Athletes collapsing from sickle cell trait

Over the past seven years, collapse during exercise due to complications from sickle cell trait has killed nine athletes, Of 136 sudden, nontraumatic sports deaths of high school and college athletes over a decade, five percent were due to exertional sickling. As a result, the National Athletic Trainers' Association (NATA), Dallas, has released an interassociation task force consensus statement with recommendations for athletes with sickle cell trait.

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"The purpose of this consensus statement is to raise awareness of this condition among athletes, coaches, athletic trainers, and other medical staff," reports Scott Anderson, head athletic trainer at the University of Oklahoma, Norman, and co-chair of the task force. "It provides details on measures that can reduce the risk of collapse during sports and exercise related to sickle cell trait among athletes."

Sickle cell trait is the inheritance of one gene for sickle hemoglobin and one for normal hemoglobin. During intense or extensive exertion, the sickle hemoglobin can change the shape of red blood cells from round to quarter-moon, or "sickle." This alteration, exertional sickling, can pose a grave risk for some athletes.

Devard Darling, a wide receiver for the National Football League's Baltimore Ravens lost his twin brother, Devaughn, to complications from sickle cell trait in 2001. "We both learned we had sickle cell trait during our freshman year at Florida State," Darling recalls. "But even knowing the risks at the time, my brother died on the practice field before his 19th birthday. I'm hopeful that this consensus statement will help others avoid the same fate."

The sickle gene is common in people whose origin is from areas where malaria is widespread. Over the millennia, carrying one sickle gene fended off death from malaria, leaving one in 12 African-Americans with sickle cell trait. The sickle gene also is present in those of Mediterranean, Middle Eastern, Indian, Caribbean, and South and Central American ancestry, one reason for the required screening of all newborns in the U.S.

"We recommend confirming sickle cell trait status in all athletes' pre-participation physical examinations," concurs James "Scott" Galloway, head athletic trainer at DeSoto (Tex.) High School. In 2002, a 14-year-old female African-American basketball player at the school died from sudden cardiac arrest during the first week of practice and conditioning drills due to widespread sickle thrombi associated with physical exertion and the sickle cell trait.

The consensus of the task force, spearheaded by NATA, is as follows:

* Athletes with sickle cell trait can participate in all sports.

* Red blood cells can sickle during intense exertion, blocking blood vessels and posing a grave risk for athletes.

* Screening and simple precautions may prevent deaths and help the athlete with sickle cell trait thrive in his or her chosen sport.

* Concerted efforts to document newborn screening results should be made during sports exams.

* In the absence of newborn screening results, institutions should weigh carefully the decision to screen based on the potential to provide key clinical information and targeted education that may save lives.

* Irrespective of screening, institutions should educate staff, coaches, and athletes on the potentially lethal nature of this condition.

* Education and precautions work best when targeted at those athletes who need it most; therefore, institutions should consider this factor in deciding whether to screen. All told, the case for screening is strong.

In the event of a sickling collapse, athletic department staff, coaches, and medical staff should treat it as a medical emergency by doing the following: call 911; check vital signs; administer high-flow oxygen with a non-rebreather face mask; cool the athlete, if necessary; and tell the doctors to expect explosive rhabdomyolysis and grave metabolic complications. Moreover, proactively prepare by having an emergency action plan and appropriate emergency equipment for all practices and competitions.

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COPYRIGHT 2008 Gale, Cengage Learning