Sickle cell trait testing considered

Nearly one year after the death of reserve linebacker Aaron O’Neal, an MU football player whose death some medical experts partially attributed to a common blood disorder, college sports trainers and team doctors are again considering whether to require preseason tests of all athletes for sickle cell trait.

Bob Blitz, one of two St. Louis attorneys for Lonnie O’Neal, the former player’s father, said testing for the trait is a nice idea but comes too late to help O’Neal, 19, who collapsed at a voluntary practice July 12 and died after being taken to University Hospital in the back of a truck.

“They’re a little late, almost two years,” Blitz said.

NCAA guidelines treat the hereditary condition found in an estimated 8 to 10 percent of the U.S. black population as a “benign condition” and ask members only to consider voluntary testing.

Chad Moller, MU Athletic Department spokesman, said the university does not have plans to start testing for the condition.

“We have not automatically tested for that in the past, and I don’t know if that’s going to change or not,” Moller said.

A growing number of trainers and team physicians — particularly at other schools in the Southeast and the Sun Belt, where intense heat and dehydration can increase the risk of exercise-related injuries and deaths — are calling for mandatory sickle cell testing.

“The more (athletes) understand about their personal health history, the better they can take care of themselves,” said Ron Courson, director of sports medicine at the University of Georgia.

However, retired Army physician and researcher John Kark, whose extensive research on the sickle cell trait in the military helped prevent deaths at U.S. boot camps that used his safety guidelines, said testing isn’t really necessary for athletes because methods to keep athletes healthy in the heat are the same for athletes regardless of whether they have the trait.

“The preventative management of this risk is common sense methods to prevent the stress of exercise and heat exposure,” Kark said.

Courson and other members of the National Athletic Trainers’ Association, in conjunction with the NCAA, will hold a summit in early 2007 to explore the link between sickle cell trait and risk to athletes.

Should a consensus emerge at the meeting, the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports could then amend its Sports Medicine Handbook, said David Klossner, the NCAA’s associate director of education outreach.

The medical handbook is a 115-page set of guidelines, not rules, he said. The goal would be for schools to more closely monitor athletes with the trait.

Kark said that general preventative methods such as checking the heat index, making sure that athletes drink water on breaks, wearing light-weight clothing and immediately treating athletes who complain of heat-related dizziness or weakness is the best way to prevent sickle cell-related deaths.

“It’s something that everybody should be doing anyway,” Kark said. “I think you’re wasting time and money testing people for (sickle cell) trait.”

Individuals with sickle cell trait have one normal gene for hemoglobin, the protein in red blood cells, and one abnormal gene. Unlike normal, rounded red blood cells, the sickle-shaped cells carry less oxygen and can clog blood vessels that flow to the heart and other muscles.

The trait is distinct from sickle cell disease, a condition that affects far fewer people and in which two abnormal genes are present.

The official cause of death for Aaron O’Neal was viral meningitis. But the chairman of MU’s pathology department and several outside experts suggested that sickle cell trait was a contributing factor.

O’Neal collapsed on the field about 45 minutes into an hour-long voluntary workout last summer and died later that afternoon. An autopsy report and medical examiner investigation found he repeatedly lost his balance during a stretching exercise and complained of blurred vision.

Blitz said the school “absolutely should have” tested O’Neal and other athletes for the genetic disorder information because it could have made a difference in the treatment he received that day.

“Had they known about it, and had they known the symptoms, he’d be alive today,” Blitz said.

Lonnie O’Neal has filed suit against Missouri athletics director Mike Alden, head football coach Gary Pinkel, team medical director Rex Sharp and 11 trainers and strength coaches. Deborah O’Neal, the player’s mother, later joined the suit. The lawsuit accuses university officials of failing to recognize signs of medical distress that could have prevented O’Neal’s death.

“These guys were obviously oblivious to the symptoms of sickle trait that he had,” Blitz said.