Sickle Cell Counseling is Urged

              Sickle Cell Counseling Is Urged
By Margaret Martin
Times Medical Writer
Physicians should unhesitatingly coun-sel
young women with sickle cell anemia
to have liberal surgical sterilization and
aggressive genetic counseling, says the
head of Department of Obstetrics and
G y n e c o 1 o g y of the Louisiana State
University Medical School at Shreveport.
" . . . . motherhood does not justify a
young woman with sickle cell disease
being exposed to the risk of pregnancy,"
said Dr. Arthur T. Fort in a paper he
delivered to the Southern Medical
Association meeting in Florida recently.
Sickle cell anemia is almost totally
limited to the black race.
The disease, which is genetic in origin
affects the hemoglobin. The red blood
cells precipitate into blood crystals in the
presence of reduced oxygen and form a
sickle shape.
In a sickle cell crisis, the minor blood
vessels are blocked by the abnormal
cells and then get in the bones and
kidneys. The crisis is particularly painful
in the bone and lungs.
Fort doesn't feel that it pays for
women with the disease to have children.
In an interview, Fort explained that
10 per cent of the mothers who become
pregnant die and only 50 per cent of the
babies live.
"The risk is not worth it," the
physician said.
He explained in the paper that "most
patients with sickle cell anemia are
handicapped because they have severe
and chronic anemia which interferes
with all body functions and makes it
difficult for the mother to nurse, to train
or support her child."
And, he said, "the survival time of
the patients with sickle cell anemia is
less than normal, and children born of
sickle cell mothers are likely to become
orphans. . ."
To have sickle cell anemia, according
to the paper, the hemoglobin abnormali-ty
must be manifest in both the matern-al
and paternal sides, but the baby can
inherit the sickle cell trait, if only one
parent has the disease.
Source material for Fort's paper was
taken from patients at Tennessee College
of Medicine.
He reported that in the group where
only one parent had sickle cell anemia,
there were 64 live births among 97
pregnancies, "of which 50 survived the
neonatal period and could be regarded as
a reproductive success, "if one regards
carrying sickle cell trait as a success."
Survival Rate Inadequate
"We do not regard these fetal survival
rates as a d e q u a t e justification for
allowing a young woman to subject
herself to the hazards of pregnancy,"
the paper stated.
And, Fort asked and a n s w e r e d ,
"Should the patient with sickle cell
disease be primary sterilization . . . or
postpartum sterilization?"
"This question has been asked many
times before," the paper said.
"It has been answered before many
times, so why have we brought it up
again," the paper asks, and answers,
"The reason is that t h e manner in
which it has been previously asked and
answered has been one of ambiguity and
timidity because of the social context of
the ties" in which it was asked. The
times have changed. We can now
c o n f r o n t sterilization, even primary
sterilization . . . candidly."
Continued on Page 3-C