Exertional sickling: questions and controversy

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.