Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Ann Hematol. 2019 Oct;98(10):2267-2271. doi: 10.1007/s00277-019-03765-0. Epub 2019 Aug 6.
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.
脑内静息性病灶可能与β地中海贫血重型（BTM）和中间型（BTI）患者的显性脑血管意外有关。阿司匹林可能对这些患者具有保护作用。我们评估了地中海贫血患者的脑磁共振成像（MRI），以观察阿司匹林是否具有保护作用。2018 年，在设拉子血液学研究中心，我们对 35 例地中海贫血患者（22 例 BTI 和 13 例 BTM）进行了一项历史性队列研究。患者的中位年龄为 32 岁，范围为 8 至 42 岁。24 例（68.6%）为女性。首次 MRI 中，10 例（28.6%）患者存在脑白质病变（WML）。3 年后，3 例患者出现新病灶，第二次 MRI 中，13 例（37.1%）患者出现 WML。此外，在 3 例患者中，WML 数量增加。与基线相比，出现新病灶或更多病灶的患者明显比其他组年龄更大（中位年龄 36.5 岁 vs. 31 岁，P = 0.046）。关于阿司匹林的使用，与其他组的 10 例（34.5%）相比，仅 1 例（16.7%）有新病灶的患者使用了阿司匹林（P = 0.640）。血小板增多、脾切除术、严重铁过载和年龄较大（>30 岁）的高危患者应密切随访，并定期评估，至少每 3 年进行一次脑 MRI。阿司匹林可能对新的或进展性脑病变具有保护作用，因此建议高危地中海贫血患者使用低剂量阿司匹林。
