Meher R Juttukonda1, Chelsea A Lee2, Niral J Patel2, Larry T Davis1, Spencer L Waddle3, Melissa C Gindville2, Sumit Pruthi1, Adetola A Kassim4, Michael R DeBaun5, Manus J Donahue1,6,7,8, Lori C Jordan2. 1. Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 2. Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 3. Chemical and Physical Biology Program, Vanderbilt University, Nashville, Tennessee, USA. 4. Department of Medicine, Division of Hematology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 5. Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 6. Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 7. Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 8. Department of Physics and Astronomy, Vanderbilt University, Nashville, Tennessee, USA.
Abstract
BACKGROUND: Blood transfusions are administered to children and adults with sickle cell anemia (SCA) for secondary stroke prevention, or as treatment for recurrent pain crises or acute anemia, but transfusion effects on cerebral hemodynamics and metabolism are not well-characterized. PURPOSE: To compare blood transfusion-induced changes in hemometabolic parameters, including oxygen extraction fraction (OEF) and cerebral blood flow (CBF), within and between adults and children with SCA. STUDY TYPE: Prospective, longitudinal study. SUBJECTS: Adults with SCA (n = 16) receiving simple (n = 7) or exchange (n = 9) transfusions and children with SCA (n = 11) receiving exchange transfusions were scanned once when hematocrit was near nadir and again within 7 days of transfusion. Adult controls without SCA or sickle trait (n = 7) were scanned twice on separate days. FIELD STRENGTH/SEQUENCE: 3.0T T1 -weighted, T2 -weighted, and T2 -relaxation-under-spin-tagging (TRUST) imaging, and phase contrast angiography. ASSESSMENT: Global OEF was computed as the relative difference between venous oxygenation (from TRUST) and arterial oxygenation (from pulse oximetry). Global CBF was computed as total blood flow to the brain normalized by intracranial tissue volume. STATISTICAL TESTS: Hemometabolic variables were compared using two-sided Wilcoxon signed-rank tests; associations were analyzed using two-sided Spearman's correlation testing. RESULTS: In adults with SCA, posttransfusion OEF = 0.38 ± 0.05 was lower (P = 0.001) than pretransfusion OEF = 0.45 ± 0.09. A change in OEF was correlated with increases in hematocrit (P = 0.02; rho = -0.62) and with pretransfusion hematocrit (P = 0.02; rho = 0.65). OEF changes after transfusion were greater (P = 0.002) in adults receiving simple versus exchange transfusions. Posttransfusion CBF = 77.7 ± 26.4 ml/100g/min was not different (P = 0.27) from pretransfusion CBF = 82.3 ± 30.2 ml/100g/min. In children with SCA, both posttransfusion OEF = 0.28 ± 0.04 and CBF = 76.4 ± 26.4 were lower than pretransfusion OEF = 0.36 ± 0.06 (P = 0.004) and CBF = 96.4 ± 16.5 (P = 0.004). DATA CONCLUSION: Cerebral OEF reduces following transfusions in adults and children with SCA. CBF reduces following transfusions more often in children compared to adults, indicating that vascular reserve capacity may remain near exhaustion posttransfusion in many adults. LEVEL OF EVIDENCE: 2 Technical Efficacy Stage 5 J. Magn. Reson. Imaging 2019;49:466-477.
BACKGROUND: Blood transfusions are administered to children and adults with sickle cell anemia (SCA) for secondary stroke prevention, or as treatment for recurrent pain crises or acute anemia, but transfusion effects on cerebral hemodynamics and metabolism are not well-characterized. PURPOSE: To compare blood transfusion-induced changes in hemometabolic parameters, including oxygen extraction fraction (OEF) and cerebral blood flow (CBF), within and between adults and children with SCA. STUDY TYPE: Prospective, longitudinal study. SUBJECTS: Adults with SCA (n = 16) receiving simple (n = 7) or exchange (n = 9) transfusions and children with SCA (n = 11) receiving exchange transfusions were scanned once when hematocrit was near nadir and again within 7 days of transfusion. Adult controls without SCA or sickle trait (n = 7) were scanned twice on separate days. FIELD STRENGTH/SEQUENCE: 3.0T T1 -weighted, T2 -weighted, and T2 -relaxation-under-spin-tagging (TRUST) imaging, and phase contrast angiography. ASSESSMENT: Global OEF was computed as the relative difference between venous oxygenation (from TRUST) and arterial oxygenation (from pulse oximetry). Global CBF was computed as total blood flow to the brain normalized by intracranial tissue volume. STATISTICAL TESTS: Hemometabolic variables were compared using two-sided Wilcoxon signed-rank tests; associations were analyzed using two-sided Spearman's correlation testing. RESULTS: In adults with SCA, posttransfusion OEF = 0.38 ± 0.05 was lower (P = 0.001) than pretransfusion OEF = 0.45 ± 0.09. A change in OEF was correlated with increases in hematocrit (P = 0.02; rho = -0.62) and with pretransfusion hematocrit (P = 0.02; rho = 0.65). OEF changes after transfusion were greater (P = 0.002) in adults receiving simple versus exchange transfusions. Posttransfusion CBF = 77.7 ± 26.4 ml/100g/min was not different (P = 0.27) from pretransfusion CBF = 82.3 ± 30.2 ml/100g/min. In children with SCA, both posttransfusion OEF = 0.28 ± 0.04 and CBF = 76.4 ± 26.4 were lower than pretransfusion OEF = 0.36 ± 0.06 (P = 0.004) and CBF = 96.4 ± 16.5 (P = 0.004). DATA CONCLUSION: Cerebral OEF reduces following transfusions in adults and children with SCA. CBF reduces following transfusions more often in children compared to adults, indicating that vascular reserve capacity may remain near exhaustion posttransfusion in many adults. LEVEL OF EVIDENCE: 2 Technical Efficacy Stage 5 J. Magn. Reson. Imaging 2019;49:466-477.
