Exertional rhabdomyolysis and renal failure in patients with sickle cell trait: Is it time to change our approach?

Abstract

Based upon numerous reported cases and despite widespread beliefs to the contrary, sickle cell trait (SCT) may be deemed a quantifiable risk factor in certain subsets of patients. As a result of common misconceptions regarding SCT, most individuals with the condition are generally not informed regarding the possible consequences of certain activities such as venturing to high altitudes or participating in overly exertional physical activities. Acute exertional rhabdomyolysis is a potentially serious clinical illness and is caused by skeletal muscle injury resulting in the release of myoglobin and other cellular contents, including creatine kinase, into the circulatory system. Mild to moderate cases of acute exertional rhabdomyolysis can cause metabolic disorders including hypernatremia, hyperkalemia, hyperphosphatemia, hypocalcemia, lactic acidosis and hyperuricemia. Severe cases may result in renal failure and even death. Several case reports have been published since the early 1970s describing significant morbidity and mortality of acute exertional rhabdomyolysis in patients with SCT. We present the case of a 27-year-old male with a past medical history significant only for SCT who presented after a 1.5 mile run with severe exertional rhabdomyolysis and subsequent acute renal failure requiring hemodialysis (HD). In presenting this case, we hope to raise awareness of a possible underlying cause to many cases of exertional rhabdomyolysis and encourage physicians to counsel their patients with SCT in order to avoid the significant morbidity and mortality that may be associated with the condition.

Sickle cell trait associated with a RR of death of 37 times in national collegiate athletic association football athletes: a database with 2 million athlete-years as the denominator

“…The death rate is 37 times higher in football athletes with SCT than those without. Death in other athletes with SCT or those undergoing strenuous physical exertion has been reported although in this cohort no other sports were represented 1 3 4 8 9 13–15. The National Center for Catastrophic Sport Injury Research has documented 12 deaths association with SCT, seven of which occurred between 2000 and 2008.…”

Association among sickle cell trait, fitness, and cardiovascular risk factors in CARDIA

“…22 Several studies have also sought to determine the pathophysiologic basis for the exertion-related sudden death described among individuals with SCT in case reports. [23][24][25][26] In a recent population study of black soldiers on active duty in the US Army, SCT was associated with an adjusted risk for exertional rhabdomyolysis that was 54% higher than that associated with absence of SCT, although all-cause mortality was not affected by SCT status.…”

Exertional Rhabdomyolysis-When Should We Start Worrying?

“…Another risk factor for patients developing complications from ER is preexisting sickle cell trait or disease. 5,7 The sickling of the red blood cells during the intense exertion can cause impaired renal blood flow leading to renal failure as well as decrease muscular blood flow further aggravating the ER. Various sports have addressed these risks through their professional organization's position statements and educational campaigns.…”

“…1Y3 In contrast, patients experiencing ER with predisposing risk factors are at a higher risk for developing complications based on several case reports. 4,5 We describe 4 patients (including 2 patients from the literature who are mentioned in the discussion part) who developed ER and who were treated only as outpatients with oral hydration and close follow-up. All the patients recovered normally without any sequelae.…”