Sickle Cell Form/Waiver - University of Texas at Dallas

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Centerfor Disease Control "Fact Sheet" on Sickle Cell DiseasentJp.11-!:1 r{\r.sd9.sq/n_cb d d dft&_Uese]|!1c,_tdlilt ISickle CclI DiseaseSickle cell discase (SCD) is a group ofinheriled red blood cell disorders. Healrhyrsd blood cells are round, and they move through small btood vessels to carryoxygen lo all parts ofthe body. In SCD, the red blood cells become hard andsticky and look like a C-shaped farm tool called a "sickle." I'he sickle cells dieearly, rvhich causes a constant shortage ofred blood cells. Also, rvhen they travelthrough small blood vessels" they get stuck and clog the blood florv. 'I his cancause pain and olher serious problenrs.Sicklc Cell TraitIIbAS - People who have this fomt ofsickle cell disease inherit one sickle cellgene and one normal gene. This is called sickle cell trait. People rvith sickle celltrait usually do not havc any ofthe symptonts ofthe disease and live a normal life,but they can pass the disease on to their children.IliagnosisSickle cell trait is diagnosed rvith a simple blood test. People at risk ofhavingsickle cell trait can talk to a doctor or health clinic about getting lhis test.Data & StatisticsSickle cell disease affccts millions ofpeople throughout the $orld and isparticularly common among those rvhose ancestors conre irom sub-SaharanAfrica, Spanish-speaking regions in rhe Wcslem Hemisphere (Sourh America, theCaribbean, and Central America), Saudi Arabia, India, and Mcditerraneancounlries such as Turkey, Grecce, and ltaly.In the Uniterl Statesr. SCD affccts an estimated 70,000 to 100,000 Americans.'''The diseaso occurs in about I out ofevery 500 African Anrericansbinhs.The disr.ase occurs in about I out ofevery 36,000 Hispanic Americansbirths.Sicklc cell trait occurs in about I in 12 African Americans.ComplicntionsIt is possible for a person rvith sickle ccll trait to espcrience complications ofsickle cell disease, such as splenic sequestration, "pain crisis," and, rarely, suddendeath.Hand-Foot SvndromeThis is usually the first symptonr of SCD. Srvclling in the hands and feet, oftenalong rvith a fever, is caused by lhe sickle cells gening stuck in the blood vesselsand blocking the florv oiblood in and out ofthe hands and feet.TreatmentPain medicine and fluids, such as water.Pain "Episode" or "Crisis"This is the most common complication, and the top reason that people with SCDgo to the emergcncy room or hospital. When sickle cells travel through smallblood vessels, lhey can get stuck and clog rhc blood florv. 'lhis causes pain that canstart suddenly, be mild to severe, and can last for any length oftime.PrevenliotrThere are simple steps that pcople lvith SCD can take to help prevent and reducethe number ofpain crises:' Drink plenry of rvater.. 'Iry not to get too hot ortoo cold.o Try to avoid places rvirh high altitudes (flying, mountain climbing, orcities rvirh a high altirude).'Try to avoid places or situationswith lorv oxygen (mountain climbingor exercising extremely hard, such as in military boot camp or whentraining for an athletic competition).' Adults wrlh severe sicklc cell disease can take a medicine calledhydroryurea 1o hclp rcduce the number ofpain crises.. People taking h1'droryurea must be checked olien by a doctor becausethe medicine can cause serious side efGcts, including an increascd risk ofdangerous inlcctionsAnemiaThis is a very common complication. With SCD, the red blood cclls die early. I hismeans there alo not enough heahhy rcd blood cells to carry o\ygcn throughout thebody. When this happens, a p!'rson nlight have:'o'''t't'TirednessInilabilityDizziness and lightheadednessFast heart ratsDifliculty breathingPale skin colorJaundice (yellorv color to thc skin and rvhites olthe eyes)Slorv groulhDelayed pubertyTrertmentBlood transfusions are used lo treat severe anemia. A sudden *orsening ofanemiaresulting fiom infcction or enlargement olthe splecn is a common reason lbr atransfirsion.Acute Chest SvndrorneThis can bc lifc-threalening and should be treatcd in a hospital. It is sinrilar topneumonia and symptoms includc chest pain, coughittg. difficulty breathing, andPreYentionAdults rvith severe SCD can take a medicine called hydroxyurea to help preventacule chest syndrome. People taking hydroryurea must be satched closelybecause the medicine can cause serious side effects, including an increased risk oldangerous infections.A person rvho is on bed rest or has recently had surgery can use an incenlivespirometer, also called "blorv bottlc," to help prevent acute chest syndrome.TreatmentDepending on the cause, treatment migbt include oxygen, nlcdicinc to treat aninfection, medicine to open up blood vessels to improve blood florv, and bloodfever-transfusions-Splenic SequestrationThis can be life-thrcalening and should be treated in a hospital. It happens when aIarge nunrber ofsickle cells get trapped in the spleen and causc it to suddenly getlarge. Symptoms include sudden rveakness, pale lips, fast breathing, e\treme lhirst,abdominal (belly) pain on the left sidc ofbody. and fast heart beat.Parents ofa child rvith SCD should learn horv lo feel and measure the size oftheirchild's spleen.PreventionFor those lvho have had a very severe, Iife-thealening episode ofsplenicsequestraiion or who have had many episodes in the past, it might be necessary tohave regular blood transfusions or the spleen can be removed (called splenectomy)to stop it {iom happenfng again.Trealment'freatment typically is a blood transfusion.
