Regular blood transfusion therapy could significantly reduce the incidence of the recurrent cerebral infarcts in children with sickle cell anemia, which occur in approximately one-third of children with the disease. The findings were reported in a new study in the New England Journal of Medicine and the research was supported by grants from the National Institute of Health’s (NIH) National Institute of Neurological Disorders and Stroke and National Heart Lung and Blood Institute.
Michael R. DeBaun, MD, from the Vanderbilt University School of Medicine, and colleagues conducted a randomized, single-blind clinical trial of 196 children ages 5–15 with a confirmed diagnosis of sickle cell anemia with no history of stroke and one or more silent cerebral infarcts on magnetic resonance imaging (MRI), and a neurologic examination showing no lesion-related abnormalities.
Patients received either regular blood transfusions or standard care every month for 3 years, with a primary endpoint of recurrence of an infarct (stroke or a newly inflamed silent cerebral infarct). Only 6.1% of the patients in the blood transfusion group experienced a new silent cerebral infarct vs. 14.4% in the control group. No differences were noted in intelligence measures between the two groups, although previous research has linked silent cerebral infarcts to a 5-point reduction in IQ.
The authors note that the benefits of blood transfusion therapy outweighed the burden of treatment, with 86% of participants completing all aspects of the trial including 36 months of transfusion therapy, 3 non-sedated MRI scans, multiple neurology evaluations, two 2-hour cognitive testing sessions, and 2 quality of life assessments. They hope to further explore the association between new silent cerebral infarcts and IQ reduction in future research.
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