We performed transcranial Doppler (TCD) to assess cerebral hemodynamics among Indian SCD

children and examined their association with clinical and hematological parameters.

India has the second highest number of cases of sickle cell disease (SCD), many belonging to low socioeconomic status, spread across a horizontal belt from Gujarat to Odisha. Despite high prevalence of SCD in India, information about cerebral hemodynamics among children with SCD remains scarce.

Children aged 3-18 with SCD living in Raipur and Ahmedabad were recruited. TCD was performed to obtain flow velocities from middle cerebral, intracranial internal carotid and basilar artery. Associations were evaluated between timed-average-mean-maximum velocities (TAMMV), end diastolic velocity (EDV), and peak systolic velocity (PSV) with clinical and hematological parameters.

In this prospective study, a total of 62 consecutive children, previously diagnosed with SCD were recruited. Study population was 9.8±3.9 years old and 31(50%) were male. Hb was 8.64±1.34 Gm/dL while the mean HbS was 6.28±1.06%. 11% of participants showed TAMMV of > 200 cm/s, higher than previous studies across the world. Higher HbS level, history of iron chelation therapy, history of blood transfusion and stroke showed a trend towards having higher TAMMV. A positive spearman correlation was observed among TAMMV, EDV and PSV (p<0.001 for all vessels). All correlations were well above 0.7, with PSV having the strongest correlation with TAMMV (more than 0.9 in all vessels).

Stroke and cerebral hemodynamic alterations are common among Indian children with SCD. A High TAMMV in Indian SCD patients could be due to coexisting variants of other hemoglobinopathies. Our findings, consistent with previous studies, support recommendation of performing TCD according to the STOP trial. This will help in risk stratification and optimization of blood transfusion to reduce stroke and physical disabilities among Indian SCD patients, especially among socioeconomically disadvantaged communities.