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Global child health
Cerebral artery conditional blood velocity in sickle cell disease: a multicentre study and evidence for active treatment
  1. Emmanuel Modebe1,
  2. Charles Nonyelu2,
  3. Augustine Duru2,
  4. Osita Ezenwosu3,
  5. Barth Chukwu3,
  6. Anazoeze Madu2,
  7. Chinedu Ezekekwu2,
  8. John Aneke4,
  9. Mildred Izuka5,
  10. Chisom Nri-Ezedi6,
  11. Oluomachi Nnachi7,
  12. Alozie Eze8,
  13. Ifeoma Ajuba4,
  14. Emeka Okwummuo4,
  15. Jane Chilaka4,
  16. Chinenye Onodugo9,
  17. Uwaoma Fidelis-Ewa2,9,
  18. Obineche Agwu8,
  19. Ikechukwu Anigbogu2,
  20. Ebele Muoghalu2,
  21. Helen Okoye2,
  22. Chilota Efobi4,
  23. Obiora Ejiofor10,
  24. Ngozi Ugwu2,
  25. Collins Maduka7,8,
  26. Nneka Iloanusi1,
  27. Angela Ugwu1,
  28. Chide Okocha4,
  29. Thomas Ulasi6,
  30. Iheanyi Okpala2
  1. 1 Department of Radiation Medicine, University of Nigeria Teaching Hospital, Ituku Ozalla, Nigeria
  2. 2 Department of Haematology and Immunology, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
  3. 3 Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku Ozalla, Nigeria
  4. 4 Department of Haematology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria
  5. 5 Department of Paediatrics, Federal Medical Centre, Umuahia, Nigeria
  6. 6 Department of Paediatrics, Nnamdi Azikiwe University, Nnewi, Nigeria
  7. 7 Department of Haematology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
  8. 8 Department of Haematology, Federal Medical Centre, Umuahia, Nigeria
  9. 9 Department of Pharmacy, University of Nigeria Teaching Hospital, Ituku Ozalla, Nigeria
  10. 10 Department of Paediatrics, Chukwuemeka Odumegwu-Ojukwu University Teaching Hospital, Amaku, Nigeria
  1. Correspondence to Professor Iheanyi Okpala, University of Nigeria Teaching Hospital, Ituku Ozalla, Nigeria; iheanyi.okpala{at}unn.edu.ng

Abstract

Objective To 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.

Design A 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.

Setting Nigeria.

Participants 308 children (126 girls, 182 boys; age 2–16 years).

Main outcome measures Percentage of children with SCD who have normal, high or intermediate (often termed conditional) PSV or TAMMV.

Results In 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%).

Conclusion Since 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.

  • child health
  • epidemiology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Supplementary material: individual cerebral artery blood velocities in all the 308 children who participated in this study are accessible as online supplemental data in tables 3 and 4.

http://dx.doi.org/10.1136/archdischild-2022-325106

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. Supplementary material: individual cerebral artery blood velocities in all the 308 children who participated in this study are accessible as online supplemental data in tables 3 and 4.

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    Footnotes

    • Contributors All authors contributed to data collection, drafting the manuscript, reviewing the revised drafts for accuracy and intellectual content, approved the final version of the manuscript as submitted and agree to be accountable for all aspects of the work. EM, BC and NI performed transcranial Doppler ultrasonography on the study participants. AM and CN-E carried out statistical analyses of the study data. IO conceptualised, designed the study and acted as guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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