Sickle Cell Trait and Fatal Rhabdomyolysis in Football Training

Anzalone, Mary L.; Green, Valerie S.; Buja, L. Maximilian; Sánchez, Luis A.; Harrykissoon, R.; Eichner, E. Randy

doi:10.1249/mss.0b013e3181ae0700

Cited by 72 publications

(58 citation statements)

References 14 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Liem

Chan

et al. 2017

Blood

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Key Points• SCT status is not significantly associated with longitudinal changes in fitness among African Americans.• SCT status is not an independent risk factor for hypertension, diabetes, or metabolic syndrome among African Americans.The contribution of sickle cell trait (SCT) to racial disparities in cardiopulmonary fitness is not known, despite concerns that SCT is associated with exertion-related sudden death. We evaluated the association of SCT status with cross-sectional and longitudinal changes in fitness and risk for hypertension, diabetes, and metabolic syndrome over the course of 25 years among 1995 African Americans (56% women, 18-30 years old) in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Overall, the prevalence of SCT was 6.8% (136/1995) in CARDIA, and over the course of 25 years, 46% (738/1590), 18% (288/1631), and 40% (645/1,611) of all participants developed hypertension, diabetes, and metabolic syndrome, respectively. Compared with participants without SCT, participants with SCT had similar baseline measures of fitness in cross-section, including exercise duration (535 vs 540 seconds; P 5 .62), estimated metabolic equivalent of tasks (METs; 11.6 vs 11.7; P 5 .80), maximum heart rate (174 vs 175 beats/min; P 5 .41), and heart rate at 2 minutes recovery (44 vs 43 beats/min; P 5 .28). In our secondary analysis, there was neither an association of SCT status with longitudinal changes in fitness nor an association with development of hypertension, diabetes, or metabolic syndrome after adjustment for sex, baseline age, body mass index, fitness, and physical activity. SCT is not associated with reduced fitness in this longitudinal study of young African American adults, suggesting the increased risk for exertion-related sudden death in SCT carriers is unlikely related to fitness. SCT status also is not an independent risk factor for developing hypertension, diabetes, or metabolic syndrome. (Blood. 2017;129(6):723-728) IntroductionSickle cell trait (SCT) is caused by the inheritance of a single copy of the variant b globin gene, which results in production of abnormal sickle hemoglobin. The coinheritance of 2 copies of the abnormal gene results in sickle cell anemia (SCA), a clinically significant blood disorder seen primarily among individuals of African or Afro-Caribbean descent. Historically, SCT, which is observed in 8% of the African American population in the United States, has been considered a clinically benign condition. Recent studies, however, suggest SCT may confer a higher risk for chronic kidney disease, thrombosis, stroke, and pregnancy-related complications in its carriers.1-6 Importantly, there is growing concern SCT may be associated with sudden death during strenuous physical activity and exercise, leading to the National College Athletics Association to mandate carrier status testing among all student athletes in division I institutions in 2010, and later in all division II and III institutions. [7][8][9] Growing evidence suggests SCT carriers may exh...

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Section: Discussionmentioning

confidence: 99%

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

Liem

Chan

et al. 2017

Blood

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“…The condition has developed from weightlifting, sprinting, contact practices, noncontact practices, and running. 1,2,[7][8][9][10][11][12][13] Our patient participated in a full-contact practice session, followed by conditioning and then a team-mandated cold-water immersion bath. The intense nature of the exercise, in combination with the temperature extremes, 1,6,7,13 may have affected the onset of rhabdomyolysis in our patient.…”

Section: Mechanism Of Illnessmentioning

confidence: 99%

“…35 Decreased body water and electrolyte imbalances have been theorized causes of exercise-associated muscle cramping, 36 and cramping has been identified in several reported cases of exertional rhabdomyolysis. 1,2,13 Cramping may be a precursor to muscle cell damage and subsequent exertional rhabdomyolysis, 1,2,7,8,13,32,37 although randomized controlled trials or other robust controlled research studies should be conducted to investigate this possibility.…”

