In his letter, Dr Adams, referring to my letter to the editor, states: "The proposed ban on scuba divers with sickle cell trait is certainly not trivial." However, I suggested no ban (notoriously not enforceable) and only recommended that only those comparatively few carriers of the sickle cell trait with relatively high hemoglobin S concentrations of 35% to 45% —not all 8% of such carriers—avoid potentially hypoxic situations.Among potentially hypoxia-producing situations, diving was mentioned, which would include skin diving (snorkeling) as well as deep-water diving with self-contained underwater breathing apparatus (scuba). While the latter, as Dr Adams correctly points out, occurs under hyper- baric rather than hypobaric conditions, a notable increase has been observed in scuba diving-related accidents—owing to its increased popularity—and related by hypoxia, not hyperbarism. Ninety percent of fatal underwater accidents observed in ten years in Los Angeles County
Lowbeer L. Sickle Cell Trait and Scuba Diving-Reply. JAMA. 1984;251(13):1682. doi:10.1001/jama.1984.03340370021014
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