Sudden death tied to sickle-cell trait.

Sudden death tied to sickle-cell trait

Black military recruits carrying the abnormal hemoglobin S in their red blood cells are 28 to 40 times more likely to die suddenly during strenuous physical exertion than are recruits without the so-called sickle-cell trait, researchers reported this week. Although scientists have previously reported cases suggesting that people with the trait are more susceptible to death without any known preexisting cause, the current study is the first large-scale look at this phenomenon.

People who inherit hemoglobin S genes from both parents can develop the oftenfatal sickle-cell anemia. Those with an abnormal gene from only one parent, however, have sickle-cell trait, ordinarily considered an innocuous disorder. Approximately 8 percent of the black population in the United States has sickle-cell trait, a condition rare among nonblack Americans. Since oxygen deprivation forces cells with hemoglobin S to become sickle-shaped, researchers have wondered about exercise's effect in people with the trait.

Scientists at Walter Reed Army Institute of Research in Washington, D.C., and the Naval Hospital in Bethesda, Md., evaluated all deaths occurring among the 2 million enlisted recruits receiving basic training in the U.S. military from 1977 through 1981. On the basis of detailed autopsy reports, the researchers conclude in the Sept. 24 NEW ENGLAND JOURNAL OF MEDICINE that the rate of "sudden unexplained death attributable to [sickle-cell trait]' among black recruits was 31 deaths per 100,000. They also calculate that the risk of sudden death for those with the trait is 28 times that for black recruits without hemoglobin S and 40 times that for all recruits, regardless of race.

The authors suggest that although civilian life is "seldom as stressful as basic military training,' studies should be done on sickle-cell trait among others involved in strenuous exercise, such as athletes and heavy laborers. During this study, the Army Medical Corps cautioned recruit training centers in 1982 about the potential risk involved, but a Defense Department spokesman told SCIENCE NEWS there is no set policy regarding the issue.

In an accompanying editorial, Louis W. Sullivan of Atlanta's Morehouse School of Medicine notes that, while the study is important, such findings do not show increased risk in ordinary occupations or in daily life. Sullivan says there should be no subsequent discrimination in employment or insurability against those with sickle-cell trait.