Athletes collapsing from sickle cell trait.

• Position: Sports Training

Over the past seven years, collapse during exercise due to complications from sickle cell trait has killed nine athletes, Of 136 sudden, nontraumatic sports deaths of high school and college athletes over a decade, five percent were due to exertional sickling. As a result, the National Athletic Trainers' Association (NATA), Dallas, has released an interassociation task force consensus statement with recommendations for athletes with sickle cell trait.

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"The purpose of this consensus statement is to raise awareness of this condition among athletes, coaches, athletic trainers, and other medical staff," reports Scott Anderson, head athletic trainer at the University of Oklahoma, Norman, and co-chair of the task force. "It provides details on measures that can reduce the risk of collapse during sports and exercise related to sickle cell trait among athletes."

Sickle cell trait is the inheritance of one gene for sickle hemoglobin and one for normal hemoglobin. During intense or extensive exertion, the sickle hemoglobin can change the shape of red blood cells from round to quarter-moon, or "sickle." This alteration, exertional sickling, can pose a grave risk for some athletes.

Devard Darling, a wide receiver for the National Football League's Baltimore Ravens lost his twin brother, Devaughn, to complications from sickle cell trait in 2001. "We both learned we had sickle cell trait during our freshman year at Florida State," Darling recalls. "But even knowing the risks at the time, my brother died on the practice field before his 19th birthday. I'm hopeful that this consensus statement will help others avoid the same fate."

The sickle gene is common in people whose origin is from areas where malaria is widespread. Over the millennia, carrying one sickle gene fended off death from malaria, leaving one in 12 African-Americans with sickle cell trait. The sickle gene also is present in those of Mediterranean, Middle Eastern, Indian, Caribbean, and South and Central American ancestry, one reason for the required screening of all newborns in the U.S.

"We recommend confirming sickle cell trait status in all athletes' pre-participation physical examinations," concurs James "Scott" Galloway, head athletic trainer at DeSoto (Tex.)...