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Comment
. 2018 Mar 1;131(9):950-952.
doi: 10.1182/blood-2018-01-824185.

Unwinding the path from anemia to stroke

John C Wood  1
Affiliations
Comment

Unwinding the path from anemia to stroke

John C Wood. Blood. .

Abstract

In this issue of Blood, Guilliams et al demonstrate that white matter is chronically hypoxic in sickle cell disease and that transfusions acutely lower the volume of brain tissue at risk for stroke.

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Conflict of interest statement

Conflict-of-interest disclosure: J.C.W. serves as an MRI imaging consultant for ApoPharma, BiomedInformatics, Celgene, and WorldCare Clinical. He receives research support in-kind from Philips Healthcare. He has grant support from the National Heart, Lung, and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases.

Figures

None
Schematic illustrating normal oxygen delivery to tissues through a healthy microvasculature (top). Slow, evenly distributed blood flow facilitates effective oxygen transfer. In this scenario, tissue OEF mirrors the oxygen difference between the artery and vein. Schematic illustrating impaired oxygen delivery in regions with vascular pruning and inhomogenous vascular transit time (bottom). Fast flow through low-resistance channels leads to high nonnutritive perfusion and ineffective oxygen unloading. The tissues are hypoxic (high OEF), even though the oxygen difference between the artery and the vein is small. Figure provided by Adam Bush.
See this image and copyright information in PMC

Comment on

References

    1. Guilliams KP, Fields ME, Ragan DK, et al. . Red cell exchange transfusions lower cerebral blood flow and oxygen extraction fraction in pediatric sickle cell anemia. Blood. 2018;131(9):1012-1021. - PMC - PubMed
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    1. Bush AM, Borzage MT, Choi S, et al. . Determinants of resting cerebral blood flow in sickle cell disease. Am J Hematol. 2016;91(9):912-917. - PMC - PubMed
    1. Prohovnik I, Hurlet-Jensen A, Adams R, De Vivo D, Pavlakis SG. Hemodynamic etiology of elevated flow velocity and stroke in sickle-cell disease. J Cereb Blood Flow Metab. 2009;29(4):803-810. - PubMed
    1. Quinn CT, Dowling MM. Cerebral tissue hemoglobin saturation in children with sickle cell disease. Pediatr Blood Cancer. 2012;59(5):881-887. - PMC - PubMed

Publication types