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Background on sickle cell trait and the NCAA

Editor’s note: A commentary in The New England Journal of Medicine on Thursday discussed and critiqued the NCAA’s sickle cell trait testing requirements and recommendations. The following explains the Association’s policies and educational efforts related to this topic.

Mandatory sickle cell testing in Division I focuses on keeping student-athletes as safe as possible. Division I colleges and universities collectively determined that 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.

In Division I, legislation was adopted in April that requires institutions, as part of the medical examination required for all incoming student-athletes before athletics participation, to include a sickle cell solubility test. The testing requirement began August 1 and follows recommendations from the National Athletic Trainers’ Association and the College of American Pathologists.

Sickle cell trait screening is normally performed at birth on all babies born in the United States. But because some student-athletes may not know if they carry the trait, the new NCAA legislation adds a verification mechanism that helps ensure safety precautions are maximized.

If a Division I student-athlete has concerns with sickle cell trait testing, he or she can choose to opt out of the test. The testing is not required if documented results of a prior test are provided to the institution. Should a student-athlete decline the test, he or she must sign a statement releasing the institution of liability if that student-athlete were to participate and experience complications due to sickle cell trait.

According to the NCAA Sports Medicine Handbook, colleges and universities should provide resources to educate student-athletes about risk factors specifically associated with physical activity for individuals with sickle cell trait.

Each member institution plays a critical role in protecting the health and well-being of students-athletes. The health and safety principle of the NCAA constitution states that each member campus must protect the health of, and provide a safe environment for, each of its participating student-athletes. Participation in intercollegiate athletics involves unavoidable exposure to an inherent risk of injury, but as data and science dictate, the NCAA membership makes necessary additions to its health and safety measures to provide a safe environment for all who compete.   

The NCAA has been a longstanding leader in protecting the health and well-being of student-athletes. Since 1975, the NCAA Sports Medicine Handbook has informed the membership and public about potential physical complications due to sickle cell trait while participating in athletics. The NCAA added a specific recommendation to its Sports Medicine Handbook in 2009 that athletics departments confirm sickle cell trait status in all student-athletes during the medical examination. The recommendation specifies that if a test is positive, the student-athlete should be offered counseling on the implications of sickle cell trait, including health, athletics and family planning.   

NCAA Divisions II and III are currently studying potential sickle cell testing legislation options that could best serve their respective division models. The Sports Medicine Handbook best practice recommendations apply to all NCAA divisions.

As outlined in the Sports Medicine Handbook, if a student-athlete tests positive for sickle cell trait, coaches and athletic trainers should take the following precautions, including but not limited to:

• Develop a year-round strength and conditioning program.
• Train the athlete with paced progressions, allowing longer periods of rest and recovery.
• Learn the symptoms – muscle cramping, pain, swelling, weakness, difficulty breathing or fatigue – and stop activity if they appear.
• Encourage the athlete to immediately report any symptoms to the athletic trainers or coaches without fear of reprisal.
• In conditions of extreme heat or high altitude, or when the athlete has asthma or is ill, either adjust the workout with an emphasis on hydration or cancel the workout.
• Should the athlete experience unusual duress, seek medical attention immediately.

The NCAA Sports Medicine Handbook guideline on the student-athlete with sickle cell trait contains additional information and precautions.

Watch a video below.

 

The NCAA provides educational materials to its members and the public online at:  http://www.ncaa.org/wps/wcm/connect/public/NCAA/Student-Athlete-Experience/Student-Athlete-Well-Being/Sickle-Cell-Trait-Materials-and-Resources

• Sickle Cell Trait - A Fact Sheet for Coaches (2010)
• Sickle Cell Trait - A Fact Sheet for Student-Athletes (2010)
• NCAA Division I Sickle Cell Trait QA for institutions