| Content Provider |
World Health Organization (WHO)-Global Index Medicus |
| Author |
Heiny, Mark E. Lehmann, Harold Kamdem, Annie Gonzalez, Corina E. Meier, Emily R. Fixler, Jason M. Kirkham, Fenella J. Airewele, Gladstone Debaun, Michael R. Kraut, Michael A. Inusa, Baba P. D. Mckinstry, Robert C. King, Allison A. Redding-lallinger, Rupa C. Casella, James F. Thompson, Alexis A. Strouse, John J. Quinn, Charles T. Telfer, Paul T. White, Desiree A. Noetzel, Michael J. Majumdar, Suvankar Berman, Brian Miller, J. Philip Kalinyak, Karen A. Mccavit, Timothy L. Rhodes, Melissa M. Woods, Gerald M. Dixon, Natalia Panepinto, Julie A. Kirby-allen, Melanie Fuh, Beng R. Ball, William S. Gordon, Mae Howard, Thomas H. Kwiatkowski, Janet L. Hirtz, Deborah Sarnaik, Sharada A. |
| Description |
Author Affiliation: DeBaun MR ( From the Department of Pediatrics, Division of Hematology-Oncology, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University School of Medicine, Nashville (M.R.D.)) |
| Abstract |
BACKGROUND: Silent cerebral infarcts are the most common neurologic injury in children with sickle cell anemia and are associated with the recurrence of an infarct (stroke or silent cerebral infarct). We tested the hypothesis that the incidence of the recurrence of an infarct would be lower among children who underwent regular blood-transfusion therapy than among those who received standard care. METHODS: In this randomized, single-blind clinical trial, we randomly assigned children with sickle cell anemia to receive regular blood transfusions (transfusion group) or standard care (observation group). Participants were between 5 and 15 years of age, with no history of stroke and with one or more silent cerebral infarcts on magnetic resonance imaging and a neurologic examination showing no abnormalities corresponding to these lesions. The primary end point was the recurrence of an infarct, defined as a stroke or a new or enlarged silent cerebral infarct. RESULTS: A total of 196 children (mean age, 10 years) were randomly assigned to the observation or transfusion group and were followed for a median of 3 years. In the transfusion group, 6 of 99 children (6%) had an end-point event (1 had a stroke, and 5 had new or enlarged silent cerebral infarcts). In the observation group, 14 of 97 children (14%) had an end-point event (7 had strokes, and 7 had new or enlarged silent cerebral infarcts). The incidence of the primary end point in the transfusion and observation groups was 2.0 and 4.8 events, respectively, per 100 years at risk, corresponding to an incidence rate ratio of 0.41 (95% confidence interval, 0.12 to 0.99; P=0.04). CONCLUSIONS: Regular blood-transfusion therapy significantly reduced the incidence of the recurrence of cerebral infarct in children with sickle cell anemia. (Funded by the National Institute of Neurological Disorders and Stroke and others; Silent Cerebral Infarct Multi-Center Clinical Trial ClinicalTrials.gov number, NCT00072761, and Current Controlled Trials number, ISRCTN52713285.). |
| ISSN |
00284793 |
| e-ISSN |
15334406 |
| Journal |
New England Journal of Medicine |
| Issue Number |
8 |
| Volume Number |
371 |
| Language |
English |
| Publisher |
Massachusetts Medical Society (United States) |
| Publisher Date |
2014-08-21 |
| Publisher Place |
United States |
| Access Restriction |
Open |
| Subject Keyword |
Anemia, Sickle Cell Therapy Blood Transfusion Cerebral Infarction Prevention & Control Adolescent Complications Adverse Effects Etiology Child, Preschool Ferritins Blood Hemoglobin, Sickle Intelligence Intention To Treat Analysis Secondary Prevention Single-Blind Method Multicenter Study Randomized Controlled Trial Research Support, American Recovery And Reinvestment Act Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Medicine |
| Content Type |
Text |
| Resource Type |
Article |
| Subject |
Medicine |
