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Predictors of Cerebral Blood Flow Velocity in Children with Sickle Cell Anaemia in Lagos State, Nigeria

Motunrayo Oluwabukola Adekunle

The Stroke Prevention Trial in Sickle Cell Anaemia study (STOP) recommends routine screening with transcranial Doppler (TCD) ultrasonography in children aged two to sixteen years with SCA. However, in resource poor countries, unavailability of TCD machine limits the possibility of routine screening for all children with SCA. Readily available clinical and laboratory tools that can predict the risk of a CVA were assessed. Methods: TCD ultrasonography was done for children with SCA that attended Sickle Cell Foundation, Nigeria between July and November 2015. Clinical and laboratory parameters were assessed as predictors of abnormal cerebral blood flow velocities. Results: In all, 360 subjects were screened within the study period. Clinical predictors of abnormal Cerebral Blood Flow Velocity (CBFV) were elevated blood pressure and transcutaneous arterial oxygen saturation less than 95%. Significant haematologic correlates were low haematocrit, low haemoglobin concentration, leukocytosis, reticulocytosis and high Lactate dehydrogenase (LDH). Of these significant correlates, the independent risk factors were mean arterial blood pressure, haematocrit, haemoglobin concentration and LDH. Conclusion: SCA children with low steady state haematocrit, low haemoglobin concentration, elevated blood pressure, leukocytosis, reticulocytosis and high LDH should be offered priority for TCD ultrasonography and institution of Preventive therapy for CVA.