Sickle cell trait.

Sickle cell trait can pose a grave risk for some athletes. In the past few years, exertional sickling has killed nine athletes, including five college football players in training. Exercise-physiology research shows how and why sickle red cells can accumulate in the bloodstream during intense exercise bouts. Sickle cells can "logjam" blood vessels and lead to collapse from ischemic rhabdomyolysis. Diverse clinical and metabolic problems from explosive rhabdomyolysis can threaten life. Sickling can begin in 2-3 minutes of any all-out exertion, or during sustained intense exertion--and can reach grave levels very soon thereafter if the athlete struggles on or is urged on by coaches despite warning signs. Heat, dehydration, altitude, and asthma can increase the risk for and worsen sickling. This exertional sickling syndrome, however, is unique and in the field can be distinguished from heat illnesses. Sickling collapse is a medical emergency. Fortunately, screening and precautions can prevent sickling collapse and enable sickle-trait athletes to thrive in their sports.