Sickle Cell Trait Syndrome and the Athlete

Written By:
Paulette Campbell RN-BC, BSN, MJ
Certified Legal Nurse Consultant

In the past seven years, nine athletes from ages nine through twenty have died while playing sport. All nine deaths could have been prevented. These athletes have died because of a pre-existing medical condition called Sickle Cell Trait. When athletes are not screened, not properly trained, or when symptoms of sickling collapse are not recognized, death can occur too easily.

To respond to this, the National Athletic Trainer’s Association (NATA) developed a guideline for athletic programs to adhere to when an athlete with sickle cell trait is a part of their program. A review of the non-traumatic sports deaths of high school and college athletes found that the top four killers were:

1. cardiovascular deaths
2. hyperthermia(heat stroke)
3. acute rhabdomyolysis tied to the sickle cell trait
4. asthma

Under intense exertion, the red blood cells of a sickle cell trait athlete can go from being round to a sickle shape. This sickling then causes major jamming of red blood cells preventing oxygen to get to other cells. This jamming prevents red blood cells which contain oxygen from getting to the muscles.

Sickling collapse has most often been associated with football athletes but it should not be seen as exclusive to that sport or even to athletics at all. In fact, the US military has seen recruits experience sickling collapse during basic training. Their research has found that recruits with sickle cell trait are thirty times more likely to die during basic training.

In all out exertion, sickling can occur within three minutes. If symptoms go unnoticed or are simply ignored, death can quickly occur. The cascading effects can occur faster and more gravely if compounded by any of the following; extreme heat, dehydration, high altitude, and asthma. Sickling collapse must be recognized as an all out emergent situation. Yet far too often, it goes unrecognized, and therefore, either without treatment or with inappropriate treatment. Sickle cell trait has four factors that create a synergistic effect of sickling:

1. severe low oxygen levels
2. metabolic acidosis
3. over-heated muscles
4. red cell dehydration

Review of records have found that the harder and faster athletes go, the earlier and greater the sickling can occur. In fact, it often occurs within two to three minutes of sprinting. These symptoms quickly cascade if athletes ignore symptoms or are urged by the coaching staff to continue.

Sickling collapse is often mistaken for cardiac collapse or heat collapse. Some key differences to note is when an athlete collapses because of sickling, they tend to slump to the ground due to weak muscles, and their muscles do not twitch the same way compared to those who experience heat collapse.

Treatment must begin promptly. When an athlete with sickle cell trait first begins to notice any signs of difficulty such as cramping, they should discontinue activity. If initial signs are ignored and symptoms progress to the point of collapse, high levels of oxygen should be delivered. The athlete should be cooled down. If vital signs deteriorate, 911 should be called. Emergency personnel should be warned that sickling collapse is occurring.

Prevention of sickling collapse is possible. Athletes should build up slowly with long periods of rest and recovery. Pre-season and off-season strength and conditioning should be strongly encouraged. Athletes with sickle cell trait should be excluded from performance tests (such as mile runs and sprints). Athletes and trainers should be warned and be aware of the symptoms, and activities should be stopped at the first signs of a potential sickling crisis. These athletes should be allowed to set their own pace. Further, training efforts should be adjusted where any of the following conditions are noted; extreme heat, dehydration, asthma, illnesses and high altitude. Most importantly, athletes should not be prevented from participating in sports because of their sickle cell trait condition.

Our medical legal consulting team at Medical Jurisprudence, Inc. can help you with any medical cases you have involves Sickle Cell Trait Syndrome. For more information regarding our services, you can contact our offices at info@medicaljurisprudence.com or call 630-551-0978.