CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Controlled trial of transfusions for silent cerebral infarcts in sickle cell anemia
Silent cerebral infarcts are a common complication in sickle cell disease and are often associated with recurrence of infarct or stroke. A silent infarct is undetectable by standard neurological screening and requires more extensive evaluation, such as MRI studies of the brain. Blood transfusion was shown to be an efficacious prevention of stroke in children with sickle cell anemia. The authors conducted a study to test the hypothesis that the incidence of infarct recurrence is lower in children receiving routine transfusion therapy. They conducted a randomized, single-blind clinical trial and assigned children with sickle cell anemia to receive regular blood transfusions or standard of care. The participants ranged from five to 15 years of age and had a history of at least one silent infarct on MRI. A total of 196 children were followed for three years. The primary end point of recurrence of stroke or new or enlarged silent cerebral infarct occurred at an incidence of two in the transfused group and 4.8 in the observation group. This resulted in an overall incidence rate ratio of 0.41 (95 percent confidence interval, 0.12–0.99; P=0.04). The study concluded that regular blood transfusion therapy significantly reduces the incidence of cerebral infarct recurrence in children with sickle cell anemia. Research is needed to identify those children most at risk for silent infarcts so they can receive transfusion therapy.
DeBaun MR, Gordon M, McKinstry RC, et al. Controlled trial of transfusions for silent cerebral infarcts in sickle cell anemia. N Engl J Med. 2014;371:699–710.
Correspondence: Dr. M. R. DeBaun at m.debaun@vanderbilt.edu