Silent Strokes Common in Pediatric Acute Anemia

The purpose of this study was to look at a group of patients who we know have problems with cerebral vascular disease –children with sickle cell disease – and look at the frequency of severe anemia-related abnormalities. The researchers also wanted to see whether children who had anemia for other reasons might be at risk for this so-called "silent infarction."

They confirmed that children who have sickle cell disease do have silent infarctions, and that having bouts of severe anemia probably makes those infarctions both more common and worse. But they also saw that children who don’t have sickle cell anemia but who do have these bouts of severe anemia may also be at risk.

I think the message for parents is to basically know the symptoms that are associated with severe anemia. These children usually are very pale, they may be very tired, they may have increased heart rate, and they may have a condition that causes either loss of blood or underproduction of red blood cells. There are many causes for these types of symptoms. Anemia is certainly among them, and it’s very easy to check.

The message here is to be careful when you’re dealing with conditions in children who have developing brains and who may also have conditions that lead to severe anemia. And be sure that you are careful with transfusing them, because you may end up with silent brain injury that adds to other problems that they have.

Robert J. Adams, M.D., is professor of neurosciences and director of the stroke center at the Medical University of South Carolina, Charleston. These comments are adapted from an interview he gave to the American Heart Association, which released them to the media. He said he has no relevant conflicts of interest.