Mandatory Sickle Cell Trait Screening For Athletic Participation Opposed By American Society Of Hematology Policy

Main Category: Blood / Hematology
Also Included In: Sports Medicine / Fitness
Article Date: 30 Jan 2012 - 0:00 PST

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The American Society of Hematology (ASH), the world's largest professional society concerned with the causes and treatment of blood disorders, has issued a policy statement* opposing mandatory screening of athletes for sickle cell trait as a prerequisite to athletic participation and urging athletics programs to adopt universal preventive interventions in their training programs to protect athletes from exertion-related illness and death. ASH's position is in direct contrast to a policy enacted in 2010 by the National Collegiate Athletic Association (NCAA) requiring Division I institutions to perform sickle cell testing for all incoming student athletes.

"Screening alone is an extremely limited approach intended to protect the liability of the NCAA and the athlete's university, not the student athlete," said ASH President-Elect Janis Abkowitz, MD, of the University of Washington School of Medicine in Seattle. "Furthermore, sickle cell trait is not the only condition that can lead to death from athletic over-exertion, underscoring the need for NCAA to require universal preventive interventions in its training programs that will better protect everyone."

Sickle cell trait is an inherited blood disorder that affects approximately 8 percent of African-Americans. Unlike sickle cell disease, a serious illness in which patients have two genes that cause the production of abnormal hemoglobin, individuals with sickle cell trait carry only one defective gene and typically live normal lives. Rarely, extreme conditions such as severe dehydration and high-intensity physical activity can lead to serious health issues, including sudden death, in these individuals.

The ASH policy statement on screening for sickle cell trait and athletic participation, derived from the recommendations of experts in sickle cell biology and care, concludes that current scientific evidence does not justify the screening of all athletes for sickle cell trait as a prerequisite to participation. The ASH policy calls for the implementation of universal preventive interventions that will render screening unnecessary and better protect all athletes from exertion-related illness and death.

The U.S. Army currently utilizes universal preventive interventions for all recruits undergoing training, including monitoring heat acclimatization and work-rest cycles adjusted for the environment, implementing guidelines for hydration, and maintaining staff preparedness for early and rapid detection and treatment of heat illness. The Army began implementing these interventions in 1996 after a military-sanctioned study concluded that such measures successfully prevented subsequent sudden death for all recruits, including those with sickle cell trait. Following the study, the Army discontinued mandatory screening of all incoming recruits for sickle cell trait.

"The U.S. Army protects recruits from exertion-related injury and death, and the NCAA should follow their lead to protect its athletes," said Dr. Abkowitz. "Until the NCAA moves to universal preventive interventions in their conditioning programs, all student athletes remain at risk for suffering significant exertion-related injury or death."

The Society also strongly supports increased biomedical and population-based research examining how sickle cell trait, as well as other clinical conditions, relate to exertion-related illness.

"Our policy serves as a call for additional research in this area that will benefit those with sickle cell trait, help inform public policy, and save lives," said Dr. Abkowitz.

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