The American Society of Hematology issued a policy statement Thursday opposing mandatory screening of athletes for sickle cell trait as a prerequisite to athletic participation. Instead ASH, the world’s largest organization devoted to the study of blood disorders, is urging athletics programs to adopt universal preventive interventions in their training programs to protect athletes from exertion-related illness and death.
As stated in an ASH press release, the group’s position is in direct contrast to a policy enacted in 2010 by the 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,” states ASH president-elect Janis Abkowitz of University of Washington School of Medicine in the release. “Furthermore, sickle cell trait is not the only condition that can lead to death from athletic over-exertion, underscoring the need for the 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 and a much smaller percentage of Caucasians. Extreme conditions such as severe dehydration and high-intensity physical activity can lead to serious health issues, including sudden death, in these individuals.
Though complications resulting from the condition remain rare, the NCAA created its mandate as part of a lawsuit settlement stemming from a 2006 fatality at Rice University. Since then, Ole Miss, North Carolina A&T and the University of Central Florida have dealt with cases involving sickle cell trait, and the condition entered the discussion of the potentially fatal condition rhabdomyolysis following the hospitalization of University of Iowa football players in January 2011. Moreover, sports nutritionist Dave Ellis warned AB readers last August of the dangers of stimulant use for athletes with “undiagnosed sickle cell trait.”
In December, 65 sports and health organizations met at the third annual Youth Sports Safety Summit in Washington, D.C., to review a National Athletic Trainers' Association position statement to be published next month in the Journal of Athletic Training. Titled "Preventing Sudden Death in Sports, the statement outlines 10 major health conditions and causes of sudden death among athletes, including exertional sickling. The statement endorses education and precaution, but makes no mention of screening for sickle cell trait.
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. It recommends that schools follow the lead of the U.S. Army, which in 1996 began implementing 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. According to the ASH, the Army has 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,” Abkowitz says. “Until the NCAA moves to universal preventive interventions in its conditioning programs, all student-athletes remain at risk for suffering significant exertion-related injury or death.”
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