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Frequency of silent brain lesions and aspirin protection evaluation over 3 years follow-up in beta thalassemia patients

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Abstract

Silent brain lesions might be associated with overt cerebrovascular accident over time in beta thalassemia major (BTM) and intermediate (BTI). Aspirin may be protective in these patients. We evaluated brain magnetic resonance imaging (MRI) in thalassemia patients to see whether aspirin is protective or not. A historical cohort study was conducted on 35 thalassemia patients, 22 BTI, and 13 BTM patients at Shiraz Hematology Research Center in 2018. Median age of the patients was 32 years and ranged from 8 to 42 years. Twenty-four patients (68.6%) were females. Overall frequency of white matter lesions (WMLs) in the first MRI was 10 patients (28.6%). After 3 years, 3 patients developed new lesions and the frequency of WMLs was 13 patients (37.1%) in the second MRI. Moreover, in 3 patients, number of WMLs increased. Patients with new lesions or more lesions compared to the baseline were significantly older than the other group (median age 36.5 years vs. 31 years, P = 0.046). Regarding aspirin consumption, only 1 patient (16.7%) of patients with new lesions was using aspirin compared to 10 (34.5%) of the other group (P = 0.640). The high-risk patients with thrombocytosis, splenectomy, severe iron overload, and older age (> 30 years) should be under close follow-up and evaluated on a regular periodic basis as well as brain MRI at least once every 3 years. Aspirin could be protective against new or progressive brain lesions so that low-dose aspirin is recommended in high-risk thalassemia patients.

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References

  1. Karimi M, Yavarian M, Afrasiabi A, Dehbozorgian J, Rachmilewitz E (2008) Prevalence of beta-thalassemia trait and glucose-6-phosphate dehydrogenase deficiency in Iranian Jews. Arch Med Res 39(2):212–214. https://doi.org/10.1016/j.arcmed.2007.09.001

    Article  CAS  PubMed  Google Scholar 

  2. Wong V, Yu Y, Liang R, Tso W, Li A, Chan T (1990) Cerebral thrombosis in beta-thalassemia/hemoglobin E disease. Stroke 21(5):812–816

    Article  CAS  PubMed  Google Scholar 

  3. Taher AT, Musallam KM, Karimi M, El-Beshlawy A, Belhoul K, Daar S, Saned M-S, El-Chafic A-H, Fasulo MR, Cappellini MD (2010) Overview on practices in thalassemia intermedia management aiming for lowering complication rates across a region of endemicity: the OPTIMAL CARE study. Blood 115(10):1886–1892

    Article  CAS  PubMed  Google Scholar 

  4. Karimi M, Cohan N, De Sanctis V, Mallat NS, Taher A (2014) Guidelines for diagnosis and management of Beta-thalassemia intermedia. Pediatr Hematol Oncol 31(7):583–596

    Article  CAS  PubMed  Google Scholar 

  5. Eldor A, Rachmilewitz EA (2002) The hypercoagulable state in thalassemia. Blood 99(1):36–43

    Article  CAS  PubMed  Google Scholar 

  6. Pignatti CB, Carnelli V, Caruso V, Dore F, De Mattia D, Di Palma A, Di Gregorio F, Romeo M, Longhi R, Mangiagli A (1998) Thromboembolic events in beta thalassemia major: an Italian multicenter study. Acta Haematol 99(2):76–79

    Article  Google Scholar 

  7. Taher A, Isma’eel H, Mehio G, Bignamini D, Kattamis A, Rachmilewitz EA, Cappellini MD (2006) Prevalence of thromboembolic events among 8,860 patients with thalassaemia major and intermedia in the Mediterranean area and Iran. Thromb Haemost 95(04):488–491

    Article  CAS  Google Scholar 

  8. Zafeiriou DI, Economou M, Athanasiou-Metaxa M (2006) Neurological complications in β-thalassemia. Brain Dev 28(8):477–481

    Article  PubMed  Google Scholar 

  9. Karimi M, Khanlari M, Rachmilewitz EA (2008) Cerebrovascular accident in β-thalassemia major (β-TM) and β-thalassemia intermedia (β-TI). Am J Hematol 83(1):77–79

