20 February 2019

The ‘silent strokes’ which can affect people with sickle cell disease (SCD) are linked to reduced oxygen delivery to the white matter of the brain, according to a new study.

Dr John Wood, from the Children’s Hospital Los Angeles, USA, used arterial spin labelling – an advanced imaging technique – to measure blood flow in 32 SCD patients, compared to 25 healthy controls. His team found that, while total oxygen delivery to the brain was unchanged, oxygen delivery to the white matter was reduced by 35% in SCD patients.

Writing in the American Journal of Hematology, he says this is an important finding because it is the white matter where most silent strokes occur in SCD patients.

It also demonstrates that the body differentiates between grey and white matter, prioritising oxygen delivery to neurons in the grey matter. Strokes in grey matter are immediately catastrophic, while strokes in white matter appear relatively silent because they only cause informational processing to slow.

The researchers also found that the oxygen delivery to the white matter was critically sensitive to the haemoglobin level: the more severe the anaemia, the lower the oxygen delivery to the white matter.

The study is the first to use arterial spin labelling to quantify oxygen delivery separately from the white and grey matter in the brain, correcting for patients’ anaemia severity.

Although the research opens up the possibility of a better understanding of strokes in SCD patients, it could also lead to a better understanding of anaemia in general.

Source: Chai, Y., Bush, A.M., Coloigner, J., Nederveen, A.J., Tamrazi, B., Vu, C., Choi, S., Coates, T.D., Lepore, N., Wood, J.C. (2019) “White Matter Has Impaired Resting Oxygen Delivery in Sickle Cell Patients”, American Journal of Hematology, available at doi: 10.1002/ajh.25423


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