Reducing risk in sports: Sickle cell trait and sports

Scott Sailor, president of National Athletic Trainers’ Association (NATA).

USA TODAY High School Sports and the National Athletic Trainers’ Association have partnered on a monthly column to address injuries, prevention and related issues to help schools, coaches and student-athletes. Here is the latest column from Scott Sailor, the president of NATA.

With preparation for summer activities around the corner, there is good news for those with sickle cell trait. Although being involved in sports poses some risk, those carrying the sickle cell trait are often able to participate with proper education and precautions. Athletes with questions about how this blood disorder may affect them should check with the school’s athletic trainer.

Sickle cell trait and sickle cell anemia: What’s the difference:

Sickle cell anemia and sickle cell trait are both blood disorders that can be harmful for athletes. Here is the difference:

  • Sickle cell trait is the inheritance of one abnormal gene for sickle hemoglobin and one gene for normal hemoglobin. During intense or extensive exercise, the sickle hemoglobin can change the shape of red blood cells from round to quarter-moon, or “sickle.” This change, known as exertional sickling, can pose a grave danger for some athletes. The abnormal blood cells can “logjam” blood vessels, blocking proper oxygen flow to the heart and other muscles, which can cause serious complications.
  • Sickle cell anemia is when the body produces abnormal hemoglobin, causing an inherited form of anemia. This means that the body’s red blood cells tend to break apart and die, causing a lack of oxygen being carried in the blood. Periodic episodes of pain and fatigue are common. Athletes with sickle cell anemia are often discouraged from participating in sports due to the serious health risks.

Sickle cell status should be confirmed during a pre-participation physical exam since every child is screened at birth. All athletes with sickle cell trait should know their status. It is important that their coaches, other players and parents be educated and aware of exertional sickling and the potential for collapse. Athletes who are unaware of their status should ask their pediatrician for their newborn screen results.

To help prevent a sickling collapse, athletes with the sickle cell trait should follow these recommendations:

  • Follow a pace-progression training program with longer periods of rest and recovery between repetitions
  • Set their own pace
  • Avoid performance tests such as mile runs, serial sprints, etc.
  • Stop activity at the onset of symptoms and report immediately to the athletic trainer or coach, in case no athletic trainer is on site.
  • Adjust work-rest cycles to accommodate environmental factors such as heat or change in altitude
  • Check with the athletic trainer about the availability of oxygen in the event of an emergency 

Exertional sickling symptoms:

Because a collapse from sickling can be mistaken for cardiac or heat collapse, it is important to know the symptoms that are specific to exertional sickling. They include:

  • Possible collapse during the first 30 minutes of exertion
  • Fatigue
  • Difficulty breathing
  • Leg or lower back pain
  • Sudden weakness in the muscles causing the athlete to slump to the ground
  • Core temperature is not greatly elevated

Additionally, environmental heat, dehydration, uncontrolled asthma, acute illness and newness to altitude can predispose athletes with sickle cell trait to potentially traumatic conditions.

What to do if a sickling collapse occurs:

An emergency action plan and appropriate emergency equipment should already be in place for all practices and competitions. A sickling collapse should be treated as a medical emergency, and the athletic trainer or other medical professional will do the following:

  • Check vital signs
  • Administer high-flow oxygen, if available, with a non-rebreather facemask
  • Cool the athlete, if necessary
  • If the athlete appears to have slowed mental responses, or as vital signs decline, call 911, attach an AED and transport the athlete to the hospital fast
  • Tell the physicians to expect serious complications due to muscle breakdown and byproducts in the bloodstream and kidneys

Knowledge, education and simple precautions may help athletes with sickle cell trait thrive in their favorite sports. The National Athletic Trainers’ Association has created an infographic handout on sickle cell and athletes. Also, visit for additional sports safety tips for athletes and parents.

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