Vocational options for those with sickle cell trait: questions about hypoxemia and the industrial environment

Many patients have parents and siblings who possess the sickle cell trait and who often require not only genetic counseling, but also information about their own health. Some have been informed that they cannot pursue careers in aviation. Some have been told that they are at special risk for the hypoxemic effects of heavy exertion, especially the exertion associated with sports. A few believe that certain elements of the industrial environment are unusually hazardous to them. An examination of the literature reveals little evidence in support of any of these beliefs. Most, if not all, unfavorable reports are clouded by faults of various kinds. All of them are of anecdotal type, based on small numbers of cases; the evidence offered is circumstantial. On the other hand, experiments designed to test the susceptibility of those with sickle cell trait have yielded favorable results. Studies of large populations indicate that those with the trait have normal health and normal life expectancy. There are almost as many favorable anecdotal reports as there are negative ones. We must conclude that people with sickle cell trait are just as tolerant to aviation and industrial environments as those who are homozygous for hemoglobin A. Also, there are strong indications that those with sickle cell trait are not endangered by heavy physical exertion, including the exertion of athletic competition.