An athlete with sickle cell trait is at risk for acute rhabdomyolysis, which can be fatal. Anzalone et al identified prognostic factors associated with a poor outcome in these athletes. The authors are from the Harris County Medical Examiner's Office and the University of Texas Health Sciences System in Houston.


Any form of sustained, all-out exertion can trigger a sickling crisis, resulting in acute rhabdomyolysis with or without collapse.


Risk factors for severe rhabdomyolysis:

(1) The athlete tries to struggle on despite symptoms.

(2) The coach urges the athlete to continue despite symptoms.

(3) The presence of excessive heat.

(4) The workout is done at a high altitude with a reduced partial pressure of oxygen.

(5) The athlete has asthma.

(6) The athlete is dehydrated.


Steps to reduce the risk to the athlete:

(1) Identify all athletes with sickle cell trait.

(2) An athlete with sickle cell trait should stop exercising immediately if symptoms appear.

(3) The athelete should lie down, receive supplemental oxygen and fluids and be evaluated.

(4) If the athlete does not improve or worsens then:

(4a) start an IV line

(4b) attach an automated external defibrillator if available

(4c) transport the athlete to a hospital

(4d) alert the receiving physician to the possibility of rhabdomyolysis


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