Prevalence and clinical significance of silent cerebral infarct in sickle cell anemia patients

Purpose: Cerebral infarct which may occur in patients with sickle cell disease is a serious complication with a high morbidity and mortality rate. Silent cerebral infarct is the vein problems seen before the occurrence of cerebral infarct clinical findings and ischemic changes in brain tissue. This study was made in order to investigate silent cerebral infarct in sickle cell anemia patients followed in Çukurova University Faculty of Medicine Child Hematology Department in order to detect silent cerebral infarct through non-invasive methods and determining susceptibility factors. Materials and Methods: : 54 patients between the ages 5 and 31 followed up by Çukurova University Faculty of Medicine Child Health and Diseases Department Child Hematology Department, had no cerebral infarct before and whose neurological examinations were normal were included in this study. Blood and serum samples were taken for total blood count, hemoglobin electrophoresis, AST, ALT, BUN, Cr, iron, TIBC and ferritin levels of the patients. Brain MRG and diffusion MRG were taken with magnetic resonance device in Radiodiagnostic Department in our hospital. Acquired data were compared statistically. Results: Silent cerebral infarct (SCI) was detected in 6 out of 54 sickle cell anemia patients (11.1%) included in the study. No statistical difference was detected in age, gender, physical examination findings and treatments taken in the comparisons between two groups with and without SCI. While HbS values were 86.2±4.4% in patients with SCI, they were 76.4±10.6 in patients without SCI. HbS values were detected significantly high in patients with SCI (p=0.014). Presence of SCI was found significantly high in patient group with HbSS or HbSβ0 genotype compared to other sickle cell syndromes (p=0.038). When total blood count results of both groups were compared, no significant difference was detected between white blood cell, thrombocyte and reticulocyte count, hemoglobin and hematocrit levels. Conclusion: When clinic and laboratory examinations were made for the risk factor in patients in our study, presence of homozygote hemoglobin SS / Sβ0 genotype and HbS were detected. In literature, our study is one of the few studies examining the presence of silent cerebral infarct in children with SCA in our country. It is considered that presence of silent cerebral infarct may be the early indicator of a significant stroke which may occur later in sickle cell anemia patients.