The American Society of Hematology says it doesn’t think student athletes should have to be screened for sickle-cell trait in order to play their sport. Instead, the group says in a policy statement, schools should take steps to protect all athletes from exertion-related illness and death.
The physicians’ position contrasts with that of the National Collegiate Athletic Association, which in 2010 instituted a controversial testing program for all incoming Division I athletes to identify those with the sickle-cell trait.
People with the trait have one abnormal copy of a certain gene; those with two copies have full-blown sickle-cell anemia. About 8% to 10% of African-Americans have sickle-cell trait, which is much more rare among Caucasians.
While people with sickle-cell trait usually have no medical problems, they can rarely experience muscle breakdown, generally “under extreme conditions such as severe dehydration and high-intensity physical activity,” ASH says.
After the preseason training death of a college football player with sickle-cell trait, and a subsequent lawsuit, the NCAA established the testing requirement for all Division I athletes — though there’s an opt-out provision for athletes who have already been tested or who sign a liability waiver.
Janis Abkowitz, president-elect of ASH and head of the hematology division at the University of Washington School of Medicine, says the NCAA policy is “insufficient and overly broad.” First, there’s no clear intervention for those identified with sickle-cell trait by screening. Second, she says that “screening without counseling is wrong,” and that there’s a potential for misinformation among those who learn they’re carriers of the gene.
Finally, she says the screening doesn’t cover other underlying health conditions — such as heart problems — that might make athletes susceptible to harm under strenuous circumstances.
ASH’s alternative to mass screening: “Universal precautions” to protect all athletes, especially in the vulnerable preseason conditioning period when many people are in less-than-ideal shape and are often working out in hot and humid weather. Sports-specific rules on things such as the length of rest and work periods, practice gear and hydration — with someone held accountable for enforcing those rules — would better protect athletes, she says.
The U.S. Army, she says, discontinued screening for sickle-cell trait after instituting its own rules for conditions in basic training and seeing sudden deaths fall across the board.
Abkowitz says ASH has been in contact with the NCAA about the issue. We reached out to the group for comment and will keep you posted if we hear from them.
Image: Associated Press