By: Lauren Crockett, ATC
Sickle cell disease (SCD) is a very common disease seen primarily in African Americans, individuals from Spanish speaking regions in the western hemisphere, Turkey, Greece, Saudi Arabia and India. Sickle cell disease is an inherited group of red blood cells that are hard, sticky, and shaped like a sickle, a C-shaped gardening tool. The cells die prematurely leading to a persistent shortage of blood cells. In addition, the shape of the cells causes them to get stuck in the blood vessels and clog. There are multiple forms for the disease. Sickle cell trait (SCT) differs from sickle cell disease in that the individual only inherited one gene containing the sickle cell trait and one normal gene. Usually, those with sickle cell trait do not have severe complications except in conditions such as extreme heat or cold and high altitude. Parents with sickle cell trait can pass the trait on to their children.
It is estimated that 1 in 500 African American births and 1 in 36,000 Hispanic births have sickle cell disease. In addition, 1 in every 12 African Americans has sickle cell trait. Because of the complications and prevalence of the disease, it is essential that athletic trainers review pre-participation physicals to determine which athletes have sickle cell disease or trait. Athletes should not be held out of competitive sports, but they need some accommodations in order to stay healthy. A proper warm up, changing the workout intensity, making modifications during extreme temperatures, maintaining hydration, adequate rest breaks and acclimatizing to heat are examples of ways to avoid sickel cell trait complications. While athletes primarily have signs and symptoms including pain, fatigue and muscle weakness, more serious complications can occur such as exertional sickling. Any athlete that is showing signs of exertional sickling should be immediately removed from practice and treated with rest, cooling, oxygen and hydration. The signs and symptoms of exertional sickling include muscle cramping, shortness of breath, difficulty breathing, fatigue, low back pain, lower body pain, slow recovery or a “slow collapse” which is not sudden like collapse from cardiac arrest.
Altitude can greatly affect those with SCD and SCT. Athletes training at higher altitudes should have oxygen available during training or limit the amount of training. In 2007, Pittsburg Steelers player Ryan Clark lost 30 pounds, his spleen, and gall bladder after suffering from complications of sickle cell trait while preparing for and playing a game in Denver, Colorado. He was not allowed to play the next time the Steelers were in Denver.
Athletes with SCD or SCT should inform their coaches of their disease so that they can be treated properly. If there are athletic trainers at the schools, they should educate coaches on the importance of making accommodations to athletes with sickle cell trait. Coaches need to let the athletic trainers know immediately if an athlete starts showing signs and symptoms of acute illness.
- Douglas JC, et al (2013) “The Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs: Best-Practices Recommendations.” Journal of Athletic Training: Jul/Aug 2013, Vol. 48, No. 4, pp. 546-553.
- CBS News Staff. “Sickle Cell Trait Sidelines Football Player: What is it?” http://www.cbsnews.com/news/sickle-cell-trait-sidelines-football-player-what-is-it/ January 4, 2012.