21 athletes collapsed and died past 10 y Complications from Sickle Cell Trait with strenuous...
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![Page 1: 21 athletes collapsed and died past 10 y Complications from Sickle Cell Trait with strenuous exertion 1 – Splenic infarction 2 – Hematuria 3 – Rhabdomyolysis.](https://reader035.fdocuments.in/reader035/viewer/2022072006/56649cf95503460f949cb2ac/html5/thumbnails/1.jpg)
Screening College Athletes for Sickle Cell
Trait
New NCAA Requirements
Brooke Durland, MD2010 NYSCHA Annual Meeting
October 22, 2010
![Page 2: 21 athletes collapsed and died past 10 y Complications from Sickle Cell Trait with strenuous exertion 1 – Splenic infarction 2 – Hematuria 3 – Rhabdomyolysis.](https://reader035.fdocuments.in/reader035/viewer/2022072006/56649cf95503460f949cb2ac/html5/thumbnails/2.jpg)
Issue of Exertional Sickling in SCT (Sickle Cell Trait)
21 athletes collapsed and died past 10 y
Complications from Sickle Cell Trait with strenuous exertion 1 – Splenic infarction 2 – Hematuria 3 – Rhabdomyolysis
Aggravating factors: 1 – Heat 2 – Dehydration 3 – Altitude 4 – Asthma 5 – Illness
![Page 3: 21 athletes collapsed and died past 10 y Complications from Sickle Cell Trait with strenuous exertion 1 – Splenic infarction 2 – Hematuria 3 – Rhabdomyolysis.](https://reader035.fdocuments.in/reader035/viewer/2022072006/56649cf95503460f949cb2ac/html5/thumbnails/3.jpg)
Research on Exertional Sickling with Sickle Cell Trait
Early studies in military recruits
High altitude sports participation
Case studies from forensic medicine
Exercise physiology studies
![Page 4: 21 athletes collapsed and died past 10 y Complications from Sickle Cell Trait with strenuous exertion 1 – Splenic infarction 2 – Hematuria 3 – Rhabdomyolysis.](https://reader035.fdocuments.in/reader035/viewer/2022072006/56649cf95503460f949cb2ac/html5/thumbnails/4.jpg)
Pathophysiology of Sickling in SCT Athletes
Low oxygen causes change Hgb shape Sickled rbcs travel in microcirculation –
obstruct blood flow Blockage of vessels starves tissues of
blood and oxygen Large muscles become ischemic -
rhabdomyolysis Setting for Lactic Acidosis
![Page 5: 21 athletes collapsed and died past 10 y Complications from Sickle Cell Trait with strenuous exertion 1 – Splenic infarction 2 – Hematuria 3 – Rhabdomyolysis.](https://reader035.fdocuments.in/reader035/viewer/2022072006/56649cf95503460f949cb2ac/html5/thumbnails/5.jpg)
Road to Rhabdomyolysis
Low oxygen causes change
Hgb shape
Sickled rbcs
travel in
micro-circulat
ion – ‘sticky’,
‘log jam’
Blockage of
vessels
starves tissues
of blood and
oxygen
Large muscle
s becom
e ischemi
c
Muscle breakdo
wn (rhabdo
my-olysis)
and lactic
acidosis
Athlete collapse: death can
result from renal failure and
acidosis
![Page 6: 21 athletes collapsed and died past 10 y Complications from Sickle Cell Trait with strenuous exertion 1 – Splenic infarction 2 – Hematuria 3 – Rhabdomyolysis.](https://reader035.fdocuments.in/reader035/viewer/2022072006/56649cf95503460f949cb2ac/html5/thumbnails/6.jpg)
Sickling vs. Heat Cramps Symptoms abrupt
onset Pain milder Athletes slump to
ground – “weak and wobbly”
Lie still, legs and back hurt, general malaise
Mild case, respond 10 – 15 minutes treatment
Prodrome with twitches and twinges
Excruciating pain of “locked-up” muscles
Athletes hobble off - muscles not work
Cry in pain, muscles ‘rock hard’
1-2 hours of treatment before improvement
![Page 7: 21 athletes collapsed and died past 10 y Complications from Sickle Cell Trait with strenuous exertion 1 – Splenic infarction 2 – Hematuria 3 – Rhabdomyolysis.](https://reader035.fdocuments.in/reader035/viewer/2022072006/56649cf95503460f949cb2ac/html5/thumbnails/7.jpg)
NCAA Recommendations
1974: Univ. Colo. player died complications SCT– NCAA adds info to handbook
2008: Strong statement about risks related to SCT after 2006 death Rice U. football player – Dale Lloyd II
2010: April this year NCAA voted require athletes submit test, get test or sign declination
Controversies about recent ruling
![Page 8: 21 athletes collapsed and died past 10 y Complications from Sickle Cell Trait with strenuous exertion 1 – Splenic infarction 2 – Hematuria 3 – Rhabdomyolysis.](https://reader035.fdocuments.in/reader035/viewer/2022072006/56649cf95503460f949cb2ac/html5/thumbnails/8.jpg)
Response from colleges and universities
NCAA survey: 2006 survey of 92 top level football programs – 21% required all screened; 64% had some sort of policy
Conversations on list serve in response to new NCAA rule – many schools seek to learn from colleagues
Screening protocols Testing methodologies Declination forms
![Page 9: 21 athletes collapsed and died past 10 y Complications from Sickle Cell Trait with strenuous exertion 1 – Splenic infarction 2 – Hematuria 3 – Rhabdomyolysis.](https://reader035.fdocuments.in/reader035/viewer/2022072006/56649cf95503460f949cb2ac/html5/thumbnails/9.jpg)
Questions for discussion
?Concern related to potential for discrimination against athletes who test positive for SCT?
?Responsible for genetic counseling with testing?
?Adjust training regimen/climate for all college athletes?
?Who are our audiences for educating about this issue?