To the Editor.—
The editorial on the pathogenic effects of the sickle cell trait, signed by Heller (225:987, 1973) has more historical background than appears on the surface. Beginning with my editorial, "Mass Screening Programs for Sickle Cell Hemoglobin," in The Journal (221:500, 1972), some polemics have appeared, including Dr. Heller's letter (222:360, 1972). He categorized the use of the term "AS disease" as a disservice to the two million black Americans who are heterozygous for hemoglobin S, speaking rather pointedly of "uncritical authors" who rush to the occasion and write articles about events that could be chance phenomena.Yet even Heller in his editorial admits that trait victims may sustain splenic infarcts, hematuria, hyposthenuria, and "factors... cause sickling, tissue damage due to ischemia, and clinical disease." He did not mention that some refractory cases of hematuria require nephrectomy. Nor did he note that there are well over 150 articles
Nalbandian RM. The Sickle Cell Trait. JAMA. 1973;226(11):1357. doi:10.1001/jama.1973.03230110045013
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