Published online May 19, 2008
PEDIATRICS (doi:10.1542/peds.2007-2771)
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ARTICLE

A Simple Index Using Age, Hemoglobin, and Aspartate Transaminase Predicts Increased Intracerebral Blood Velocity as Measured by Transcranial Doppler Scanning in Children With Sickle Cell Anemia

David C. Rees, FRCPa, Moira C. Dick, FRCPa, Sue E. Height, MDa, Sandra O'Driscoll, BSca, Keith R. E. Pohl, FRCPCHb, David E. Goss, PhDc and Colin R. Deane, PhDc

a Department of Paediatric Haematology, King's College School of Medicine
c Vascular Laboratory, King's College Hospital, London, United Kingdom
b Department of Paediatric Neurology, Evelina Children's Hospital, Guy's and St Thomas’ Foundation Trust, London, United Kingdom

OBJECTIVE. Increased intracerebral blood velocity measured by transcranial Doppler scanning identifies children with sickle cell anemia who are at increased risk of stroke. We have tried to develop an index based on routine clinical measurements that also predicts increased intracerebral blood flow.

METHOD. Routinely collected clinical and laboratory data were correlated with transcranial Doppler measurements on children with sickle cell anemia seen in a single institution in 2006. The index produced was validated on a second independent data set from children with sickle cell anemia.

RESULTS. The time-averaged mean of the maximum velocity in centimeters per second in the middle cerebral artery circulation correlated significantly with age, hemoglobin, lactate dehydrogenase, and aspartate transaminase levels, white blood cell count, and creatinine level. On multiple regression, hemoglobin and aspartate transaminase levels maintained their significance, whereas age had borderline significance, and an index was developed linked to a time-averaged mean of the maximum velocity of 220 – (8 x hemoglobin) – (1.4 x age) + (0.4 x aspartate transaminase). This detected a time-averaged mean of the maximum velocity of >170 cm/second with 100% sensitivity and 58% specificity. The index was validated on the second data set and again showed 100% sensitivity with 73% specificity.

CONCLUSION. This simple index has the potential to identify children who are at higher risk of cerebrovascular disease to allow them to be prioritized for transcranial Doppler scanning and other intracerebral imaging.

Key Words: sickle • stroke • transcranial Doppler • pediatric • anemia

Abbreviations: SCA—sickle cell anemia • TCD—transcranial Doppler • LDH—lactate dehydrogenase • AST—aspartate transaminase • TAMMV—time-averaged mean of the maximum velocity • ROC—receiver-operator characteristic • WBC—white blood cell

Accepted Nov 14, 2007.