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
- High altitude
- 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.
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
- 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/
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