I read with interest the editorial of O'Connor et al on screening for
the presence of sickle cell trait (SCT) in student athletes (1). Although
some aspects are indeed agreeable, such as the need of continued research
to strengthen the rationale for either continuing or revoking SCT
mandatory testing in student athletes, there is however a drawback in
their analysis that must be clearly emphasized. The cost-effectiveness
analysis was in fact based on the sickle cell solubility test, which is
indeed inappropriate for routine screening of SCT wherein most clinical
laboratories worldwide are now equipped with fully-automated thin-layer
isoelectric focusing (IEF) or high performance liquid chromatography
(HPLC). Clear recommendations against the use of sickle cell solubility
test as a primary screening tool have been recently endorsed by the
British Committee for Standards in Haematology. Both HPLC and IEF are
instead recommended by the U.S. Preventive Services Task Force (USPSTF)
and the British Committee for Standards in Haematology, since they carry
100% sensitivity and specificity for detecting hemoglobin variants,
including hemoglobin S, with a cost comparable to that of a solubility
test. As such, the following analysis of O'Connor et al about the 22
hypothetical "false negatives" cases using the sickle cell solubility
test, as well as the debate on discrimination of SCT from sickle cell
disease (SCD), are seemingly pleonastic. Although we would all agree that
it is still unclear as to whether SCT screening in student athletes is
really cost-effective, further analyses of cost and effectiveness must
entail the correct and most appropriate methodology. Why using a coach for
travelling from Paris to Rome, when we can use an airplane?
References.
1. O'Connor FG, Deuster P, Thompson A. Sickle cell trait: what's a sports
medicine clinician to think? Br J Sports Med. 2012 May 19. [Epub ahead of
print]
2. Ryan K, Bain BJ, Worthington D, James J, Plews D, Mason A, Roper D,
Rees DC, de la Salle B, Streetly A; British Committee for Standards in
Haematology. Significant haemoglobinopathies: guidelines for screening and
diagnosis. Br J Haematol 2010;149:35-49.
3. Lin KW. Screening for sickle cell disease in newborns. Am Fam Physician
2009;79:507-8.
Conflict of Interest:
None declared
I read with interest the editorial of O'Connor et al on screening for the presence of sickle cell trait (SCT) in student athletes (1). Although some aspects are indeed agreeable, such as the need of continued research to strengthen the rationale for either continuing or revoking SCT mandatory testing in student athletes, there is however a drawback in their analysis that must be clearly emphasized. The cost-effectiveness analysis was in fact based on the sickle cell solubility test, which is indeed inappropriate for routine screening of SCT wherein most clinical laboratories worldwide are now equipped with fully-automated thin-layer isoelectric focusing (IEF) or high performance liquid chromatography (HPLC). Clear recommendations against the use of sickle cell solubility test as a primary screening tool have been recently endorsed by the British Committee for Standards in Haematology. Both HPLC and IEF are instead recommended by the U.S. Preventive Services Task Force (USPSTF) and the British Committee for Standards in Haematology, since they carry 100% sensitivity and specificity for detecting hemoglobin variants, including hemoglobin S, with a cost comparable to that of a solubility test. As such, the following analysis of O'Connor et al about the 22 hypothetical "false negatives" cases using the sickle cell solubility test, as well as the debate on discrimination of SCT from sickle cell disease (SCD), are seemingly pleonastic. Although we would all agree that it is still unclear as to whether SCT screening in student athletes is really cost-effective, further analyses of cost and effectiveness must entail the correct and most appropriate methodology. Why using a coach for travelling from Paris to Rome, when we can use an airplane?
References.
1. O'Connor FG, Deuster P, Thompson A. Sickle cell trait: what's a sports medicine clinician to think? Br J Sports Med. 2012 May 19. [Epub ahead of print]
2. Ryan K, Bain BJ, Worthington D, James J, Plews D, Mason A, Roper D, Rees DC, de la Salle B, Streetly A; British Committee for Standards in Haematology. Significant haemoglobinopathies: guidelines for screening and diagnosis. Br J Haematol 2010;149:35-49.
3. Lin KW. Screening for sickle cell disease in newborns. Am Fam Physician 2009;79:507-8.
Conflict of Interest:
None declared