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Intracranial hemorrhage in patients with sickle cell disease.

Sir.—In their recent article van Hoff et al1failed to mention a special group of patients with sickle cell disease who have a characteristic syndrome of post-transfusion hypertension, seizures, and intracranial hemorrhage. We2reported three children (aged 6, 10, and 12 years, respectively) with this syndrome. Two children developed the three components of the syndrome (hypertension, seizure, and intracranial hemorrhage); a spinal tap was not done on the third child. Royal and Seeler3reported two children (aged 8 and 14 years, respectively) with the syndrome; one child had intracranial hemorrhage while the other child had normal cerebrospinal fluid. The only adult patient reported with this syndrome had hypertension and seizures but no intracranial hemorrhage.4A similar syndrome was reported by Wasi et al5in patients with thalassemia major. The pathogenesis is not known; however, it might be multifactorial. Release of a vasopressor substance from