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Blood, 10 December 2009, Vol. 114, No. 25, pp. 5117-5125. Prepublished online as a Blood First Edition Paper on October 1, 2009; DOI 10.1182/blood-2009-05-220921. This Article Full Text Full Text (PDF) All Versions of this Article: blood-2009-05-220921v1 114/25/5117    most recent e-Letter: Submit a Response Alert me when this article is cited Alert me when e-Letters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Verduzco, L. A. Articles by Nathan, D. G. Search for Related Content PubMed PubMed Citation Articles by Verduzco, L. A. Articles by Nathan, D. G. Related Collections Free Research Articles Red Cells, Iron, and Erythropoiesis Review Articles Social Bookmarking                         What's this?  Previous Article  |  Table of Contents  |  Next Article  REVIEW ARTICLE Sickle cell disease and stroke Luis A. Verduzco1, and David G. Nathan1,2 1 Harvard Medical School, Boston, MA; and 2 Children's Hospital and Dana-Farber Cancer Institute, Boston, MA Twenty-four percent of sickle cell disease (SCD) patients have a stroke by the age of 45 years. Blood transfusions decrease stroke risk in patients deemed high risk by transcranial Doppler. However, transcranial Doppler has poor specificity, and transfusions are limited by alloimmunization and iron overload. Transfusion withdrawal may be associated with an increased rebound stroke risk. Extended blood typing decreases alloimmunization in SCD but is not universally adopted. Transfusions for thalassemia begun in early childhood are associated with lower rates of alloimmunization than are seen in SCD, suggesting immune tolerance. Optimal oxygen transport efficiency occurs at a relatively low hematocrit for SCD patients because of hyperviscosity. Consequently, exchange rather than simple transfusions are more effective in improving oxygen transport efficiency, but the former are technically more demanding and require more blood units. Although viscosity is of importance in the noncerebral manifestations of SCD, inflammation may play a larger role than viscosity in the development of large-vessel stroke. The future of SCD stroke management lies in the avoidance of transfusion. Hydroxyurea and anti-inflammatory measures may reduce the need for transfusion. Recent genome-wide association studies may provide methods for modulating fetal hemoglobin production enough to attenuate stroke risk and other complications of SCD. CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this? This article has been cited by other articles: H. F. Bunn, D. G. Nathan, G. J. Dover, R. P. Hebbel, O. S. Platt, W. F. Rosse, and R. E. Ware Pulmonary hypertension and nitric oxide depletion in sickle cell disease Blood, August 5, 2010; 116(5): 687 - 692. [Abstract] [Full Text] [PDF] R. F. Gottesman, Z. Bahrainwala, R. J. Wityk, and A. E. Hillis Neglect Is More Common and Severe at Extreme Hemoglobin Levels in Right Hemispheric Stroke Stroke, August 1, 2010; 41(8): 1641 - 1645. [Abstract] [Full Text] [PDF]

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