The National Athletic Trainers' Association (NATA) releases "Sickle Cell Trait and the Athlete" consensus statement
Ellen Satlof, NATA
THE NATIONAL ATHLETIC TRAINERS’ ASSOCIATION (NATA) RELEASES “SICKLE CELL TRAIT AND THE ATHLETE” CONSENSUS STATEMENT
Knowledge of sickle cell trait status can be a gateway to education; recommendations offered
to reduce the risk of collapse during sports and exercise
DALLAS, June 27, 2007 – Over the past seven years, collapse during exercise due to complications from sickle cell trait has killed nine athletes. Of 136 sudden, non-traumatic sports deaths in high school and college athletes over a decade, 5 percent were due to exertional sickling. Today at its annual meeting, the National Athletic Trainers’ Association (NATA) released an inter-association task force consensus statement with recommendations for athletes with sickle cell trait. An electronic version of the statement is available at http://www.nata.org/statements/consensus/sicklecell.pdf.
“The purpose of this consensus statement is to raise awareness of this condition among athletes, coaches, athletic trainers and other medical staff,” said Scott Anderson, ATC, head athletic trainer at the University of Oklahoma and co-chair of the task force. “It provides details on measures that can reduce the risk of collapse during sports and exercise related to sickle cell trait among athletes.”
“Our consensus statement was written in order to guide key decisions regarding athletes with sickle cell trait,” said E. Randy Eichner, MD, team internist for University of Oklahoma intercollegiate athletics and co-chair of the task force.
What is Sickle Cell Trait?
Sickle cell trait is the inheritance of one gene for sickle hemoglobin and one for normal hemoglobin. During intense or extensive exertion, the sickle hemoglobin can change the shape of red blood cells from round to quarter-moon, or “sickle.” This change, exertional sickling, can pose a grave risk for some athletes.
Devard Darling, a wide receiver for the NFL’s Baltimore Ravens lost his twin brother, Devaughn, to complications from sickle cell trait in 2001. “We both learned we had sickle cell trait during our freshman year at Florida State,” Darling said. “But even knowing the risks at the time, my brother died on the practice field before his 19th birthday. I’m hopeful that this consensus statement will help others avoid the same fate.”
The sickle gene is common in people whose origin is from areas where malaria is widespread. Over the millennia, carrying one sickle gene fended off death from malaria, leaving one in 12 African-Americans with sickle cell trait. The sickle gene is also present in those of Mediterranean, Middle Eastern, Indian, Caribbean and South and Central American ancestry, one reason for the required screening of all newborns in the United States.
Task Force Consensus
“We recommend confirming sickle cell trait status in all athletes’ pre-participation physical examinations,” said James “Scott” Galloway, ATC, head athletic trainer at DeSoto High School in DeSoto, Texas, and inter-association task force member. In 2002, a 14-year-old female
African-American basketball player at the school died from sudden cardiac arrest during the first week of practice and conditioning drills due to widespread sickle thrombi associated with physical exertion and the sickle cell trait.“Knowledge of sickle cell trait status can be a gateway to education and simple precautions that may prevent sickling collapse and enable athletes with sickle cell trait to thrive in whatever sport he or she chooses.”
The consensus of the task force, spearheaded by NATA, is as follows:
1. Athletes with sickle cell trait can participate in all sports.
2. Red blood cells can sickle during intense exertion, blocking blood vessels and posing a grave risk for athletes with sickle cell trait.
3. Screening and simple precautions may prevent deaths and help the athlete with sickle cell trait thrive in his or her chosen sport.
4. Efforts to document newborn screening results should be made during the pre-participation exam.
5. In the absence of newborn screening results, institutions should carefully weigh the decision to screen based on the potential to provide key clinical information and targeted education that may save lives.
6. Irrespective of screening, institutions should educate staff, coaches, and athletes on the potentially lethal nature of this condition.
7. Education and precautions work best when targeted at those athletes who need it most; therefore, institutions should carefully weigh this factor in deciding whether to screen. All told, the case for screening is strong.
In the event of a sickling collapse, athletic department staff, coaches and medical staff should treat it as a medical emergency by doing the following:
- Check vital signs.
- Administer high-flow oxygen, if available, with a non-rebreather face mask.
- Cool the athlete, if necessary.
- If the athlete appears to have slowed mental responses, or as vital signs decline, 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.
For more information, please visit www.nata.org.
About the National Athletic Trainers’ Association (NATA):
Athletic trainers are unique health care providers who specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. The National Athletic Trainers' Association represents and supports 30,000 members of the athletic training profession through education and research. NATA advocates for equal access to athletic trainers for athletes and patients of all ages, and supports H.R. 1846. www.nata.org. NATA is participating in the Bone and Joint Decade, the global initiative in the years 2002-2011 to raise awareness of musculoskeletal health to stimulate research and improve people's quality of life. President Bush has declared the years 2002-2011 National Bone and Joint Decade in support of these objectives. NATA, 2952 Stemmons Freeway, Ste. 200, Dallas, TX 75247, 214.637.6282; 214.637.2206 (fax).