Sickle cell trait and diving: review and recommendations

Sickle cell trait, once thought to be a benign condition, has been associated with complications which may be of concern to the diver, such as splenic infarction and exercise-related sudden death. Medical clearance to dive for those with this common hemoglobinopathy has been a source of debate, with differing recommendations for both civilian and military candidates. To assess this disparity, a review was conducted of published findings and opinions regarding sickle cell trait and fitness to dive.

Literature search was conducted using PubMed/Medline. Keywords included sickle cell trait, hemoglobinopathy, exercise-related sudden death, decompression sickness, diving, special operations, military. Results that included cases of sickle cell trait were included. Further, current guidelines were ascertained from public institutions, prominent diving texts, and the U.S. Military.

Review of the literature reveals that complications of sickle cell trait are rare, with no reports of corresponding dive-related injury. Analysis of the physiology of diving as it pertains to the condition, as well as the absence of reported cases, suggest there is minimal increased risk in sport and technical civilian diving. Opinion for military fitness to dive is varied.

As specific circumstances thought to predispose to sickle cell trait complication may be unavoidable in the completion of military duties, diving is not recommended for these individuals. However, recreational and commercial diving using typical precautions seems reasonable.