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Sickle Cell Anemia

Accommodation and Compliance: Sickle Cell Anemia

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About Sickle Cell Anemia

Sickle cell anemia, or sickle cell disease, is a genetically inherited blood disorder that affects the shape of red blood cells.  Red blood cells are normally round, smooth, and soft, which allows them to move easily through the blood system.  In sickle cell disease, blood cells are crescent, or sickle-shaped, and rigid.  This is due to blood cells that contain an abnormal type of hemoglobin.  The abnormal shape of red blood cells prevents the cells from properly moving through blood vessels and carrying oxygen to all parts of the body.  The sickle-shaped blood cells die sooner than ordinary blood cells, which results in significantly fewer red blood cells and causes anemia.

People with sickle cell disease experience chronic anemia and periodic episodes of pain, sometimes referred to as “crisis.”  When the sickle-shaped blood cells block the flow of blood and oxygen to the limbs and organs of the body, severe pain and damage to tissues and organs can result.  People can experience pain episodes affecting the arms, legs, chest, and abdomen; damage to the lungs, spleen, kidneys, and liver, among other organs; have a stroke; and develop acute chest syndrome and bacterial infections.  Symptoms can range from mild to very severe.

Sickle cell disease is a lifelong, chronic condition, and its symptoms can be treated, but for most people there is no cure.  People with sickle cell disease often require prophylactic antibiotics, folic acid supplementation, pain management, intravenous fluids, and frequent blood transfusions.  Blood transfusions reduce recurrent pain crises, the risk of stroke, and other complications.

Sickle Cell Anemia and the Americans with Disabilities Act

The ADA does not contain a definitive list of medical conditions that constitute disabilities. Instead, the ADA defines a person with a disability as someone who (1) has a physical or mental impairment that substantially limits one or more "major life activities," (2) has a record of such an impairment, or (3) is regarded as having such an impairment. For more information about how to determine whether a person has a disability under the ADA, see How to Determine Whether a Person Has a Disability under the Americans with Disabilities Act Amendments Act (ADAAA).

Accommodating Employees with Sickle Cell Anemia

People with sickle cell anemia may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people who are aging will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.

Questions to Consider:

  1. What limitations is the employee experiencing?
  2. How do these limitations affect the employee and the employee’s job performance?
  3. What specific job tasks are problematic as a result of these limitations?
  4. What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?
  5. Once accommodations are in place, would it be useful to meet with the employee to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
  6. Do supervisory personnel and employees need training?

Accommodation Ideas:

Situations and Solutions:

The following situations and solutions are real-life examples of accommodations that were made by JAN customers. Because accommodations are made on a case-by-case basis, these examples may not be effective for every workplace but give you an idea about the types of accommodations that are possible.

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