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Transcranial Doppler velocity among Jamaican children with sickle cell anaemia: determining the significance of haematological values and nutrition
Author(s) -
RankineMullings Angela E.,
MorrisonLevy Nadine,
Soares Deanne,
Aldred Karen,
King Lesley,
Ali Susanna,
KnightMadden Jennifer M.,
WisdomPhipps Margaret,
Adams Robert J.,
Ware Russell E.,
Reid Marvin
Publication year - 2018
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.15162
Subject(s) - transcranial doppler , medicine , mean corpuscular volume , middle cerebral artery , cardiology , body mass index , confidence interval , internal carotid artery , anterior cerebral artery , hematocrit , ischemia
Summary This study investigated the association of nutritional and haematological variables with maximum time‐averaged mean velocity (TAMV) measured by transcranial Doppler (TCD) velocity and the agreement of classification between two protocols. TCD categories included: normal (<170 cm/s), conditional (170–199 cm/s) and abnormal (≥200 cm/s) based on TAMV in distal internal carotid artery (dICA), middle cerebral artery (MCA), internal carotid bifurcation, anterior and posterior cerebral arteries. Of 358 children with sickle cell anaemia (SCA) examined, the mean age (±standard deviation) was 7·4 ± 2·7 years; 13·1% and 6·7% had conditional and abnormal velocities, respectively. Children with abnormal TCD velocities had higher prevalence of prior stroke ( P = 0·006). Increased TAMV was associated with younger age ( P = 0·001), lower weight ( P = 0·001), height ( P = 0·007) and oxygen saturation ( P = 0·005). There was no association of TAMV with height‐age or body mass index (BMI) z ‐scores. Adjusting for gender, BMI z ‐score, age, previous stroke and oxygen saturation, mean corpuscular volume ( P = 0·005) and reticulocyte count ( P = 0·013) were positively associated with TAMV, while haemoglobin concentration ( P = 0·009) was negatively associated. There was good agreement [99%; weighted Kappa 0·98 (95% confidence interval 0·89–1), P = 0·0001] in TCD classification using data from five vessels versus two vessels (dICA and MCA). Haematological variables, rather than nutritional status, may be useful markers that identify high‐risk children with SCA.