What are the management strategies for Sickle Cell Trait (SCT)?

From the Guidelines

Individuals with Sickle Cell Trait (SCT) can generally lead normal lives, but they require awareness of their condition and precautionary measures in certain situations. According to the updated recommendations for athletes with heart disease 1, individuals with SCT should be aware of their condition, especially before undergoing extreme physical exertion, and inform their healthcare providers.

Key Management Strategies

• Hydration and rest: Individuals with SCT should stay hydrated, especially in high-altitude or high-temperature environments, to prevent complications 1.
• Awareness of acute medical strategies: They should be aware of the signs and symptoms of an emerging event, such as cramping, dyspnea, and muscle pain and weakness, and know how to respond 1.
• Caution in high temperatures or altitudes: Individuals with SCT should exercise caution when engaging in physical activity in high temperatures or altitudes, and avoid extreme exertion 1.
• Routine prenatal care: Pregnant women with SCT should receive routine prenatal care, and their healthcare providers should be aware of their condition to monitor for potential complications.
• Folic acid supplements: They may be advised to take folic acid supplements (typically 0.4-1 mg daily) to support red blood cell production.
• Dehydration prevention: Individuals with SCT should drink plenty of water (at least 8-10 glasses per day) to avoid dehydration, especially in hot or high-altitude environments.

General Guidance

Individuals with SCT can lead normal, active lives, and their condition does not typically require ongoing medical management. However, they should be aware of their condition and take precautions to avoid potential complications, as recommended by the updated guidelines 1.

From the Research

Management Strategies for Sickle Cell Trait (SCT)

• The management of SCT involves increasing knowledge about its clinical manifestations and their prevention and management, which can be a useful tool for all healthcare providers involved in this issue 2.
• Reproductive counseling is of crucial importance for individuals with SCT, as it can be a risk factor for several clinical complications, such as extreme exertional injury, chronic kidney disease, and complications during pregnancy and surgery 2.
• Pregnant women with SCT should be given appropriate pre-conceptual advice and multidisciplinary antenatal and postnatal care, as SCT is associated with adverse pregnancy outcomes, including maternal and neonatal anaemia, low birth weight, and increased risk of stillbirth, miscarriage, and admission to SCBU 3.
• Individuals with SCT can experience the same functional asplenia and increased risk of cerebrovascular accidents, kidney disease, cardiovascular effects, and veno-occlusive diseases as SCD patients when they are exposed to extreme conditions and stressful environments, and therefore require unique management of chronic illnesses such as diabetes mellitus 4.
• SCT-positive individuals may require education and mitigation strategies to reduce the risk of negative health outcomes during intense physical exertion, especially in hot climates and high-elevation locations, or when dehydrated 5.

Clinical Considerations

• SCT can impact the management of chronic illnesses, and healthcare providers should be aware of the potential risks and complications associated with SCT 4.
• SCT-positive individuals may require regular monitoring and follow-up to prevent and manage potential complications, such as splenic infarction and chronic kidney disease 4.
• Healthcare providers should be aware of the potential risks and complications associated with SCT during pregnancy and childbirth, and provide appropriate care and management to reduce the risk of adverse outcomes 3.

Public Health Implications

• The public health implications of SCT are significant, with approximately 300 million people worldwide and 3 million people in the U.S. possessing the trait, and therefore require a coordinated approach to prevention, diagnosis, and management 6.
• Efforts should be made to reduce the stigma associated with SCT and to support SCT-positive individuals in their daily lives and careers, as SCT-positive airmen were found to have similar career and operational outcomes to their SCT-negative peers, with some exceptions 5.