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ASH Opposes Routine Testing of College Athletes for Sickle Cell Trait

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May 18, 2012

In April 2010, the National Collegiate Athletic Association (NCAA) adopted the policy of screening all incoming athletes for the sickle-cell trait (see In the News: NCAA urges sickle cell trait screening for college athletes). In January 2012, the American Society of Hematology (ASH), the world's largest professional society concerned with the causes and treatment of blood disorders, issued a policy statement opposing this practice as unnecessary and possibly harmful, recommending instead universal procedures that prevent exertion-related collapse in all athletes.

People with sickle cell trait have one copy and are therefore carriers of a mutant gene that causes production of abnormal hemoglobin, the substance in red blood cells that helps carry oxygen. When a person has two copies (one from each parent) of the gene, they have sickle cell disease. This is associated with sickle-shaped red cells that are deformed and rigid and therefore cannot pass through tiny blood vessels, which can result in devastating health consequences, including severe anemia, pain and life-threatening organ damage. However, the majority (about 60%) of the hemoglobin in those with sickle cell trait is normal. As a result, people with this trait can have normal life spans without serious health consequences. It affects 1-3 million individuals in the U.S. and an estimated 8-10% of African Americans.

Athletes with sickle cell trait are at risk for "exertional sickling," a condition in which intense exercise can cause blood cells to become deformed enough to block the blood flow to muscles and cause rapid muscle deterioration. In 2007, the National Athletic Trainers Association stated that 9 athletes had collapsed during exercise due to complications from sickle cell trait and died, and that of 136 sudden, sports-related deaths not due to trauma among high school and college athletes over the previous ten years, 5% were due to exertional sickling.

In April 2010, the NCAA adopted a policy requiring Division 1 colleges to test for sickle cell trait in all incoming student athletes. The policy arose from a lawsuit following the death of a Rice University football player during pre-season training who was later found to have sickle cell trait. Most college athletes were born prior to widespread and routine screening, and existing state newborn screening, which aims primarily to find full-blown sickle cell disease, does not always notify parents of babies with sickle cell trait. The NCAA believes that screening can protect athletes who lack documentation of their sickle cell status.

In January 2012, ASH issued a policy opposing the NCAA policy of mandatory sickle cell trait screening for incoming athletes, saying that current scientific evidence does not justify routine screening. The policy argues further that current NCAA policy has the potential to harm student athletes and the larger population with sickle cell trait. Routine screening is not always accurate in its risk assessment; it obscures consideration of other relevant factors, fails to incorporate appropriate counseling, and could lead to stigma and racism by focusing on the African American community. Based on expert findings in sickle cell biology, ASH urges instead that college athletic programs implement universal preventive interventions that will make screening unnecessary and better protect all athletes for exertion-related illness and death. ASH notes that this approach is used by the U.S. Army.

In its policy statement, ASH strongly supports increased research examining how sickle cell trait, as well as other clinical conditions, relate to exertion-related illness. New knowledge gained from the research should both benefit individuals with sickle cell trait and help inform public policy.

Several other health care professional organizations support the ASH policy, including the Sickle Cell Disease Association of America (SCDAA), the American Society of Pediatric Hematology/Oncology (ASPHO), American Public Health Association (APHA), Association of Public Health Laboratories (APHL), and the American Society of Clinical Pathology (ASCP).

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

ASH Policy Opposes Mandatory Sickle Cell Trait Screening for Athletic Participation, Recommends Universal Training Interventions & Additional Research. January 26, 2012. Available online at http://www.hematology.org/News/2012/7703.aspx through http://www.hematology.org. Accessed May 2012. 

Statement on Screening for Sickle Cell Trait and Athletic Participation. January 26, 2012. Available online at http://www.hematology.org/advocacy/policy-statements/7704.aspx through http://www.hematology.org. Accessed May 2012.

Docs Contradict NCAA on Sickle Cell Trait Tests. By Cole Petrochko, Associate Staff Writer. MedPage Today. Published: January 27, 2012. Available online through http://www.medpagetoday.com. Accessed May 2012. 

National Athletic Trainers' Association. The National Athletic Trainers' Association (NATA) releases "Sickle Cell Trait and the Athlete" consensus statement. June 27, 2007. Available online at http://www.nata.org/NR062107 through http://www.nata.org. Accessed May 2012. 

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