Cerebral Artery Velocity in Patients with β-Thalassemia Intermedia Compared to β-Thalassemia Major Using Transcranial Doppler Ultrasonography,

Patients with β-thalassemia, especially β-thalassemia intermedia (β-TI), are prone to hypercoagulable state and subsequently cerebral thromboembolic events. In this study we aimed to determine cerebral artery velocity as a determinant of stroke risk in patients with β-TI compared to β-thalassemia major (β-TM) and healthy subjects. Method: Sixty patients with β-TM and 64 β-TI were randomly selected in this cross sectional study. Sixty healthy adults comprised as a control group. The Time average Maximum Mean Velocity (TAMMV) was measured in large cerebral arteries using Transcranial Doppler (TCD) Ultrasonography. The TAMMVs in different arteries were compared between the patients with β-TI, β-TM and controls. Results: TAMMV in all arteries was significantly higher in β-TI patients than β-TM patients and controls (P< 0.001). Also β-TM patients had significantly higher TAMMVs than controls in all arteries except for the left and right posterior cerebral arteries (P< 0.001). In univariate analysis we found that the lack of transfusion, thrombocytosis, splenectomy, higher platelet counts and lower age could contribute to increase TAMMV (P< 0.05). However, in the multiple linear regression models the only important factors influencing TAMMV were the lack of transfusion in all evaluated arteries following with age only in some investigated arteries. Conclusion: We showed that patients with β-TI has a higher TAMMV in comparison with the healthy subjects as well as with the β-TM patients probably due to the lack of transfusion and chronic anemia. In addition, β-TI patients are more prone to thromboembolic events and subsequently cerebral infarction due to hypercoagulable state. We recommend MRI screening in β-TI patients for detection of silent lesions, in the presence of asymptomatic lesions, TCD would be beneficial. In patients with high cerebral artery velocity and silent lesion further evaluation, close observation and prophylactic treatment including regular blood transfusion and antiplatelet therapy should be considered. However further prospective studies are suggested to confirm the correlation between the stroke risk and high cerebral velocity as well as the protective effect of regular transfusion in β-TI patients.

No relevant conflicts of interest to declare.