Exertional sickling is a medical emergency occurring in athletes carrying the sickle cell trait.  When the red blood cells(RBC) change shape or “sickle” this causes a build up of RBCs in small blood vessels, leading to decreased blood flow. The drop in blood flow leads to a breakdown of muscle tissue and cell death, known as fulminant rhabdomyolysis.

HOW DO YOU PREVENT EXERTIONAL SICKLING?

  • Screen all athletes for sickle cell trait and counsel athletes who are identified as having the trait
  • Mandate Preparticipation exams to ensure athletes are healthy for activity
  • Acclimatize all athletes by slowly increasing intensity when conditioning or lifting
  • Modify drills for sickle cell trait athletes by avoiding timed runs and implementing breaks between runs
  • Have water readily available during all activity
  • Limit activity if any type of illness is present
  • Educate athletes, parents, and coaches about the signs, symptoms, and treatment of exertional sickling
  • Be aware of predisposing factors:
    • Sickle cell trait
    • Heat
    • Dehydration
    • High altitude
    • Asthma
    • Illness
    • Unacclimatized
    • High intensity exercise with short rest intervals


LOOK FOR THESE SYMPTOMS IN ATHLETES WHEN EXERTIONAL SICKLING IS SUSPECTED:
Common Signs and Symptoms of an Exertional Sickling episode

  • CrampingMuscle weakness that exceeds muscle pain
  • Athlete “slumps” to the ground rather than a sudden collapse (rules out cardiac)
  • Able to speak
  • Muscles look and feel normal (rules out heat cramps)
  • Rapid breathing, but pulmonary exam reveals normal air movement (rules out asthma)
  • Rectal temperature less than 103 degrees F (rule out heat stroke)


Adapted from: Eichner, ER. Sickle cell considerations in athletes. Clin Sports Med. 2011;30:3:537-549.

SICKLING
Exertional sickling is most common when exercise is high intensity and has short or small amounts of recovery time between drills.  Sports settings common for exertional sickling collapse are:

  • Football conditioning
  • Basketball training
  • Cross-country racing
  • University track tryout
  • Golden Gloves boxing bout


WHAT ELSE COULD THIS BE?

  • Exertional heat illness
  • Dehydration
  • Heat syncope
  • Asthma attack
  • Cardiac conditions


HOW DO YOU TREAT AN INDIVIDUAL WITH EXERTIONAL SICKLING?

  • Stop activity
  • Check vital signs (Heart rate, blood pressure, breathing)
  • Activate Emergency Medical Services and prepare for CPR
  • Administer high-flow oxygen (15L/min)
  • Cool athlete if necessary
  • Call ahead to hospital and tell staff to expect explosive rhabdomyolysis
  • Extended care will be needed to assess body damage (kidneys, liver, etc.)


WHEN CAN THE INDIVIDUAL RETURN TO ACTIVITY?

  • Physician clearance
  • Gradual return to play based on level of sickling and severity of symptoms.


​Taken from Korey Stringer Institute. https://ksi.uconn.edu/emergency-conditions/exertional-sickling/

SICKLE CELL TRAIT (SCT)

Smitty's Plan for O​rthopedic Rehabilitation & Training