THE UNIVERSITY OF TEXAS AT DALTAS ATHLETIC TRAININGSICKLE CEIL TESTTNG AGREEMENT, RELEASE AND WAIVER OF LIABILITYPLEASE INITIAL ONE OF THE OPTIONS BELOW, FILI-IN THE SECTIONS, AND SIGN AND DATE IN THE APPROPIATE AREAS.RETURN THIS FORM, AND ALL OTHER REQUIRED FORMS OR MATERIATS AS INSTRUCTED IN THE ATTACHED COVERLETTER,OPTION 1 - PROVIDE DOCUMENATION OF PREYIOUS TEST(lnitial)I, . the undersigned, agree to provide documentation ofmy prior sickle cellstatus test to the Athletic Training Department of The University of Texas at Dallas. I understand that this information must beon-file with the athletic trainers prior to me being allowed to participate in any athletically related activity.Student-Athlete Signature Date Signed Sport(s)ParenVGuardian Signature(if student is under I 8 years of age)Date SignedParent/Guardian Print Name(lnitial)OPTION 2 - CONSENT TO VOLUNTARILY TAKE A SICKLE CELL TRAIT TESTL- the undersigned agree to voluntarily take a sickle cell test and thenprovide documentation of my prior sickle cell status test to the Athletic Training Depaltment of The Universify of Texas at Dallas.I understand that this information must be on-file with the athletic trainers prior to me being allowed to participate in anyathletically related activity.Student-Athlete Signature Date Signed Sport(s)ParenVGuardian Signature(if student is under I 8 years of age)Date SignedParent/Guardian hint NameOPTION 3 - VOLUNTARY DECLINE TO SICKLE CELL TESTINGI, , the undersigned, understand and acknowledge that the NCAA andThe University of Texas at Dallas Department of Dallas mandate that all student-athletes have knowledge of their sickle cell traitstatus. Additionally, I have read and fully understood the provided facts on sickle cell trait, sickle cell disease, and testinginformation. I have been provided with education regmding the implications of exercising the waiver, and have engaged inmandatory education regarding sickle cell status.Recognizing that my true physical condition is dependent upon an accurate medical history and a full disclosure of any symptoms,complaints, prior injuries, ailments, and/or disabilities experienced, I hereby affrrm that I have fully disclosed in writing any priormedical history and/or knowledge of sickle cell trait status to The University of Texas at Dallas Sports Medicine personnel.I DO NOT wish to undergo sickle cell trait testing as part of my pre-participation physical examination and I voluntarily agree toretease, discharge, indemnif and hold harmless the State of Texas, The University, its officers, employees and agents from anyand all costs, liabilities, expenses, claims, demands, or causes ofaction on account ofany loss or personal injury that might resultfrom my non-compliance with the mandate of the NCAA and The University of Texas at Dallas Departrnent of IntercollegiateAthletics.I have read and signed this document with fuIl knowledge of its significance. I further state that I am at least 18 years of age andcompetent to sign this waiver.Student-Athlete Signature Date Signed Sport(s)Parent/Guardian Signature(if student is under I 8 years of age)Date SignedParent/Guardian Print Name
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Sickle Cell Form/Waiver - University of Texas at Dallas

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