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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
    
  • Heat
    
  • Dehydration
    
  • High altitude
    
  • Asthma
    
  • Illness
    
  • Unacclimatized
    
  • 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.

SICKLING
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
• Dehydration
  
• 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/

SICKLE CELL TRAIT (SCT)