Belisario et al identified risk factors for intracerebral changes in neonates with sickle cell anemia. These can help to identify a patient who may benefit from more aggressive management. The authors are from multiple institutions in Minas Gerais, Brazil.

Patient selection: neonate with sickle cell anemia


Intracranial changes: acute cerebral ischemia; high-risk transcranial Doppler ultrasonography


Management of a high-risk patient with either finding may include prophylactic blood transfusion or therapy with hydroxyurea.


Risk factors for acute cerebral ischemia

(1) high white blood cell count (leukocytosis)

(2) high reticulocyte count

(3) acute chest syndrome

(4) SNP (single nucleotide polymorphism) TEK rs289347 GC or CC (versus GG)

(5) SNP TNF-alpha rs1800629 GA or AA (versus GG)


High-risk transcranial Doppler (TCD) is defined as time-averaged mean of the maximum velocity (TAMMX) >= 200 cm/s n the internal carotid or middle cerebral artery recorded twice (Adams et al).


Risk factors for high-risk transcranial Doppler (TCD):

(1) high reticulocyte count

(2) SNP (single nucleotide polymorphism) TEK rs489347 CC (versus GG or GC)

(3) SNP TGFBR3 rs284875 GA or AA (versus GG)

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