Page 144 - Athletic Health Handbook
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athletes suffering from exertional to the eight-fold higher death rate of Table 1. Exertional Sickling
sickling can have core body 28–29 year olds versus that of 17–18 and Heat Cramping Differences
temperatures less than 105°F and year olds with sickle cell trait.2 (NATA Consensus Statement)
often appear to be in less pain than
those having heat-related problems.6 Screening Exertional sickling Heat cramping
Additionally, heat-related illness
typically progresses over a period With the treatment of exertional Slump to the ground Muscle twinges
of time with painful heat cramping sickling and rhabdomyolysis largely with weak muscles
often preceding heat stroke. Exertional supportive, most efforts have been Muscles appear normal Pain
sickling can occur quickly and without focused upon the identification of Quick recovery “Hobble to a halt”
warning signs. If symptoms exist, those with sickle cell trait to prevent Visible contracted
pain and weakness in the working or limit episodes of exertional and spastic
muscles, such as the thigh, buttocks, sickling. While no clear evidence muscles
and back, are most common among exists that screening for sickle cell Slower recovery
exertional sicklers. Other differences trait prevents death, athletic programs
between athletes suffering from have begun to develop programs to by researchers who argue that the
exertional sickling and heat cramping identify those carrying the sickle cell program may result in more harm
have been described by the National trait. Many professional organizations than benefit. A recent commentary in
Athletic Trainers’ Association have already electively chosen the New England Journal of Medicine
and outlined in Table 1. to screen athletes with blood tests to suggested that the new NCAA
confirm sickle cell status. Screening program has many of the potential
Prompt recognition and treatment practices among most high schools pitfalls that plagued sickle cell trait
of rhabdomyolysis, especially among are less sophisticated and consist screening efforts in the past.1 The
those with sickle cell trait, is critical solely of the following question authors cited the since-abandoned
to limit potentially fatal consequences. on the Pre-Participation Physical screening efforts for sickle cell trait
If exertional sickling and/or Evaluation monograph: “Do you during reproductive counseling.
rhabdomyolysis are suspected, or someone in your family have This voluntary screening effort
initial efforts should include removal sickle trait or disease?” was halted due to lack of counseling
from play and fluid resuscitation. and confusion in conveying proper
Rehydration to expand the The NCAA’s decision to institute a information to patients differentiating
intravascular volume increases renal universal screening program represents sickle cell trait versus sickle cell
blood flow and helps limit further the largest effort to detect athletes disease.1 Furthermore, due in part
erythrocyte sickling and buildup possessing the sickle cell trait. The to potential discrimination against
of myoglobin casts. If symptoms decision to proceed with the testing sickle cell trait carriers, the Sickle
persist, the athlete should be resulted largely from the settlement of Cell Disease Advisory Committee of
transported for further treatment Dale Lloyd II against the NCAA and the National Heart, Lung, and Blood
and closer monitoring. Rice University.1 Lloyd, a 19-year-old Institute (a section of the National
freshman with sickle cell trait, died Institute of Health) has urged
While rhabdomyolysis and its from exertional rhabdomyolysis after the military to halt routine testing
sequelae account for the majority football practice in 2006. According of their recruits.2 Pundits of mass
of sudden-death fatalities among to the new regulations, all Division I screening for sickle cell trait claim
those with sickle cell trait, evidence student-athletes must be tested for that the costs, both financial and
suggests that asymptomatic sickle cell trait, show proof of a prior discriminatory, and benefits of these
repetitive exertional sickling test, or sign a waiver so that athletes screening programs have not been
may have long-term effects on renal with sickle cell trait can be identified clearly elucidated.
function. Repetitive renal papillary and precautions instituted. It is
necrosis caused by intermittent expected that as a result of this testing The goal of sickle cell screening
ischemia eventually leads to program between 400 and 500 new is not to disqualify or prevent
isothenuria, the inability to cases of sickle cell trait will be these athletes from participating in
maximally concentrate urine.10 The identified each year.1 intercollegiate athletics. Rather, the
chronic renal damage and resultant knowledge gained from screening
isothenuria may contribute The use of routine screening for efforts may enable health care
sickle cell trait has been questioned providers to establish simple

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