The Sickle Cell Complexity

Abstract

Since passage of the National Sickle Cell Anemia Control Act on May 16, 1972, the American public has become increasingly aware of sickle cell disease. This growing cognizance led to the establishment of mass sickle cell anemia testing (SCAT) programs, as well as the institution, in various states, of legislation requiring mandatory screening. With such legislation and mass testing, medical and social questions have arisen concerning previously unconsidered problems associated with the detection of sickle cell anemia and trait. Many investigators regard the trait as a benign condition. However, reports of associated morbidity during periods of "extraordinary physiological stress"¹have generated much controversy regarding its true nature. Additional discussion concerns the effectiveness of mass screening programs for a genetic disease, with a benign carrier state, that has no treatment or preventive modalities presently available other than ineffectual genetic counseling. Since the principal outcome of current mass SCAT programs is