    Article  PubMed  Google Scholar 

  10. Karimi M, Bagheri H, Rastgu F, Rachmilewitz EA (2010) Magnetic resonance imaging to determine the incidence of brain ischaemia in patients with β-thalassaemia intermedia. Thromb Haemost 103(5):989–993

    Article  CAS  PubMed  Google Scholar 

  11. Karimi M, Haghpanah S, Bagheri MH, Bordbar MR, Pishdad P, Rachmilewitz EA (2012) Frequency and distribution of asymptomatic brain lesions in patients with β-thalassemia intermedia. Ann Hematol 91(12):1833–1838

    Article  CAS  PubMed  Google Scholar 

  12. Karimi M, Toosi F, Haghpanah S, Pishdad P, Avazpour A, Rachmilewitz EA (2016) The frequency of silent cerebral ischemia in patients with transfusion-dependent β-thalassemia major. Ann Hematol 95(1):135–139

    Article  CAS  PubMed  Google Scholar 

  13. Sandercock P, Gubitz GJ, Foley P, Counsell C (2003) Antiplatelet therapy for acute ischaemic stroke. Cochrane Database Syst Rev (2):CD000029

  14. Ali N, Srey R, Pavlakis S (2012) Hemoglobinopathies and stroke: strategies for prevention and treatment. Curr Treat Options Cardiovasc Med 14(3):227–236

    Article  PubMed  Google Scholar 

  15. Adams HP Jr, Del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C (2007) Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation 115(20):e478–e534

    Article  PubMed  Google Scholar 

  16. Taher AT, Otrock ZK, Uthman I, Cappellini MD (2008) Thalassemia and hypercoagulability. Blood Rev 22(5):283–292

    Article  PubMed  Google Scholar 

  17. Haghpanah S, Karimi M (2012) Cerebral thrombosis in patients with β-thalassemia: a systematic review. Blood Coagul Fibrinolysis 23(3):212–217

    Article  CAS  PubMed  Google Scholar 

  18. Taher A, Musallam K, Nasreddine W, Hourani R, Inati A, Beydoun A (2010) Asymptomatic brain magnetic resonance imaging abnormalities in splenectomized adults with thalassemia intermedia. J Thromb Haemost 8(1):54–59

    Article  CAS  PubMed  Google Scholar 

  19. Karimi M, Haghpanah S, Pishdad P, Rachmilewitz EA (2016) Frequency of silent cerebral ischemia in patients with transfusion-dependent β-thalassemia major compared to healthy individuals. Ann Hematol 95(8):1387–1387

    Article  PubMed  Google Scholar 

  20. Pazgal I, Inbar E, Cohen M, Shpilberg O, Raanani P, Rachmilewitz E, Stark P (2014) C0431: high incidence of thrombotic cerebral lesions in adult patients with beta-thalassemia major. Thromb Res 133:S116

    Article  Google Scholar 

  21. Fibach E, Rachmilewitz EA (2010) The role of antioxidants and iron chelators in the treatment of oxidative stress in thalassemia. Ann N Y Acad Sci 1202(1):10–16

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

I would like to express my appreciation to Professor Eliezer A Rachmilewitz who provided valuable collaboration and support to this research, but sadly passed away before finishing this study. Peace be upon him.

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Authors and Affiliations

  1. Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

    Mehran Karimi, Sezaneh Haghpanah, Zohreh Zahedi, Shirin Parand & Sanaz Safaei

  2. Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

    Parisa Pishdad

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  1. Mehran Karimi
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  2. Sezaneh Haghpanah
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  3. Parisa Pishdad
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  4. Zohreh Zahedi
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  5. Shirin Parand
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  6. Sanaz Safaei
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Correspondence to Mehran Karimi.

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Karimi, M., Haghpanah, S., Pishdad, P. et al. Frequency of silent brain lesions and aspirin protection evaluation over 3 years follow-up in beta thalassemia patients. Ann Hematol 98, 2267–2271 (2019). https://doi.org/10.1007/s00277-019-03765-0

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