Scary Sickle Cell

Living at altitude there are some things that you become hyper aware about. One of the more obvious things is the lack of oxygen in the air. When it comes to athletics there are a few advantages but many disadvantages to the limited O2. Having played and watched sports at the mile high level for many years you start to become in tune to ailments or conditions that might worsen because of the high altitude. One of those conditions that you definitely need to be aware of is Sickle Cell Anemia and Sickle Cell Anemia Trait. The National Athletic Trainer’s Association defines Sickle Cell Anemia Trait in their position statement as the inheritance of one gene for sickle hemoglobin and one for normal hemoglobin. Hemoglobin is a protein in the red blood cells that transports oxygen. In times of extreme exertion or exercise the sickle hemoglobin will cause the red blood cell to shrink into a quarter or half-moon shape. This greatly affects the body’s oxygen levels. The sickle cells also causes blockages in vessels because the cells catch on each other and cannot move freely.


Sickle cell is a genetic adaptation and  it is common in people whose origin is from areas where malaria is widespread. Just carrying one of the sickle-cell genes could defend off malaria (NATA Position Statement). 1 in 12 African-Americans posses the trait. It is good to take note that the trait is also seen in Mediterranean, Middle Eastern, Indian, Caribbean and South and Central American descendents.

Some startling stats about sickle-cell:

  • In the past four decades, exertional sickling has killed at least 15 football players.
  • In the past seven years alone, sickling has killed nine athletes:
    • Five college football players in training,
    • Two high school athletes
    • Two 12-year-old boys training for football
  • Of 136 sudden, non-traumatic sports deaths in high school and college athletes over a decade, seven (5%) were from exertional sickling


So what are some signs and symptoms of a sickle-cell attack:

  • Cramping muscle weakness that exceeds muscle pain 
  • Athlete “slumps” to the ground rather than a sudden collapse (Rules out cardiac)
  • Able to speak (Rules out cardiac)
  • 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 103oF (rule out heat stroke)


Ways to avoid a sickle-cell attack:

  • Build up slowly in training with paced progressions,
  • Allow longer periods of rest and recovery between repetitions.
  •  Encourage participation in preseason strength and conditioning programs
  • Athletes with sickle-cell trait should be excluded from participation in performance tests such as mile runs, serial sprints, etc., as several deaths have occurred from participation in this setting.
  • Stop any activity with onset of symptoms [muscle ‘cramping’, pain, swelling, weakness, tenderness; inability to “catch breath”, fatigue].
  •  Athletes with sickle-cell trait who perform repetitive high-speed sprints and/or interval training that induces high levels of lactic acid should be allowed extended recovery between repetitions
  • Ambient heat stress, dehydration, asthma, illness, and altitude predispose the athlete with sickle trait to an onset of crisis in physical exertion.
  •  Emphasize hydration
  • Control asthma
  • No workout if an athlete with sickle trait is ill
  • Watch closely the athlete with sickle-cell trait who is new to altitude.
  • Modify training and have supplemental oxygen available for competitions
  • Educate to create an environment that encourages athletes with sickle-cell trait to report any symptoms immediately;
  • Any signs or symptoms such as fatigue, difficulty breathing, leg or low back pain, or leg or low back cramping in an athlete with sickle-cell trait should be assumed to be sickling



How to treat a sickle-cell attack:

  • Check vital signs.
  • Administer high-flow oxygen, 15 lpm (if available),
  • Cool the athlete, if necessary.
  • Call 911, attach an AED, start an IV, and get the athlete to the hospital fast.
  • Tell the doctors to expect explosive rhabdomyolysis and grave metabolic complications.
  • Proactively prepare by having an Emergency Action Plan and appropriate emergency equipment for all practices and competitions.

Sickle cell anemia is a very serious condition and needs to be treated as soon as possible! The good thing about this disease is that it is easily screened for and once the proper people are aware of the condition it can definitely be well managed! Be aware and get screened!