NCAA urges sickle cell trait screening for college athletes

Many state newborn screening programs now test for sickle cell disease, which strikes people who carry two copies of a recessive gene, but many college athletes were born prior to the advent of widespread screening, notes a NCAA statement issued in June 2009.

NCAA made the recommendation as part of resolution of a lawsuit by the family of a Rice University football player who had sickle cell trait and died in 2006 shortly after a practice session. The condition, which contributed to his death, was unknown prior to that practice and subsequent testing.

Sickle cell trait differs from sickle cell disease. In sickle cell disease, oxygen-carrying hemoglobin clumps inside red blood cells. The cells become sickle-shaped and can't move through tiny blood vessels. The roughly 80,000 Americans with the condition carry two copies of a recessive gene, one from each parent. The disease causes pain, infections, and eventually, life-threatening organ damage. The approximately 2.5 million Americans with sickle cell trait carry just one copy of the abnormal hemoglobin gene instead of the two needed to cause full disease. These carriers only occasionally experience health problems, including blood in the urine and some blood clumping at high altitudes. Athletes with sickle cell trait are at risk for "exertional sickling," in which intense exercise can cause blood cells to become deformed enough to block blood flow to muscles and cause their rapid deterioration. The National Athletic Trainers Association (NATA) has recorded a dozen sports-related deaths from exertional sickling, mostly among college football players, since 2000.

Most of today's college athletes were born prior to establishment of programs that offer widespread screening for either sickle cell disease or sickle cell trait. However, existing state newborn screening programs primarily aim to find full-blown sickle cell disease and do not always notify parents of babies with sickle cell trait. It is most common among African Americans, 10% who have sickle cell trait.

Other Recommendations
NCAA says its recommendation is based on previous suggestions from the College of American Pathologists (CAP) and NATA. Both organizations suggest that college athletic programs screen athletes who lack documentation of their sickle cell status. Like NCAA, the organizations maintain that athletes with sickle cell trait can participate in college sports. They also promote education to create an environment that encourages trainers and athletes with sickle cell trait to immediately recognize and report any symptoms assumed to be caused by sickling.

These include fatigue, difficulty breathing, and leg or low back pain or cramping. Heat stress, dehydration, asthma, illness, and altitude predispose training athletes with sickle trait to exertional sickling, NATA notes.

Repetitive sprints or interval training induce high lactic acid levels and are very risky for athletes with sickle cell trait. These athletes should be allowed extended recovery between repetitions, NATA says. It adds that athletes with the condition who must train or compete at high altitudes but are unaccustomed to them may have to modify training and should have supplemental oxygen available during competition.

Position statement. Sickle cell trait and the athlete. College of American Pathologists. Issued July 11, 2007. Available online through http://www.cap.org. Accessed August 25, 2009.

Fact sheet. Sickle cell trait and the athlete: Consensus statement. National Athletic Trainers Association. PDF available for download at http://www.nata.org/statements/consensus/SickleCell_FactSheet.pdf through http://www.nata.org. Accessed August 25, 2009.