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DII moves toward start of testing for sickle cell trait

By Brian Hendrickson

When Tom Ryan learned that the Division II Management Council overwhelmingly approved testing for sickle cell trait earlier this month, the news struck the Eckerd men’s basketball coach as an obvious decision.

The trait has been a hot-button health subject in high-level athletics in recent years after it was blamed in the deaths of high school and college athletes. In the last two years, the NCAA has addressed concerns by promoting testing of incoming student-athletes. Division I schools approved testing legislation in 2010, which required all of its member institutions to offer a sickle cell test to incoming student-athletes beginning that fall. Division II will now follow on Aug. 1 after the membership approved a similar testing program by a 242-34-5 vote during the 2012 NCAA Convention. Division III is also considering that legislation and could vote on a proposal next January.

To Ryan, who has confronted the trait within his own program and understands its potential for harm, there was no other choice to make.

“I don’t know why anyone would be against it,” Ryan said. “Why would you not do something that could possibly help a kid that can help him figure out what he has and take care of it, or save a life?”

Testing did just that for Tritons guard Lance Kearse, who struggled through two seasons with the trait’s adverse health effects. Like some trait carriers, Kearse never experienced symptoms until he was in the midst of intense periods of exercise, such as conditioning drills or games. At that point, the sickle hemoglobin gene he inherited caused his red blood cells to warp into sticky half-moon shaped cells, which can block blood vessels and deprive muscles and organs of oxygen.

The trait presents differently for each patient depending on their physiology. Eckerd’s medical staff said Kearse’s symptoms were acute: severe full-body cramping episodes and rhabdomyolysis that led to multiple hospital visits. A test before his junior season uncovered the trait, and he and his trainers have since worked on developing treatment and game-management strategies to help Kearse enjoy a healthy finish to his career.

After receiving an extra year of eligibility from the NCAA, Kearse is having the most successful season of his career, leading Eckerd in scoring through 17 games (a career-high 17.4 points per game) as well as in rebounding (6.1 rpg) and  blocks (1.0 bpg) in a career-best 27.6 minutes per game.

With Kearse providing a successful example, Eckerd started its own sickle cell screening program two years ago along with Charleston (West Virginia), where Athletics Director Bren Stevens has been an advocate for testing. But most schools needed to be educated on the issue, which only recently became a focus of discussions.

Ann Martin, athletic director at Regis (Colo.) and chair of the Division II Management Council, admits she wasn’t aware of sickle cell trait or its potential for harm until testing discussions started two years ago. But throughout that discussion period, Martin said the NCAA’s Committee on Safeguards and Medical Aspects of Sport presented studies to council members, conducted education sessions, and made presentations to both the Division II Management Council and Student Athlete Advisory Committee.

Martin said those education efforts helped ease concerns, which included the cost of testing and handling of the results, and became the core reason the Division II membership overwhelmingly passed the testing legislation.

“It definitely brought awareness that we didn’t have before,” Martin said. “I think when you do that (education) on the front end people feel more comfortable signing on to something – especially when it comes to student-athlete safety.”

Mandatory testing remains a polarizing subject in the medical community, though. The American Hematology Society issued a statement Thursday opposing the NCAA’s testing program, citing the potential for discrimination as a reason for opposing testing. The ASH also described screening as a limited approach to prevention.

In place of testing, the AHS said it favors “universal preventative interventions that will render screening unnecessary,” offering as examples policies for heat acclimatization, work-rest cycles and guidelines for hydration implemented by the Army.

The NCAA’s Sport Medicine Handbook, however, already lays down guidelines for both preseason conditioning and sickle cell trait precautions that parallel the ASH’s recommendations, including a 10- to 14-day heat acclimatization period.

And a recent study from Health Services Research and Educational Trust supported the effectiveness of testing: Its analysis of the NCAA’s program estimated that the screening program would identify 2,123 trait carriers in a single four-year class, and the intervention procedures resulting from those discoveries would prevent seven deaths over a decade.

In addition, Stevens said Charleston’s testing program has helped raise awareness and initiated education among its athletes and athletic department staff. That increased awareness, she said, adds another layer of prevention.

“We’re not just saying, ‘You have to get this test,’ Stevens said. “When we talk about that with our student-athletes, it’s an educational process. … All of us are smarter today (about the issue) than we were two years ago.”