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Sickle cell trait: what's a sports medicine clinician to think?
  1. Francis G O'Connor1,
  2. Patricia Deuster2,
  3. Alexis Thompson3
  1. 1Department of Military and Emergency Medicine, USUHS, Fairfax Station, Maryland, USA
  2. 2Department of Military Medicine, Uniformed Services University, Bethesda, Maryland, USA
  3. 3Department of Pediatrics, Northwestern University, Chicago, Illinois, USA
  1. Correspondence to Francis G O'Connor, Department of Military and Emergency Medicine, USUHS, 7305 Scarlet Oak Ct, Fairfax Station, Maryland 22039, USA; francis.oconnor{at}

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In April of 2010, the National Collegiate Athletic Association (NCAA), supported by other professional organisations (College of American Pathologists 2007; National Athletic Trainers' Association 2007) approved mandatory testing for the presence of sickle cell carrier status in student athletes participating in Division I sports. This action was in part a response to the legal case against the NCAA and Rice University brought forward by the family of Dale Lloyd II. Dale Lloyd's death was attributed to exertional rhabdomyolysis associated with sickle cell trait; this association has been described in the medical literature in athletes, as well as in military populations.1

The story so far

Mandatory testing, although implemented to prevent future deaths, has generated controversy. Whereas some believe that screening or a priori knowledge of sickle cell trait (SCT) status may potentially save lives, others argue that screening may do more harm than good. In January 2012, the American Society of Haematology (ASH), which represents over 16 000 physicians and researchers, issued a statement opposing SCT testing and/or disclosure of status as a prerequisite for athletic participation.2 They stated that screening cannot be justified based on current scientific evidence. In contrast, ASH supports implementation of universal guidelines to reduce exertion-related injuries and deaths. Given the strong and contrasting opinions, physicians and other providers are left wondering how to properly advise athletes, in particular those who may not fall under recommendations of the NCAA. Their policy has been supported by several other medical organisations, including the American Society of Pediatric Hematology Oncology, American Public Health Association, Sickle Cell Disease Association of …

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  • Competing interests Dr Thompson is a member of the American Society of Hematology. Dr O’Connor and Dr Deuster both work for the Department of Defense. There opinions, however, are personal and do not reflect opinions of the US Army, the Military Health System or the Department of Defense.

  • Provenance and peer review Not commissioned; externally peer reviewed.