Study of Sickle Cell Anemia Complications in Children using Ultrasound in Elobeid Pediatric Hospital

Abstract

Cerebrovascular and abdominal complications are more prevalent in children with sickle cell anemia. The most severe cerebrovascular manifestation is stroke, affecting 11% of homozygous children by the age of 20 years. Velocities obtained by Tran cranial Doppler are measured by using a specific parameter, the time-averaged mean of the maximum velocity. Children with time-averaged mean of the maximum velocity ≥200 cm/sec are at high risk of stroke. Sickle cell anemia patients were screened by TCD at Sudan Sickle Cell Anemia Centre to study of sickle cell anemia complications in children. The purpose of this study was to study sickle cell anemia complications in children using Trans-cranial Doppler ultrasound and transabdominal ultrasound. A total of 134 normal children and 96 patients with sickle cell anemia disease were recruited in this study. On ultrasound scan the time-averaged mean of the maximum velocity in both proximal middle cerebral arteries and longitudinal length of liver, spleen and both kidneys were obtained from each subject and the data were analysed with Statistical Package for Social Sciences version 16 (SPSS). Using linear regression equation, the study showed correlation between time-averaged mean of the maximum velocity in the left middle cerebral artery and patients age, where the time averaged mean of the maximum velocity in the left middle cerebral artery decreased by a rate of 1.7109 for each year. And a correlation between time-averaged mean of the maximum velocity in the right middle cerebral artery and patients age, where the time-averaged mean of the maximum velocity in the right middle cerebral artery decreased by a rate of 1.6813 for each year. IV The study showed ninety four patients with time-averaged mean of the maximum velocity in proximal middle cerebral artery < 170 cm/s), two in the conditional category (>170) cm /s. On the basis of the STOP criteria, Tran-cranial Doppler examinations placed the majority of patients in the normal risk category, which means that it was within the lowest risk of stroke. They should rescan annually until 16 years old. The study also showed correlations between liver, spleen and both kidneys lengths with age where the rate of change for liver length increased with a rate of 0.2916 for each year. The rate of change for spleen length decreased with a rate of 0.1156 for each year. The rates of change for right kidney length increased with a rate of 0.216 for each year. The rates of change for left kidney length increased with a rate of 0.1963 for each year. The commonest abdominal complication in this study was the increase of renal size in 74 (77%) patients followed by Hepatomegaly in 53 (55 %), autosplenomegaly in 47 (49 %) splenomegaly in 12 (13%), and gallbladder stone in 5 (5.21 %) patients. Patients within the age group of 6– 10 years had the highest preponderance of SCD abdominal complications. 41(42%), followed by those within the age group of 11–16 years with 32(33%), while patients with age group of 2–5 years were least 23 (24%).