Exercise-induced cardiac arrest in a sickle cell trait-positive Air Force recruit: a case report

In October 2011, a sickle cell trait (SCT)-positive Air Force recruit collapsed and died immediately following his physical fitness test. The cause of death was reported to be a cardiac dysrhythmia secondary to an acute sickling crisis. Although it is well known that SCT-positive individuals have a significant risk of exercise-related death (ERD), this case is notable in that none of the commonly cited risk factors were present, including exertional heat injury, dehydration, training at altitude, and rhabdomyolysis. Our findings challenge the commonly held assertion exertional heat illness is the fundamental underlying etiology in these cases, and that the current Department of Defense's policy on SCT screening is ineffective at mitigating the risk of ERD in SCT-positive recruits. Furthermore, we argue that without a clearer understanding of the precise risk factors for ERD in this population, screening programs may actually shift excessive health risks onto those without SCT.