Format

Send to

Choose Destination
Am J Hematol. 2016 Sep;91(9):912-7. doi: 10.1002/ajh.24441. Epub 2016 Jul 4.

Determinants of resting cerebral blood flow in sickle cell disease.

Author information

1
Department of Biomedical Engineering, University of Southern California, California.
2
Division of Neonatology and Radiology, Children's Hospital Los Angeles, California.
3
Neurosciences Program, University of Southern California, California.
4
Department of Radiology, Academic Medical Center, Amsterdam.
5
Department of Radiology, Children's Hospital Los Angeles, California.
6
Section of Hematology, Children's Hospital Los Angeles, California.
7
Division of Cardiology, Children's Hospital Los Angeles, California.

Abstract

Stroke is common in children with sickle cell disease and results from an imbalance in oxygen supply and demand. Cerebral blood flow (CBF) is increased in patients with sickle cell disease to compensate for their anemia, but adequacy of their oxygen delivery has not been systematically demonstrated. This study examined the physiological determinants of CBF in 37 patients with sickle cell disease, 38 ethnicity matched control subjects and 16 patients with anemia of non-sickle origin. Cerebral blood flow was measured using phase contrast MRI of the carotid and vertebral arteries. CBF increased inversely to oxygen content (r(2)  = 0.69, P < 0.0001). Brain oxygen delivery, the product of CBF and oxygen content, was normal in all groups. Brain composition, specifically the relative amounts of grey and white matter, was the next strongest CBF predictor, presumably by influencing cerebral metabolic rate. Grey matter/white matter ratio and CBF declined monotonically until the age of 25 in all subjects, consistent with known maturational changes in brain composition. Further CBF reductions were observed with age in subjects older than 35 years of age, likely reflecting microvascular aging. On multivariate regression, CBF was independent of disease state, hemoglobin S, hemoglobin F, reticulocyte count and cell free hemoglobin, suggesting that it is regulated similarly in patients and control subjects. In conclusion, sickle cell disease patients had sufficient oxygen delivery at rest, but accomplish this only by marked increases in their resting CBF, potentially limiting their ability to further augment flow in response to stress. Am. J. Hematol. 91:912-917, 2016.

PMID:
27263497
PMCID:
PMC4987198
DOI:
10.1002/ajh.24441
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for PubMed Central
Loading ...
Support Center