Sickle Cell Trait In Sickle Cell Trait In AthletesAthletes

“REAL LIFE”“REAL LIFE”“A Common Sense Approach”“A Common Sense Approach”

Chris A. Gillespie, MEd, ATC, LATChris A. Gillespie, MEd, ATC, LAT

THE FACTSTHE FACTS• Since 2000 exertional sickling is the leading cause of non-

traumatic death in NCAA Football … All Divisions.

• In FBS --- if you add heat, heart, and asthma --- Combined, match the total dead from sickling.  

• In the last 12 years there have been NO traumatic deaths in FBS; no catastrophic head injury; no catastrophic neck injury; no comotio cordis.  (although three deaths in non FBS schools – One cardiac non-trauma related AND two head injury related)

• Not one single FBS football player in the last 12 years has died playing football.  

• Not one single FBS football player in the last 12 years has died practicing football. 

• They have ALL died PREPARING to play football … 4 in winter workouts, 4 in summer workouts, and 2 in September conditioning drills … ALL in STRENGTH/CONDITIONING SESSIONS!

NOT JUST COLLEGE or NOT JUST COLLEGE or FOOTBALLFOOTBALL

• 2000 - 12 y/o male football, conditioning, Ohio• 2002 - 14 y/o female basketball, conditioning,

Texas• 2004 - 15 y/o male football, pre-season practice,

Texas• 2006 - 12 y/o male football, conditioning, Florida• 2009 - 16 y/o male football, conditioning,

Maryland• 2010 - 15 y/o male football, pre-season practice,

Florida• 2011 - 14 y/o male football, conditioning, South

Carolina – 15 y/o male football, conditioning, Texas– 16 y/o male football, conditioning, Florida

HIGH SCHOOL FOOTBALL HIGH SCHOOL FOOTBALL 20112011

• 7 non-traumatic practice deaths• 5 were African-American• 3 deaths attributed to exertional sickling• 4th is suspected exertional sickling• 60-80% of African-American high school

football players who collapsed and died in summer practices had SCT/sickling as a COD

Case StudyCase Study• 1990 football season• 19 year old black

male football player• Collapsed after

running one and one half mile distance run

• Complained of leg pain and mid & low back ache

• Sickle cell crisis with acute exercise related rhabdomyolysis

• Increased Creatine Kinase level (CK)

RhabdomyolysisRhabdomyolysis

Definition: A disorder involving injury to

the kidney caused by toxic effects of the contents of muscle

cells.

RhabdomyolysisRhabdomyolysisCauses & Incidence

Myoglobin is an oxygen binding protein pigment found in skeletal muscle. When skeletal muscle is damaged, myoglobin is released into the bloodstream. It is filtered out of the bloodstream by the kidneys. Myoglobin may occlude the structures of the kidney, causing damage such as acute tubular necrosis or kidney failure. Myoglobin breaks down into potentially toxic compounds, which will also cause kidney failure. Necrotic (dead tissue) skeletal muscle may cause massive fluid shifts from the bloodstream into the muscle, reducing the relative fluid volume of the body and leading to shock and reduced blood flow to the kidneys.

Creatine Kinase (CK)Creatine Kinase (CK)oror

Creatine Photokinase (CPK)Creatine Photokinase (CPK)

An enzyme found predominantly in the heart, brain, and skeletal

muscle. When the total CPK level is

substantially elevated, it usually indicates injury or stress to one or

more of these areas.

Normal Creatine Kinase (CK) Normal Creatine Kinase (CK) ValuesValues

Male: 38 - 174 units/L Female: 96 – 140 units/L

CK LevelsCK Levels

A high CK, or one that goes up from the first to the second or later samples, generally indicates that there has been some damage to the heart or

other muscle. It can also indicate that your muscles have experienced heavy use.

CK LevelsCK Levels

People who have greater muscle mass have higher CK levels than those who don’t, and

African-Americans may have higher CK levels than other ethnic groups.

Very heavy exercise (such as in weight lifting, contact sports, or long exercise sessions) can also

increase CK.

What is Sickle Cell Trait?What is Sickle Cell Trait?• Not itself a

disease• Hereditary

condition • One abnormal

gene for hemoglobin (S)

• Genetic type AS• Sickle Cell Anemia

Disease is SS

Who has Sickle Cell Trait?Who has Sickle Cell Trait?

