CLINICAL NEWS
Sickle Cell Trait Not Associated With Increased Risk of Death
in African-American U.S. Army Soldiers
Research has suggested that sickle cell trait (SCT) contributes to elevated risks of exertional rhabdomyolysis
(muscle deterioration due to extreme physical exertion) and death, particularly among people who engage
in strenuous physical activities, such as professional
athletes and military personnel. Results from a retrospective, longitudinal study of nearly 48,000 AfricanAmerican U.S. Army soldiers found that SCT was not
associated with a higher overall risk of death, though it
was associated with a higher risk of exertional rhabdomyolysis, compared with soldiers without SCT.
The study, published in The New England Journal
of Medicine, was conducted by D. Alan Nelson, PhD,
from the Department of Medicine at Stanford University School of Medicine, and colleagues.
“Many organizations proceed with caution regarding the potential for exertion-related events among
persons with SCT who are exposed to demanding
physical training,” Dr. Nelson and colleagues wrote,
with some using universal screening for SCT. However,
organizations like the American Society of Hematology have raised concerns that mandatory SCT screening could lead to stigmatization and discrimination.
“These concerns warrant consideration, especially
given the absence of published evidence that such
screening is effective in preventing exertion-related
events.”
Using data from the Stanford Military Data Repository, which comprises all digitally recorded medical
and administrative data for military personnel, Dr.
Nelson and co-authors identified 47,944 AfricanAmerican soldiers who had undergone hemoglobin
AS (HbAS) testing (either before or during the study
period) and were on active duty between January 2011
and December 2014: 3,564 had SCT (of whom 69.8%
were men) and 44,380 did not have SCT (71.7% of
whom were men).
tive, randomized, controlled trials.”
Additional analyses are in development in collaboration with the European
Group for Blood and Marrow Transplantation to validate these results in a larger
international patient cohort.
The study is limited by its observational registry design and patients’ treatment
included different interventions that could
have been influenced by treating centers’
or physicians’ preferences. In addition,
the study did not evaluate quality of life or
other patient-reported outcomes, which
are important to the impact of chronic