Through an Athletic Trainer’s Eyes: Sickle Cell Trait

Sickle cell trait is not a disease but the inheritance of one gene for sickle hemoglobin and one gene for normal hemoglobin.² A sickle hemoglobin can cause a red blood cell to transform from it’s original round shape to a quarter moon shape. The sickle cell trait is not a barrier for participation in athletics. Many can participate within a high level of sport without any complications of the trait.  In the United States more than four million people carry the sickle cell trait and experience very few symptoms.¹ Although, the individual may not carry the sickle cell anemia disease they can still suffer from the symptoms under extreme physical activity or when oxygen levels are low.³

In the United States, most children are screened for sickle cell. Although tested a birth, very few are aware that they carry the trait. This is due to the majority of the population do not see having the sickle cell trait as a treat.⁴ A simple, inexpensive blood test is all that is needed  to see if an individual  carries the sickle cell trait. At the Division I and Division II universities, athletes must be screened for sickle cell or sign a written release declining the screening.⁴

An individual that is positive for sickle cell trait will be a carrier for the remainder of their life. There is no cure for this trait therefore the individual must be aware of what the signs and symptoms are and how to prevent the symptoms for affecting their athletic performance. No athlete is disqualified from the experience the symptoms regardless of how cardiovascular fit they are. The NATA provides precautionary guidelines athletes should consider. ²

1. Training and conditioning should be built up slowly with paced progressions. The athlete should be allowed long periods of rest between repetitions. Athlete can set their own pace during a workout.
2. The athlete is encouraged to participate in a sports-specific preseason strength and conditioning program that excludes: mile runs, serial sprints, and other performance tests that are similar.
3. Activity should cease at the onset of symptoms (muscle ‘cramping’, pain especially to the legs or low back, swelling, weakness, tenderness, shortness of breath, inability to “catch breath”, and fatigue)
4. The athlete should participate in a year-round, periodized strength and conditioning program that is individualized to the athlete.
5. Extended rest periods between repetitions between high speed sprints and high intensity interval training that induce high levels of lactic acid build up.
6. Be aware of the environment, dehydration, asthma, illness and altitude that the athlete may be exposed to while participating in physical exertion.

Individuals with sickle cell trait can experience a Sickling Collapse. A sickling collapse should not be mistaken for a cardiac or heat-related collapse. An athlete experiencing a sickling collapse with have symptoms of cramping, a core temperature that is not greatly elevated and typically occur within the first half hour on the field.² A few distinctions between sickling cramps and heat cramps are as followed: no muscle twinges, a different type of pain (heat cramping pain is more excruciating), athlete will slump to the ground because of weakened muscles, athlete will lie fairly still, not yelling in pain, and the muscles will not be visibly contracted. Treatment for an athlete suffering from a sickling collapse includes checking the vital signs, administering oxygen and Call 911 if the athlete vitals decline and not responding to the oxygen.

The athletic trainer and coaches should be aware of which athletes are sickle cell trait positive and create a trusting relationship with those athletes. Athletes should report any symptoms immediately to their athletic trainer or coach as they can lead to life threatening situation.

References

¹ACSM and NCAA Joint Statement on Sickle Cell Trait and Exercise. (2013, August 23). Retrieved November 06, 2016, from http://www.ncaa.org/health-and-safety/medical-conditions/acsm-and-ncaa-joint-statement-sickle-cell-trait-and-exercise

²I. (2002). Consensus Statement: Sickle Cell Trait and the Athlete. Retrieved November 6, 2016, from http://www.nata.org/sites/default/files/sickle-cell-trait-and-the-athlete.pdf

³Parsons, J. T., Ph.D, ATC. (2013, June). The Student-Athlete with Sickle Cell Trait. 2014-15 NCAA Sports Medicine Handbook, 91-93. Retrieved November 6, 2016, from http://www.ncaapublications.com/productdownloads/MD15.pdf

⁴Sickle Cell Trait. (2014, January 17). Retrieved November 06, 2016, from http://www.ncaa.org/health-and-safety/medical-conditions/sickle-cell-trait