• About 8-10% of the U.S. black population has sickle cell trait

• Only about 1% have the disease

• SCT is also found in non-blacks as well, but less frequently

For Many YearsFor Many YearsAthletic Organizations…Athletic Organizations…

•Characterized SCT as a benign condition that does not affect the longevity of the individual

GeneticsGenetics

Testing for Sickle Cell Trait?Testing for Sickle Cell Trait?

• Simple blood test• Mandatory vs.

voluntary (changes)

• What do we do if the test is positive?– Genetic

Counseling– Health care issues– Work-out

adaptation

Sickle Cell Trait – Medical Sickle Cell Trait – Medical ProblemsProblems

• Inability to concentrate urine normally

• Blood in the urine• Spleen problems

especially at high altitudes

• Exercise related rhabdomyolysis

• Exercise associated sudden death

Warning SignsWarning Signs

• Leg pain• Back pain• Hematuria• Dehydration• Fatigue• A positive SCT

test• When in doubt…..

Crisis – Time is of the Crisis – Time is of the Essence!Essence!

• Must seek timely and appropriate medical care for the athlete who is potentially suffering from sickle cell crisis….This is a TRUE medical emergency !

Proper Hydration & Hot Proper Hydration & Hot WeatherWeather

• Avoid dehydration• Acclimatization is

key• Condition before

athletic bouts begin• Do not exercise in a

dehydrated state or during acute illness

• Drink fluids “all day”• Know your athletes

Exercise and Work-Out Exercise and Work-Out RoutineRoutine

• CONTROVERSIAL• No running over 100

yards at any time!• Increased rest

periods between bouts of exercise

• Unlimited hydration before, during, and after exercise

• Performance levels increase with these changes

Precautions per the Inter-Precautions per the Inter-AssociationAssociation

Consensus Statement Consensus Statement• Exclude from Day-1 conditioning tests• Slow, paced progressions of training• Allowing longer periods of rest and recovery

between repetitions• Heat stress, dehydration, asthma, illness, and

altitude create additional risk • Stop activity with onset of symptoms• Set a tone that encourages consideration for

the athlete with sickle cell trait

Selectively Opting Out of Selectively Opting Out of SportsSports

• All SCT positive athletes at Samford University since 1990 have been football players

• In interviews with these athletes, we have hypothesized that athletes choose sports where they will excel

• Athletes with SCT most likely cannot excel in sports with high aerobic demand so they opt out of these sports at an early age

Medical History QuestionsMedical History Questions• Do any of your close relatives suffer

from SCD or SCT?• Have you ever been tested for SCT?

– If yes, was the test positive?– If yes, what have you done differently?

• Do you fatigue more than your peers in aerobic related activities?– If yes, explain?

• Have you ever selectively opted out of a sport or activity because of fatigue?– If yes, explain why and list the types of

symptoms that you have had during these situations.

CONCLUSIONCONCLUSION• Most of the studies in this area have

been done in the military setting• Most of the knowledge that we have

gained in athletics is gained from anecdotal information

• More studies regarding the risk involved in athletics must be done

• An Inter-Associational SCT Task Force met in February 2007 to discuss ways to prevent the senseless deaths of athletes with Sickle Cell Trait. As a result the NCAA took some corrective action – but it’s not enough!

THE FACTSTHE FACTS• Since 2000 exertional sickling is the leading cause of non-

traumatic death in NCAA Football … All Divisions.

• In FBS --- if you add heat, heart, and asthma --- Combined, match the total dead from sickling.  

• In the last 12 years there have been NO traumatic deaths in FBS; no catastrophic head injury; no catastrophic neck injury; no comotio cordis.  (although three deaths in non FBS schools – One cardiac non-trauma related AND two head injury related)

• Not one single FBS football player in the last 12 years has died playing football.  

• Not one single FBS football player in the last 12 years has died practicing football. 

• They have ALL died PREPARING to play football … 4 in winter workouts, 4 in summer workouts, and 2 in September conditioning drills … ALL in STRENGTH/CONDITIONING SESSIONS!

Thank YouThank Youfor yourfor your

time & attention!time & attention!