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Exercise collapse associated with sickle cell trait (ECAST): case report and literature review
Richard D Quattrone1, E Randy Eichner, Anthony Beutler
11Primary Care Sports Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; 2University of Oklahoma Health Sciences Center, Oklahoma City, OK; 3National Capital Consortium Sports Medicine, Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; 4Naval Health Clinic, Quantico, VA; and 5Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
Sickle cell trait (SCT) can lead to exertional collapse (ECAST) in athletes and military personnel. This review explores risk factors and introduces the "double hit" hypothesis for ECAST mechanisms.
Area of Science:
- Sports Medicine
- Genetics
- Exercise Physiology
Background:
- Sickle cell trait (SCT) is linked to exertional collapse (ECAST) and sudden death in athletes and military warfighters.
- The exact mechanisms causing ECAST are debated within sports medicine.
- Potential contributing factors include intense exercise, dehydration, heat, prior rhabdomyolysis, genetic factors, and supplements.
Observation:
- This case report reviews SCT in relation to exercise in warfighters and athletes.
- It identifies established and hypothesized risk factors for ECAST.
- The report introduces the "double hit" concept as a potential mechanism for ECAST.
Findings:
- Extraordinary exercise intensity is often cited, but other factors like dehydration, heat, and genetic cofactors are also implicated.
- A combination of factors, a "perfect storm," may trigger ECAST and a fatal metabolic crisis.
- The "double hit" hypothesis suggests a synergistic effect of multiple stressors.
Implications:
- Understanding these risk factors is crucial for preventing ECAST in high-exertion scenarios.
- Further research into the "double hit" mechanism could refine ECAST prevention strategies.
- Educating athletes and military personnel about SCT risks and preventative measures is vital.
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