Most persons with sickle cell disease (SCD) lack conventional stroke risk factors, yet nearly 50% have evidence of brain infarcts by age 30 years, indicating alternative etiologies for ischemia. We investigated whether accelerated red cell transit affects oxygen extraction and improves following transfusion-induced increases in hemoglobin. Findings suggest that evidence of accelerated capillary transit is present on arterial spin labeling (ASL) MRI, and reduces following transfusion-induced increases in hemoglobin. Furthermore, the relationship between dural ASL signal and brain oxygen extraction evolves following transfusion, suggesting that oxygen delivery is complexly dependent on blood oxygen content and capillary dynamics.
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