Introduction
Sickle cell trait (SCT) is not a disease. It is a descriptive term for a hereditary condition in which an individual has one normal gene for hemoglobin and one abnormal gene for hemoglobin. Sickle cell trait is not a barrier to exercise or participation in sport. It appears that problems can occur primarily with intense physical exertion.
SCT has been linked to an increased risk of exercise-associated sudden death in individuals undergoing intense physical exertion, and possibly rhabdomyolysis. Exercise-associated sudden death in individuals who have SCT most commonly occurs in those undergoing intense physical exertion such as student-athletes during conditioning workouts; although, it can occur in activities as well.
Testing Requirements
NCAA requires that all student-athletes submit sickle cell trait status. Student-athletes are required to provide Converse Sports Medicine Department with the results of their sickle cell test prior to their preparticipation examination. Sickle cell tests can be obtained through their primary care provider or a medical lab. All states in the United States screen infants at birth for their sickle cell status. A student-athlete can also obtain their sickle cell trait status from their medical records at birth.
If a test is positive, the student-athlete will be offered counseling on the implications of sickle cell trait, including health and athletics, with the team physician and athletic trainers. The student-athlete will be aware of the risks and symptoms associated with activity with sickle cell trait. The student-athlete will complete and sign the Sickle Cell Acknowledgement Form. The student-athlete can continue participating in intercollegiate athletics, but with restrictions communicated between the team physician, athletic trainer, coach, and student-athlete. The student-athlete will fill out an individual emergency action plan based on guidance from the team physician. This document will be signed by the student-athlete, coach, athletic trainer, and strength and conditioning coach. Take home education materials will be provided to the student-athlete and, if warranted, the parent/guardian.
Sickle Cell Collapse Symptoms
Sickling collapse has been mistaken for cardiac collapse or heat collapse. But unlike sickling collapse, cardiac collapse tends to be “instantaneous,” has no “cramping” with it, and the student-athlete who hits the ground no longer talks. Unlike heat collapse, sickling collapse often occurs within the first half hour on field, as during initial windsprints.
Sickling is often confused with heat cramping; but, student-athletes who have had both syndromes know the difference, as indicated by the following distinctions:
- Heat cramping often has a symptom of muscle twinges; whereas, sickling has none.
- The pain is different – heat-cramping pain is more excruciating.
- What stops the student-athlete is different – heat crampers hobble to a halt with “locked-up” muscles, while sickling players slump to the ground with weak muscles.
- Physical findings are different – heat crampers twist and yell in pain, with muscles visibly contracted and rock-hard; whereas, sicklers lie fairly still, not yelling in pain, with muscles that look and feel normal.