Sickle Cell Trait In Athletes
“REAL LIFE”
“A Common Sense Approach”
Chris A. Gillespie, MEd, ATC, LAT
THE FACTS
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Since 2000 exertional sickling is the leading cause of non-traumatic
death in NCAA Football … All Divisions.
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In FBS --- if you add heat, heart, and asthma --- Combined, match the
total dead from sickling.
•
In the last 12 years there have been NO traumatic deaths in FBS; no
catastrophic head injury; no catastrophic neck injury; no comotio
cordis. (although three deaths in non FBS schools – One cardiac nontrauma related AND two head injury related)
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Not one single FBS football player in the last 12 years has died
playing football.
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Not one single FBS football player in the last 12 years has died
practicing football.
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They have ALL died PREPARING to play football … 4 in winter
workouts, 4 in summer workouts, and 2 in September conditioning
drills … ALL in STRENGTH/CONDITIONING SESSIONS!
NOT JUST COLLEGE or FOOTBALL
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2000 - 12 y/o male football, conditioning, Ohio
2002 - 14 y/o female basketball, conditioning, Texas
2004 - 15 y/o male football, pre-season practice, Texas
2006 - 12 y/o male football, conditioning, Florida
2009 - 16 y/o male football, conditioning, Maryland
2010 - 15 y/o male football, pre-season practice, Florida
2011 - 14 y/o male football, conditioning, South Carolina
– 15 y/o male football, conditioning, Texas
– 16 y/o male football, conditioning, Florida
HIGH SCHOOL FOOTBALL 2011
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7 non-traumatic practice deaths
5 were African-American
3 deaths attributed to exertional sickling
4th is suspected exertional sickling
60-80% of African-American high school
football players who collapsed and died
in summer practices had SCT/sickling
as a COD
Case Study
• 1990 football season
• 19 year old black male
football player
• Collapsed after running
one and one half mile
distance run
• Complained of leg pain
and mid & low back ache
• Sickle cell crisis with
acute exercise related
rhabdomyolysis
• Increased Creatine
Kinase level (CK)
Rhabdomyolysis
Definition:
A disorder involving injury to the
kidney caused by toxic effects of the
contents of muscle cells.
Rhabdomyolysis
Causes & Incidence
Myoglobin is an oxygen binding protein pigment found in skeletal
muscle. When skeletal muscle is damaged, myoglobin is released into
the bloodstream.
It is filtered out of the bloodstream by the kidneys.
Myoglobin may occlude the structures of the kidney, causing damage
such as acute tubular necrosis or kidney failure.
Myoglobin breaks down into potentially toxic compounds, which will also
cause kidney failure.
Necrotic (dead tissue) skeletal muscle may cause massive fluid shifts
from the bloodstream into the muscle, reducing the relative fluid
volume of the body and leading to shock and reduced blood flow to the
kidneys.
Creatine Kinase (CK)
or
Creatine Photokinase (CPK)
An enzyme found predominantly in the
heart, brain, and skeletal muscle.
When the total CPK level is substantially
elevated, it usually indicates injury or
stress to one or more of these areas.
Normal Creatine Kinase (CK) Values
Male: 38 - 174 units/L
Female: 96 – 140 units/L
CK Levels
A high CK, or one that goes up from
the first to the second or later samples,
generally indicates that there has been
some damage to the heart or other
muscle. It can also indicate that your
muscles have experienced heavy use.
CK Levels
People who have greater muscle mass
have higher CK levels than those who
don’t, and African-Americans may have
higher CK levels than other ethnic
groups. Very heavy exercise (such as in
weight lifting, contact sports, or long
exercise sessions) can also increase CK.
What is Sickle Cell Trait?
• Not itself a disease
• Hereditary condition
• One abnormal gene
for hemoglobin (S)
• Genetic type AS
• Sickle Cell Anemia
Disease is SS
Who has Sickle Cell Trait?
• About 8-10% of the U.S. black
population has sickle cell trait
• Only about 1% have the disease
• SCT is also found in non-blacks as
well, but less frequently
For Many Years
Athletic Organizations…
• Characterized
SCT as a benign
condition that
does not affect
the longevity of
the individual
Genetics
Testing for Sickle Cell Trait?
• Simple blood test
• Mandatory vs.
voluntary (changes)
• What do we do if
the test is positive?
– Genetic Counseling
– Health care issues
– Work-out adaptation
Sickle Cell Trait – Medical Problems
• Inability to concentrate
urine normally
• Blood in the urine
• Spleen problems
especially at high
altitudes
• Exercise related
rhabdomyolysis
• Exercise associated
sudden death
Warning Signs
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Leg pain
Back pain
Hematuria
Dehydration
Fatigue
A positive SCT test
When in doubt…..
Crisis – Time is of the Essence!
• Must seek timely and
appropriate medical
care for the athlete
who is potentially
suffering from sickle
cell crisis….This is a
TRUE medical
emergency !
Proper Hydration & Hot Weather
• Avoid dehydration
• Acclimatization is key
• Condition before athletic
bouts begin
• Do not exercise in a
dehydrated state or
during acute illness
• Drink fluids “all day”
• Know your athletes
Exercise and Work-Out Routine
• CONTROVERSIAL
• No running over 100
yards at any time!
• Increased rest periods
between bouts of
exercise
• Unlimited hydration
before, during, and
after exercise
• Performance levels
increase with these
changes
Precautions per the Inter-Association
Consensus Statement
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Exclude from Day-1 conditioning tests
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Slow, paced progressions of training
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Allowing longer periods of rest and recovery
between repetitions
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Heat stress, dehydration, asthma, illness, and
altitude create additional risk
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Stop activity with onset of symptoms
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Set a tone that encourages consideration for the
athlete with sickle cell trait
Selectively Opting Out of Sports
• All SCT positive athletes
at Samford University
since 1990 have been
football players
• In interviews with these
athletes, we have
hypothesized that
athletes choose sports
where they will excel
• Athletes with SCT most
likely cannot excel in
sports with high aerobic
demand so they opt out
of these sports at an
early age
Medical History Questions
• Do any of your close relatives suffer from
SCD or SCT?
• Have you ever been tested for SCT?
– If yes, was the test positive?
– If yes, what have you done differently?
• Do you fatigue more than your peers in
aerobic related activities?
– If yes, explain?
• Have you ever selectively opted out of a sport
or activity because of fatigue?
– If yes, explain why and list the types of symptoms
that you have had during these situations.
CONCLUSION
• Most of the studies in this area have been
done in the military setting
• Most of the knowledge that we have gained
in athletics is gained from anecdotal
information
• More studies regarding the risk involved in
athletics must be done
• An Inter-Associational SCT Task Force met in
February 2007 to discuss ways to prevent the
senseless deaths of athletes with Sickle Cell
Trait. As a result the NCAA took some
corrective action – but it’s not enough!
THE FACTS
•
Since 2000 exertional sickling is the leading cause of non-traumatic
death in NCAA Football … All Divisions.
•
In FBS --- if you add heat, heart, and asthma --- Combined, match the
total dead from sickling.
•
In the last 12 years there have been NO traumatic deaths in FBS; no
catastrophic head injury; no catastrophic neck injury; no comotio
cordis. (although three deaths in non FBS schools – One cardiac nontrauma related AND two head injury related)
•
Not one single FBS football player in the last 12 years has died
playing football.
•
Not one single FBS football player in the last 12 years has died
practicing football.
•
They have ALL died PREPARING to play football … 4 in winter
workouts, 4 in summer workouts, and 2 in September conditioning
drills … ALL in STRENGTH/CONDITIONING SESSIONS!
Thank You
for your
time & attention!