EVALUATION OF FINDINGS IN CHILDREN WITH SICKLE CELL ANAEMIA USING TRANSCRANIAL DOPPLER ULTRASOUND IN SICKLE-CELL FOUNDATION CENTRE, LAGOS
Background: Sickle Cell Disease (SCD) is the most common genetic cause of illness and death in the world, with Africa bearing the highest burden. Trans-cranial Doppler ultrasound (TCD) which is different from transfontanelle ultrasound, was used to measure mean flow velocities in the large intra-cranial arteries. It is a readily available, economical, reliable, non invasive method of imaging and has been shown to predict risk of stroke when cerebral blood flow velocity> 200cm/s.
Aim & Objectives: The aim of this study was to evaluate the common findings in TCD in children with Sickle Cell Anemia (SCA) in this environment, the associated various risk factors and to identify the high risk patients who are likely to have primary stroke.
Materials and Methods: This prospective study was conducted on 200 children with SCA, without a known history of stroke, at the Sickle Cell Foundation Nigeria, Lagos over a period of 6 months. A TCD machine - DWL Doppler box (Scan Med) s/n DB-0563, p/n 301748 ® manufactured in Germany and equipped with a 2MHz transducer probe was used to measure the cerebral blood flow (CBFv) in internal carotid artery (ICA), middle cerebral artery (MCA) and
anterior cerebral artery (ACA). Measurements were entered into the data sheet and analyzed using Statistical Package for Social Science Software (SPSS) version 20.
Results showed that the 5-8years age group constituted 43.5% of those screened, 25% was under 4 years of age, 24% were 9-12 years and 7.5% were 13-16 years. Females were 56.5% while 43.5% were males. They were grouped according to CBFv in the analyzed vessels. The standard risk (CBFv <170cm/seconds) was 60.5%, conditional risk (170-200cm/s) was 36% and high risk group (>200cm/s) was 3.5%.
Conclusion: Significant correlation was noted between haematocrit and Time Averaged Mean of the Maximum Velocity (TAMMV), with a p-value of 0.045, white blood cell and TAMMV (p-value of 0.032) and dactylitis and TAMMV (p-value of 0.007). Also a significant negative correlation was shown between children below 4years and dactylitis (p-value 0.026).