Jan 29, 2015
Sickle Cell Precautions

By Kenny Berkowitz

At an off-season football workout earlier this year, sickle cell trait proved fatal for University of Central Florida wide receiver Ereck Plancher. But with proper precautions, the sickle cell doesn’t have to be a barrier to safe athletic participation.

In March, University of Central Florida wide receiver Ereck Plancher became the sixth football student-athlete with sickle cell trait to die in the past eight years. Plancher, a 19-year-old redshirt freshman, collapsed after running sprints in an indoor conditioning drill and died at Orlando Hospital about an hour later.

Unlike Florida State University’s Devaughn Darling, who died in 2001, and the University of Missouri’s Aaron O’Neal, who died in 2005, Plancher had been diagnosed with sickle cell trait, which was discovered during a team physical. But like Darling and O’Neal, Plancher hadn’t experienced any symptoms until the day he died and had been cleared by UCF physicians to participate fully in team activities.

It’s not uncommon for athletes with sickle cell trait to be completely asymptomatic, and even though all U.S. newborns are tested, many high school and college athletes are unaware of the results. The sickle gene, which affects one in 12 African Americans, can also be present in people of Caribbean, Central American, Indian, Mediterranean, Middle Eastern, and South American descent. Sickle cell trait, which is caused by the presence of one gene for sickle hemoglobin and one for normal hemoglobin, is much more common–and less debilitating–than sickle cell disease, which is caused by inheriting sickle genes from both parents and is present in one in 500 African Americans.

In most situations, people with the sickle gene have round red blood cells, just like everyone else. But with strenuous exercise and overexertion, the trait can cause red blood cells to become crescent-shaped, decreasing the flow of oxygenated blood to the heart and leading to explosive rhabdomyolysis (muscle breakdown), which can then lead to heart dysrhythmia and death.

Steps can be taken to help protect athletes with sickle cell trait, says Scott Anderson, Head Athletic Trainer at the University of Oklahoma and co-chair of the NATA’s Sickle Cell Trait in Athletes Task Force. To lower the risk of sustained, high-tempo exertion, especially during times of high heat, he suggests slowing the tempo of exercises and increasing the time for rest and recovery between drills.

Athletic trainers should stay alert to the earliest signs of rhabdomyolysis in athletes with sickle cell trait: cramping in the lower back and legs.

“If athletes feel that, they need to immediately bring it to our attention,” Anderson told the Orlando Sentinel. “If they can recognize it early on and withdraw from the activity, it gives them an opportunity to get better.”

In 2007, the NATA issued a fact sheet and a consensus statement calling for athletes with sickle cell trait to be immediately pulled from training if they experience pain, swelling, weakness, tenderness, fatigue, or an inability to catch their breath. The report found evidence that offseason end-of-practice sprints could be particularly dangerous, as they were for Plancher, and recommended that athletes with the trait be excluded from performance tests such as mile runs, serial sprints, uphill runs, and stadium step runs.

“Knowledge of sickle trait status can be a gateway to education and simple precautions that may prevent sickling collapse and enable athletes with sickle cell trait to thrive in sports,” stated the consensus report, which recommends screening all athletes during preparticipation physicals. “Nearly all of the 13 deaths in college football have been at institutions that did not screen for sickle trait or had a lapse in precautions for it.”

According to the report, sickling can be confused with heat cramping, but athletes who have experienced both can easily tell the difference. In the onset of sickling, the pain is much less intense and the muscles more relaxed. Heat crampers hobble to a halt with locked-up muscles, while sicklers slump to the ground with muscles that look and feel normal.

The response to early detection and treatment is very different, too. Crampers respond much slower than sicklers, who can recover quickly as the body rests and blood cells regain oxygen, reverting to their normal shape. And with proper safety measures, including close attention to stress and hydration, athletes with sickle cell trait can participate in athletics year-round.

“Precautions can enable student-athletes with sickle cell trait to thrive in their sport,” states the 2008-09 NCAA Sports Medicine Handbook, which calls sickle cell trait a “generally benign condition” that does not pose a barrier to “outstanding athletic performance.”

Kenny Berkowitz is an Assistant Editor at Training & Conditioning.

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