title: The frequency of silent cerebral ischemia in patients with transfusion-dependent β-thalassemia major.
abstract: The aim of this study is to determine the frequency of silent cerebral ischemia (SCI) in a group of patients with β-thalassemia major and correlate them with demographic parameters, blood and spleen status, volume and frequency of transfusions. In this cross-sectional study, 40 β-thalassemic patients over 10 years old who had no neurologic deficit were studied. Brain MRI was performed to detect SCI. Silent cerebral ischemia was classified according to number and size. Silent cerebral ischemia was found in 15 patients (37.5 %). Mean number of SCI was 6.73 ± 10.33 (1-40), and mean size of the brain lesions was 3.07 ± 2.81 mm (1-11 mm). The patients with SCI were significantly older (31.1 ± 6.5 vs. 25 ± 6.8 years, P = 0.009), and most of them were splenectomized (80% vs. 36 %, P = 0.01). Interestingly, 10 out of 15 patients with SCI had platelet count less than 500,000/mm(3). Eight of these patients (80 %) were splenectomized. Other variables had no statistically significant association with the presence of SCI. Older age and splenectomized multitransfused β-thalassemic patients even with normal platelet count have a higher incidence of SCI. The effect of splenectomy is more significant in statistical analysis. In splenectomized patients with a high platelet count and even with normal platelet count, aspirin therapy is indicated. Based on the results, it seems that regular blood transfusions are not going to have a significant effect on the number and size of SCI.
authors.affiliation: Hematology Research Center, Shiraz University of Medical Science, Shiraz, Iran. karimim@sums.ac.ir.
authors.forename: Mehran
authors.initials: M
authors.lastname: Karimi
authors.affiliation: Hematology Research Center, Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Foroogh
authors.initials: F
authors.lastname: Toosi
authors.affiliation: Hematology Research Center, Shiraz University of Medical Science, Shiraz, Iran.
authors.forename: Sezaneh
authors.initials: S
authors.lastname: Haghpanah
authors.affiliation: Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Parisa
authors.initials: P
authors.lastname: Pishdad
authors.affiliation: Hematology Research Center, Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Avazpour
authors.affiliation: Medicine and Pediatrics, Presbyterian Hospital, New York Cornell University, New York, NY, USA.
authors.forename: Eliezer A
authors.initials: EA
authors.lastname: Rachmilewitz
mesh_terms: D000293:Adolescent; D000328:Adult; D001803:Blood Transfusion / Q000639:trends*; D002545:Brain Ischemia / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult; D017086:beta-Thalassemia / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy
keywords: Silent cerebral ischemia; Splenectomy; Transfusion; β-Thalassemia