Authors: Meher R Juttukonda; Manus J Donahue; Larry T Davis; Melissa C Gindville; Chelsea A Lee; Niral J Patel; Adetola A Kassim; Sumit Pruthi; Jeroen Hendrikse; Lori C Jordan Journal: J Cereb Blood Flow Metab Date: 2017-12-20 Impact factor: 6.200
Authors: Meher R Juttukonda; Lori C Jordan; Melissa C Gindville; Larry T Davis; Jennifer M Watchmaker; Sumit Pruthi; Manus J Donahue Journal: NMR Biomed Date: 2017-01-04 Impact factor: 4.044
Authors: Colin P Derdeyn; Tom O Videen; Kent D Yundt; Susanne M Fritsch; David A Carpenter; Robert L Grubb; William J Powers Journal: Brain Date: 2002-03 Impact factor: 13.501
Authors: Rajat Dhar; Allyson R Zazulia; Tom O Videen; Gregory J Zipfel; Colin P Derdeyn; Michael N Diringer Journal: Stroke Date: 2009-07-23 Impact factor: 7.914
Authors: Adam M Bush; Matthew T Borzage; Soyoung Choi; Lena Václavů; Benita Tamrazi; Aart J Nederveen; Thomas D Coates; John C Wood Journal: Am J Hematol Date: 2016-07-04 Impact factor: 10.047
Authors: Wenbo Li; Xiang Xu; Peiying Liu; John J Strouse; James F Casella; Hanzhang Lu; Peter C M van Zijl; Qin Qin Journal: Magn Reson Med Date: 2019-09-04 Impact factor: 4.668
Authors: Meher R Juttukonda; Manus J Donahue; Spencer L Waddle; Larry T Davis; Chelsea A Lee; Niral J Patel; Sumit Pruthi; Adetola A Kassim; Lori C Jordan Journal: J Cereb Blood Flow Metab Date: 2020-04-11 Impact factor: 6.200
Authors: Shuai Yuan; Lori C Jordan; Larry T Davis; Petrice M Cogswell; Chelsea A Lee; Niral J Patel; Spencer L Waddle; Meher Juttukonda; R Sky Jones; Allison Griffin; Manus J Donahue Journal: Br J Haematol Date: 2020-12-16 Impact factor: 6.998
Authors: Jenna Wade; Marianne E M Yee; Kirk A Easley; Shannon Pahz; Hailly Butler; Patricia E Zerra; Cassandra D Josephson; Ross M Fasano Journal: Transfusion Date: 2022-01-24 Impact factor: 3.157
Authors: Seung Yup Lee; Rowan O Brothers; Katherine B Turrentine; Ayesha Quadri; Eashani Sathialingam; Kyle R Cowdrick; Scott Gillespie; Shasha Bai; Adam E Goldman-Yassen; Clinton H Joiner; R Clark Brown; Erin M Buckley Journal: Front Neurol Date: 2022-07-01 Impact factor: 4.086
Authors: Lori C Jordan; Meher R Juttukonda; Adetola A Kassim; Michael R DeBaun; Larry T Davis; Sumit Pruthi; Niral J Patel; Chelsea A Lee; Spencer L Waddle; Manus J Donahue Journal: Am J Hematol Date: 2019-03-24 Impact factor: 10.047
Authors: Melanie E Fields; Amy E Mirro; Michael M Binkley; Kristin P Guilliams; Josiah B Lewis; Slim Fellah; Yasheng Chen; Monica L Hulbert; Hongyu An; Andria L Ford; Jin-Moo Lee Journal: Am J Hematol Date: 2022-02-14 Impact factor: 13.265
Authors: Sara B Keller; Jacob M Bumpus; J Christopher Gatenby; Elizabeth Yang; Adetola A Kassim; Carlton Dampier; John C Gore; Amanda K W Buck Journal: Cardiovasc Eng Technol Date: 2021-07-20 Impact factor: 2.305
Authors: M R DeBaun; L C Jordan; A A King; J Schatz; E Vichinsky; C K Fox; R C McKinstry; P Telfer; M A Kraut; L Daraz; F J Kirkham; M H Murad Journal: Blood Adv Date: 2020-04-28