Preoperative Screening for Sickle Cell Trait

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.^4,5

While it is true that all patients must have adequate oxygenation during all types of anesthesia, prior