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Preoperative Screening for Sickle Cell Trait FREE

Santosh Kalhan, MD; Glenn DeBoer
JAMA. 1988;259(24):3558-3558. doi:10.1001/jama.1988.03720240020015
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To the Editor.  —Dr Eichhorn1 gives several reasons against the routine preoperative screening of black patients for sickle cell trait. However, based on available published data, the issue is far from being resolved.All patients with hemoglobin SS disease will not necessarily have been clearly diagnosed prior to the administration of anesthesia. Powars2 describes seven children under 5 years of age not suspected of having any illness who were demonstrated to have hemoglobin SS disease on postmortem studies following sudden death. Death was also the presenting manifestation of undiagnosed hemoglobin SS disease in three children in the Cincinnati area.3 There are several references in the medical literature on increased morbidity and mortality in sickle cell trait with anesthesia, and even if these are anecdotal they cannot be completely ignored.4,5While it is true that all patients must have adequate oxygenation during all types of anesthesia, prior

REFERENCES

Eichhorn JH:  Preoperative screening for sickle cell trait. JAMA 1988;;259:907.
Powars DR:  Natural history of sickle cell disease—the first ten years. Semin Hematol 1975;;12:267-285.
Lobel JS, Cameron BF, Johnson E, et al:  The value of screening umbilical cord blood for hemoglobinopathy. Ohio State Med J 1984;;80:140-142.
McGarry P, Duncan C:  Anesthetic risks in sickle cell trait. Pediatrics 1973;;51:507-512.
Dalal FY, Schmidt AB, Bennett EJ, et al:  Sickle cell trait—a report of a postoperative neurosurgical complication. Br J Anaesth 1974;;46:387-388.
Kark JA, Posey DM, Schumacher HR, et al:  Sickle cell trait as a risk factor for sudden death in physical training. N Engl J Med 1987;;317:781-787.
 Newborn screening for sickle cell disease and other hemoglobinopathies, CONSENSUS CONFERENCE. JAMA 1987;; 258:1205-1209.

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Eichhorn JH:  Preoperative screening for sickle cell trait. JAMA 1988;;259:907.
Powars DR:  Natural history of sickle cell disease—the first ten years. Semin Hematol 1975;;12:267-285.
Lobel JS, Cameron BF, Johnson E, et al:  The value of screening umbilical cord blood for hemoglobinopathy. Ohio State Med J 1984;;80:140-142.
McGarry P, Duncan C:  Anesthetic risks in sickle cell trait. Pediatrics 1973;;51:507-512.
Dalal FY, Schmidt AB, Bennett EJ, et al:  Sickle cell trait—a report of a postoperative neurosurgical complication. Br J Anaesth 1974;;46:387-388.
Kark JA, Posey DM, Schumacher HR, et al:  Sickle cell trait as a risk factor for sudden death in physical training. N Engl J Med 1987;;317:781-787.
 Newborn screening for sickle cell disease and other hemoglobinopathies, CONSENSUS CONFERENCE. JAMA 1987;; 258:1205-1209.
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