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Case Reports
. 2022 Feb 1;38(2):e497-e500.
doi: 10.1097/PEC.0000000000002632.

Sudden Death in High School Athletes: A Case Series Examining the Influence of Sickle Cell Trait

Katherine Shoush Cools  1 , Melissa D Crowder  2 , Kristen L Kucera  3 , Leah C Thomas  3 , Yuri Hosokawa, Douglas J Casa  4 , Adil Gasim  5 , Sang Lee, Tina M Schade Willis  2
Affiliations
Case Reports

Sudden Death in High School Athletes: A Case Series Examining the Influence of Sickle Cell Trait

Katherine Shoush Cools et al. Pediatr Emerg Care. .

Abstract

Athletes with sickle cell trait (SCT) have up to a 37-fold increased risk of exercise-related death. Exertional collapse associated with sickle cell trait (ECAST) is uncommon but can lead to exercise-related death due to exertional sickling. We present a case series of fatal ECAST in high school athletes aged 14 to 16 years. All 3 athletes experienced collapse during practice sessions with muscle pain or weakness. Upon evaluation at the hospital, the athletes had a significant metabolic acidosis that did not respond as expected to fluid resuscitation. Admitting diagnoses for the athletes included exertional heat stroke or dehydration. All 3 athletes had profound rhabdomyolysis leading to acute renal failure, worsening metabolic acidosis, and hyperkalemia. They rapidly progressed to disseminated intravascular coagulation, multiorgan system failure, and death. The autopsies of all 3 athletes showed extensive sickle cell vaso-occlusion involving the spleen liver, and muscles. Final clinical and pathologic diagnosis supported ECAST with fatal exertional rhabdomyolysis. Exertional collapse associated with sickle cell trait is an uncommon but potentially deadly condition that is often underrecognized or misdiagnosed as exertional heat stroke. The development of ECAST is thought to be multifactorial with exercise intensity, recent illness, and exercising conditions (ie, heat and altitude). Prevention should be the primary goal for athletes with SCT through exercise modification, education of precipitation factors, and cessation of exercise with recent illness. Athletes with suspected ECAST should undergo aggressive resuscitation with a low threshold for early transfer to a tertiary care facility for further management and potential hemodialysis.

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Conflict of interest statement

Disclosure: K.L.K. is the Director of National Center for Catastrophic Sport Injury Research, which is funded by the following organizations: American Football Coaches Association, the National Collegiate Athletic Association, the National Federation of State High School Associations, the National Athletic Trainers' Association, the American Medical Society for Sports Medicine, and the National Operating Committee on Standards for Athletic Equipment. D.J.C. is the CEO of the Korey Stringer Institute at the University of Connecticut, which is funded by the following organizations: Mission, CamelBak, NFL, Kestrel, Heartsmart.com, Eagle Pharmaceuticals, National Athletic Trainers' Association, and Gatorade. D.J.C. also receives grant/research/clinical trial/corporate partners support from General Electric, Quest, Halo, Nix, Brainscope, WHOOP, Polar, Danone, Timex, UNC (National Center for Catastrophic Sport Injury Research), the National Collegiate Athletic Association, US Air Force, and US Army. D.J.C. also receives royalties from Jones and Bartlett, Springer, LWW, