Tags

Type your tag names separated by a space and hit enter

Sickle cell trait: what are the costs and benefits of screening?
J Sports Med Phys Fitness. 2016 Dec; 56(12):1562-1573.JS

Abstract

INTRODUCTION

Eight percent of African Americans are carriers of the sickle cell trait. Some regard this as a benign anomaly, but others point to incidents of sudden exercise-related death, calling for a preliminary screening of either all athletes or those of African-American ancestry. This brief review considers the costs and benefits of such screening.

EVIDENCE ACQUISITION

The Ovid/Health Star data-base was searched from 1996 to June 2015. 2014. The terms "exercise", "exercise therapy", "sports", "athletes", "physical activity/motor activity" and "physical fitness" were combined to yield 227,120 citations. Likewise, the terms "sickle cell trait", "sickle cell disease", "splenic infarction", "hemoglobin S" and "rhabdomyolysis" identified 12,325 citations. A combination of the 2 searches yielded 416 abstracts.

EVIDENCE SYNTHESIS

Excluding items relating to animal research or forms of rhabdomyolysis other than sickling left 375 abstracts; 115 papers merited full examination. This material covered the risks of sickle cell trait and of screening (55 items), effects upon physical performance (31 items), cellular mechanisms (23 items), nutrition (4 items), and other topics (2 items). Supplemented material was drawn from reference lists and personal files. The tendency to sickling was provoked by excessive exercise relative to physical condition in hot or hypoxic conditions, and by local tissue acidosis, conditions that were best avoided by all athletes. The condition had little impact upon physical performance, but the relative risks of heat illness, exertional rhabdomyolysis, splenic infarction and sudden death were all increased by the sickle cell trait. The absolute number of critical incidents was nevertheless small, calling for close assessment of the costs and putative benefits of widespread screening.

CONCLUSIONS

Sports physicians should be aware of the clinical picture of sickling and be prepared to treat it. Screening may be cost-effective if targeted to black athletes involved in certain sports, although it has yet to be demonstrated how far the diagnosis of sickle cell trait reduces the risk of death when exercising in an adverse environment. A better tactic may be to reduce risks for all competitors by educating athletes and their coaches to adopt an intensity of training appropriate to the individual's physical condition, to maintain full hydration, and to avoid exposure to excessive heat and hypoxia.

Authors+Show Affiliations

Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada - royjshep@shaw.ca.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

26842866

Citation

Shephard, Roy J.. "Sickle Cell Trait: what Are the Costs and Benefits of Screening?" The Journal of Sports Medicine and Physical Fitness, vol. 56, no. 12, 2016, pp. 1562-1573.
Shephard RJ. Sickle cell trait: what are the costs and benefits of screening? J Sports Med Phys Fitness. 2016;56(12):1562-1573.
Shephard, R. J. (2016). Sickle cell trait: what are the costs and benefits of screening? The Journal of Sports Medicine and Physical Fitness, 56(12), 1562-1573.
Shephard RJ. Sickle Cell Trait: what Are the Costs and Benefits of Screening. J Sports Med Phys Fitness. 2016;56(12):1562-1573. PubMed PMID: 26842866.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sickle cell trait: what are the costs and benefits of screening? A1 - Shephard,Roy J, Y1 - 2016/02/03/ PY - 2016/2/5/pubmed PY - 2017/4/20/medline PY - 2016/2/5/entrez SP - 1562 EP - 1573 JF - The Journal of sports medicine and physical fitness JO - J Sports Med Phys Fitness VL - 56 IS - 12 N2 - INTRODUCTION: Eight percent of African Americans are carriers of the sickle cell trait. Some regard this as a benign anomaly, but others point to incidents of sudden exercise-related death, calling for a preliminary screening of either all athletes or those of African-American ancestry. This brief review considers the costs and benefits of such screening. EVIDENCE ACQUISITION: The Ovid/Health Star data-base was searched from 1996 to June 2015. 2014. The terms "exercise", "exercise therapy", "sports", "athletes", "physical activity/motor activity" and "physical fitness" were combined to yield 227,120 citations. Likewise, the terms "sickle cell trait", "sickle cell disease", "splenic infarction", "hemoglobin S" and "rhabdomyolysis" identified 12,325 citations. A combination of the 2 searches yielded 416 abstracts. EVIDENCE SYNTHESIS: Excluding items relating to animal research or forms of rhabdomyolysis other than sickling left 375 abstracts; 115 papers merited full examination. This material covered the risks of sickle cell trait and of screening (55 items), effects upon physical performance (31 items), cellular mechanisms (23 items), nutrition (4 items), and other topics (2 items). Supplemented material was drawn from reference lists and personal files. The tendency to sickling was provoked by excessive exercise relative to physical condition in hot or hypoxic conditions, and by local tissue acidosis, conditions that were best avoided by all athletes. The condition had little impact upon physical performance, but the relative risks of heat illness, exertional rhabdomyolysis, splenic infarction and sudden death were all increased by the sickle cell trait. The absolute number of critical incidents was nevertheless small, calling for close assessment of the costs and putative benefits of widespread screening. CONCLUSIONS: Sports physicians should be aware of the clinical picture of sickling and be prepared to treat it. Screening may be cost-effective if targeted to black athletes involved in certain sports, although it has yet to be demonstrated how far the diagnosis of sickle cell trait reduces the risk of death when exercising in an adverse environment. A better tactic may be to reduce risks for all competitors by educating athletes and their coaches to adopt an intensity of training appropriate to the individual's physical condition, to maintain full hydration, and to avoid exposure to excessive heat and hypoxia. SN - 1827-1928 UR - https://www.unboundmedicine.com/medline/citation/26842866/Sickle_cell_trait:_what_are_the_costs_and_benefits_of_screening L2 - http://www.minervamedica.it/index2.t?show=R40Y2016N12A1562 DB - PRIME DP - Unbound Medicine ER -