Why Football Players Should Get Tested for Sickle Cell Trait

Andrew Black

With football season right around the corner, football players of all playing levels must be in their best conditioned shape and ready to play an entire season of fast-paced running and tackling. Being a highly physical sport, football athletes’ bodies will suffer bumps and bruises throughout the season.
But are players aware of something that may be inside them that might take them out of the game?

Sickle cell trait

The sickle cell trait is a relatively mild condition caused by the presence of a single gene for sickle cell anemia, producing a smaller amount of abnormal hemoglobin. People who inherit one sickle cell gene and one normal gene have sickle cell trait.
Sickle cell trait is not considered rare and individuals with the trait generally do not have any symptoms that are typical of the rare sickle cell disease. However, there is growing evidence that person with sickle cell trait are susceptible to cardiovascular problems and those problems seem to appear following intense physical activity.  And those problems can be lethal if the person is unaware there is even a risk to begin with.

Exercise collapse associated with sickle trait (ECAST)

A study was conducted involving an in depth look at the deaths of 9 college football players from 2000-2010 who were diagnosed with the sickle cell trait. Results showed that all players showed symptoms of Exercise collapse associated with sickle trait ( ECAST) occurred during intense conditioning including serial sprints and/or agility training. Eventually, players died from an ECAST scenario.
Unfortunately, none of the players were asked or encouraged to stop exercising even though there were signs that the person was in trouble. Many experienced unusual cramps, muscle weakness, and extreme fatigue prior to collapsing.
The estimated risk of death from ECAST is about 26-51 out of 100,000 players

Emerging symptoms

Unfortunately for some football players, they do not find out they are at risk of ECAST until after it is too late. Symptoms usually occur during intense or extensive exertion. The sickle hemoglobin can change the shape of red cells from round to quarter-moon, or sickle shape. This change, known as exertional sickling, can pose a grave risk for some athletes as it
Symptoms include: feeling tired, faint, short of breath, dizziness, nausea fast breathing pain episodes and liver, kidney, or spleen enlargement/infection.

Vigorous Exercise

Strenuous exercise evokes four forces that in concert foster sickling
• severe hypoxemia
• metabolic acidosis (too much acid accumulates)
• hyperthermia in muscles
• red-cell dehydration

Precautions, managing and treatments

A sickling collapse has often been mistaken for cardiac collapse or heat collapse. However, sickling collapse often occurs usually within the first half hour on field during warm up sprints. Core temperature is not greatly elevated with sickle collapse.  
Athletes with sickle cell trait should build up slowly in training with paced progressions, allowing longer periods of rest and recovery between repetitions. Players should consider being excluded from participation in performance tests such as mile runs, serial sprints. Stay well hydrated at all times, especially in hot and humid conditions
Treatments include medications, blood transfusions to help manage symptoms of the disease but there is no cure for sickle cell disease
Getting tested will help any athlete. If a player or athlete knows they have sickle cell trait, it might just save their lives.
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