Section: Hypohydration and Rhabdomyolysismentioning

confidence: 99%

“…[1][2][3][4][5] Rhabdomyolysis can also result from extreme crushing injuries (as in a car crash) or disease or drug toxicity, but these causes are typically not observed in athletes. [1][2][3][4][5] Exertional rhabdomyolysis has been noted to occur with muscle activity, temperature extremes, and muscle ischemia. 6 During activities that result in muscle fatigue, adenosine triphosphate (ATP) cannot supply the demand; therefore, cellular energy supplies are insufficient.…”

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confidence: 99%

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Exertional Rhabdomyolysis in a Collegiate American Football Player After Preventive Cold-Water Immersion: A Case Report

Kahanov

Eberman

Wasik

et al. 2012

Journal of Athletic Training

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Objective: To describe a case of exertional rhabdomyolysis in a collegiate American football player after preventive coldwater immersion.Background: A healthy man (19 years old) participated in full-contact football practice followed by conditioning (2.5 hours). After practice, he entered a coach-mandated postpractice cold-water immersion and had no signs of heat illness before developing leg cramps, for which he presented to the athletic training staff. After 10 minutes of repeated stretching, massage, and replacement of electrolyte-filled fluids, he was transported to the emergency room. Laboratory tests indicated a creatine kinase (CK) level of 2545 IU/L (normal range, 45-260 IU/L), CK-myoglobin fraction of 8.5 ng/mL (normal < 6.7 ng/mL), and CK-myoglobin relative index of 30% (normal range, 25%-30%). Myoglobin was measured at 499 ng/mL (normal = 80 ng/ mL). The attending physician treated the athlete with intravenous fluids.Differential Diagnosis: Exercise-associated muscle cramps, dehydration, exertional rhabdomyolysis.Treatment: The patient was treated with rest and rehydration. One week after the incident, he began biking and swimming. Eighteen days later, the patient continued to demonstrate elevated CK levels (527 IU/L) but described no other symptoms and was allowed to return to football practice as tolerated. Two months after the incident, his CK level remained high (1900 IU/L).Uniqueness: The athlete demonstrated no signs of heat illness upon entering the cold-water immersion but experienced severe leg cramping after immersion, resulting in a diagnosis of exertional rhabdomyolysis. Previously described cases have not linked cold-water immersion with the pathogenesis of rhabdomyolysis.Conclusions: In this football player, CK levels appeared to be a poor indicator of rhabdomyolysis. Our patient demonstrated no other signs of the illness weeks after the incident, yet his elevated CK levels persisted. Cold-water immersion immediately after exercise should be monitored by the athletic training staff and may not be appropriate to prevent muscle damage, given the lack of supporting evidence.

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“…Sickle cell trait should also be considered a possible contributing clinical risk/complicating factor for vascular dysfunction, exertional rhabdomyolysis, and collapse related to red blood cell sickling in youth during strenuous physical activity in the heat. [27][28][29] A previous episode of heat stroke, however, generally does not seem to have long-term negative effects on thermoregulation, exerciseheat tolerance, or exertional heatillness risk, especially for those who received prompt cooling therapy. 30 …”

Section: Introductionmentioning

confidence: 99%

Climatic Heat Stress and Exercising Children and Adolescents

Bergeron¹,

Devore²,

Rice³

2011

Pediatrics

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Results of new research indicate that, contrary to previous thinking, youth do not have less effective thermoregulatory ability, insufficient cardiovascular capacity, or lower physical exertion tolerance compared with adults during exercise in the heat when adequate hydration is maintained. Accordingly, besides poor hydration status, the primary determinants of reduced performance and exertional heat-illness risk in youth during sports and other physical activities in a hot environment include undue physical exertion, insufficient recovery between repeated exercise bouts or closely scheduled same-day training sessions or rounds of sports competition, and inappropriately wearing clothing, uniforms, and protective equipment that play a role in excessive heat retention. Because these known contributing risk factors are modifiable, exertional heat illness is usually preventable. With appropriate preparation, modifications, and monitoring, most healthy children and adolescents can safely participate in outdoor sports and other physical activities through a wide range of challenging warm to hot climatic conditions.

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Sickle Cell Trait and Fatal Rhabdomyolysis in Football Training

Cited by 72 publications

References 14 publications

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

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

Exertional Rhabdomyolysis in a Collegiate American Football Player After Preventive Cold-Water Immersion: A Case Report

Climatic Heat Stress and Exercising Children and Adolescents

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