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Severe anemia also predisposes to white matter strokes in young children, independent of the anemia subtype. We previously demonstrated symmetrically decreased white matter (WM) volumes in patients with sickle cell disease (SCD). In the current study, we investigated whether patients with non\u2010sickle anemia also have lower WM volumes and cognitive dysfunction. Magnetic Resonance Imaging was performed on 52 clinically asymptomatic SCD patients (age\u2009=\u200921.4 \u00b1 7.7; F\u2009=\u200927, M\u2009=\u200925; hemoglobin = 9.6 \u00b1 1.6 g\/dL), 26 non\u2010sickle anemic patients (age\u2009=\u200923.9 \u00b1 7.9; F\u2009=\u200914, M\u2009=\u200912; hemoglobin\u2009=\u200910.8 \u00b1 2.5 g\/dL) and 40 control subjects (age\u2009=\u200927.7 \u00b1\u200911.3; F\u2009=\u200928, M\u2009=\u200912; hemoglobin\u2009=\u200913.4 \u00b1 1.3 g\/dL). Voxel\u2010wise changes in WM brain volumes were compared to hemoglobin levels to identify brain regions that are vulnerable to anemia. White matter volume was diffusely lower in deep, watershed areas proportionally to anemia severity. After controlling for age, sex, and hemoglobin level, brain volumes were independent of disease. WM volume loss was associated with lower Full Scale Intelligence Quotient (FSIQ; <jats:italic>P<\/jats:italic> =\u2009.0048; r<jats:sup>2<\/jats:sup> =\u2009.18) and an abnormal burden of silent cerebral infarctions (<jats:italic>P<\/jats:italic> =\u2009.029) in males, but not in females. Hemoglobin count and cognitive measures were similar between subjects with and without white\u2010matter hyperintensities. The spatial distribution of volume loss suggests chronic hypoxic cerebrovascular injury, despite compensatory hyperemia. Neurocognitive consequences of WM volume changes and silent cerebral infarction were strongly sexually dimorphic. Understanding the possible neurological consequences of chronic anemia may help inform our current clinical practices.<\/jats:p>","DOI":"10.1002\/ajh.25570","type":"journal-article","created":{"date-parts":[[2019,7,1]],"date-time":"2019-07-01T11:58:19Z","timestamp":1561982299000},"page":"1055-1065","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Anemia predicts lower white matter volume and cognitive performance in sickle and non\u2010sickle cell anemia syndrome"],"prefix":"10.1002","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7165-4691","authenticated-orcid":false,"given":"Soyoung","family":"Choi","sequence":"first","affiliation":[{"name":"Neuroscience Graduate Program University of Southern California  Los Angeles California"},{"name":"Signal and Image Processing Institute University of Southern California  Los Angeles California"},{"name":"Division of Hematology, Oncology and Blood and Marrow Transplantation Children's Hospital Los Angeles  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon H.","family":"O'Neil","sequence":"additional","affiliation":[{"name":"The Saban Research Institute, Children's Hospital Los Angeles  Los Angeles California"},{"name":"Division of Neurology Children's Hospital Los Angeles  Los Angeles California"},{"name":"Department of Pediatrics, Keck School of Medicine University of Southern California  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand A.","family":"Joshi","sequence":"additional","affiliation":[{"name":"Signal and Image Processing Institute University of Southern California  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Li","sequence":"additional","affiliation":[{"name":"Signal and Image Processing Institute University of Southern California  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam M.","family":"Bush","sequence":"additional","affiliation":[{"name":"Division of Hematology, Oncology and Blood and Marrow Transplantation Children's Hospital Los Angeles  Los Angeles California"},{"name":"Biomedical Engineering University of Southern California  Los Angeles California"},{"name":"Radiology Department Stanford University  Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9878-6029","authenticated-orcid":false,"given":"Thomas D.","family":"Coates","sequence":"additional","affiliation":[{"name":"Division of Hematology, Oncology and Blood and Marrow Transplantation Children's Hospital Los Angeles  Los Angeles California"},{"name":"Department of Pediatrics, Keck School of Medicine University of Southern California  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard M.","family":"Leahy","sequence":"additional","affiliation":[{"name":"Neuroscience Graduate Program University of Southern California  Los Angeles California"},{"name":"Signal and Image Processing Institute University of Southern California  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Wood","sequence":"additional","affiliation":[{"name":"Division of Hematology, Oncology and Blood and Marrow Transplantation Children's Hospital Los Angeles  Los Angeles California"},{"name":"Department of Pediatrics, Keck School of Medicine University of Southern California  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,7,23]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"World Health Organization. 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