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ASH opposes extension of NCAA sickle cell trait screening policy
The American Society of Hematology recently issued a statement expressing its opposition to the National Collegiate Athletic Association’s decision to require all student-athletes at Division III institutions to undergo screening for sickle cell trait.
Janis L. Abkowitz
“ASH believes the NCAA policy is medically groundless — perhaps even dangerous — and is focused more on protecting the NCAA from legal liability than protecting the health of student-athletes,” ASH President Janis L. Abkowitz, MD, said in the statement.
The screening requirement — already in effect at Division I and Division II institutions — requires all first-year and transfer students at Division III institutions to provide confirmation of sickle cell trait status by the 2013-2014 academic year. All other Division III student-athletes will be required to provide such confirmation by the 2014-2015 academic year.
The roughly 2 million Americans who have sickle cell trait — an inherited blood disorder — are carriers of one of the two defective globin genes associated with sickle cell disease, which causes production of abnormal hemoglobin. About 8% of blacks have sickle cell trait; the condition is much less common in the white population.
In rare cases, sickle cell trait can trigger severe distress during periods of intense physical activity or dehydration.
Twenty-three young athletes with sickle cell trait have died in the past 30 years, and complications from the trait were considered the primary cause of death in 15 of those cases, according to the US National Registry of Sudden Death in Athletes.
One of those athletes — Dale Lloyd II, a 19-year-old Rice University freshman — collapsed during practice in 2006 and later died of complications related to previously undiagnosed sickle cell trait. Lloyd’s parents sued Rice and the NCAA. As part of a 2009 settlement, the NCAA required all incoming Division I athletes to undergo sickle cell solubility tests as a prerequisite to athletic participation.
That policy — which includes an opt-out provision for students who provide results of a prior test, as well as for those who sign a waiver of liability against the NCAA and its respective institutions — took effect in fall 2010. It was extended to Division II institutions in summer 2012.
The schools determined mandatory screening “is the best way to raise awareness among student athletes and coaches and prevent potential serious illness or death in student-athletes who may carry the trait,” according to a background statement on the NCAA website.
Abkowitz called the NCAA policy “broad and insufficient.” It also “attributes risk imprecisely, obscures consideration of other relevant risk factors, and can lead to stigmatization or racial discrimination,” she said.
ASH instead called for the NCAA to require its athletic programs to adopt universal preventive interventions in their training programs to protect all athletes from exertion-related illness and death. Examples of interventions previously studied in US Army recruits included adjustable work-rest cycles, hydration guidelines and ensuring staff members are trained to detect heat illness.
“To save lives, screening needs to be accompanied by effective preventive interventions,” Abkowitz said. “While neither screening nor universal precautions will provide complete protection, universal precautions will mitigate risk and have no potential harm.”