Reductions in white matter integrity are associated with neurocognitive dysfunction in sickle cell anemia (SCA) patients, but the aetiology is poorly understood. Aiming to explore whether anemia severity, silent cerebral infarction (SCI), and vascular abnormalities may all play a role, we conducted tract-based-spatial statistics in 62 Tanzanian children with SCA. We found anemia severity to be independently associated with increased mean and axial diffusivity, SCI with increased radial diffusivity, and turbulence or vasculopathy with reduced fractional anisotropy. Our findings are consistent with a model of neurological complications in which these pathologies may all contribute to functionally-significant reductions in tissue integrity.
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