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Related Experiment Video

Updated: Apr 18, 2026

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Exertional sickling: questions and controversy.

Morey A Blinder1, Sarah Russel2

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Summary

Sickle cell trait (SCT) can lead to sudden death in athletes during intense exercise, known as ECAST. This review examines case studies and current guidelines to clarify prevention and treatment strategies for this rare but serious condition.

Keywords:
exercise collapsesickle cell traitsudden death

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Area of Science:

  • Sports Medicine
  • Genetics
  • Pathophysiology

Background:

  • Sickle cell trait (SCT) affects 8% of African-Americans, often considered benign.
  • Exercise collapse associated with sickle trait (ECAST) represents a rare but catastrophic risk, particularly in athletes.
  • Despite numerous reports, the pathophysiology of ECAST remains poorly understood.

Purpose of the Study:

  • To examine case studies of ECAST in athletes.
  • To review current recommendations for ECAST prevention, recognition, and treatment.
  • To identify areas of consensus and controversy regarding SCT screening and ECAST management.

Main Methods:

  • Review of medical literature and lay press case reports on ECAST.
  • Analysis of existing guidelines and recommendations for SCT screening and ECAST.
  • Examination of ECAST cases, particularly in collegiate football players.

Main Results:

  • ECAST is linked to physical exertion in individuals with SCT.
  • Screening for hemoglobin S and ECAST management strategies are debated.
  • Current guidelines for ECAST recognition and treatment are fragmented.

Conclusions:

  • Further research is needed to elucidate ECAST pathophysiology.
  • Clearer, unified guidelines are required for ECAST prevention and management.
  • Addressing controversies surrounding SCT screening is crucial for athlete safety.