure, which both occur in sickle cell anaemia (SCA), predispose to paradoxical embolization. We hypothesized that children with SCA and overt stroke (SCA + stroke) have an increased prevalence of potential RLS. We performed contrasted transthoracic echocardiograms on 147 children (aged 2-19 years) with SCA + stroke) mean age 12·7 ± 4·8 years, 54·4% male) and a control group without SCA or stroke (n = 123; mean age 12·1 ± 4·9 years, 53·3% male). RLS was defined as any potential RLS detected by any method, including intrapulmonary shunting. Echocardiograms were masked and adjudicated centrally. The prevalence of potential RLS was significantly higher in the SCA+stroke group than controls (45·6% vs. 23·6%, P < 0·001). The odds ratio for potential RLS in the SCA + stroke group was 2·7 (95% confidence interval: 1·6-4·6) vs controls. In post hoc analyses, the SCA + stroke group had a higher prevalence of intrapulmonary (23·8% vs. 5·7%, P < 0·001) but not intracardiac shunting (21·8% vs. 18·7%, P = 0·533). SCA patients with potential RLS were more likely to report headache at stroke onset than those without. Intrapulmonary and intracardiac shunting may be an overlooked, independent and potentially modifiable risk factor for stroke in SCA.
organization: UT Southwestern Medical Center, Dallas, USA; Cincinnati Children's Hospital Medical Center; Medical University of South Carolina; The Levine Cancer Institute, Carolinas HealthCare System, USA; Guy's and St. Thomas NHS Trust, London; University of Mississippi Medical Center; University of Pennsylvania Perelman School of Medicine, Philadelphia; Cook Children's Health Care System, Ft. Worth, USA; Children's Hospital of the King's Daughters, Norfolk, USA; The Johns Hopkins University School of Medicine, Baltimore; Medical College of Wisconsin/Children's Hospital of Wisconsin; UCSF Benioff Children's Hospital, Oakland, USA; Wayne State University, Detroit, USA; Evelina Children's Hospital, London; UCL Institute of Child Health, London.DOI: 10.1111/bjh.14391
read more full text
+myBinderRelated Content
-
Sickle Cell Disease – Children’s Hospital of PhiladelphiaSickle cell disease is the name of a gro...
-
Blood transfusions for treating acute chest syndrome in people with sickle cell diseaseBackground: Sickle cell disease is an...
-
Multidisciplinary Care Team Greatly Reduces Risk in Pregnant SCD Patients in Low-income CountriesAccording to a study published in the Am...
-
GBT expands sickle cell disease pipeline with worldwide licensing agreement for inclacumab for the treatment of vaso...Global Blood Therapeutics, Inc...
-
Fighting Through Our Pain TV With Thomas J. Harrington MDhttps://www.youtube.com/watch?time_conti...
-
Crizanlizumab designated FDA breakthrough therapy for potential in vaso-occlusive crisis preventionCrizanlizumab (SEG101), Novartis‘ inve...
-
SCA Therapy Hydroxyurea Doesn’t Boost Malaria Risk in Sub-Saharan Africa, Study FindsHydroxyurea, a treatment recommended for...
To improve your experience on this site, we use cookies. This includes cookies essential for the basic functioning of our website, cookies for analytics purposes, and cookies enabling us to personalize site content. By clicking on 'Accept' or any content on this site, you agree that cookies can be placed. You may adjust your browser's cookie settings to suit your preferences. More Information
The cookie settings on this website are set to "allow cookies" to give you the best browsing experience possible. If you continue to use this website without changing your cookie settings or you click "Accept" below then you are consenting to this.
Powered by
Support for this site is provided by
This platform is made possible through a partnership with the Sickle Cell Disease Association of America, Inc. (SCDAA) and its member organizations. SCDAA's mission is to advocate for people affected by sickle cell conditions and empower community-based organizations to maximize quality of life and raise public consciousness while advancing the search for a universal cure.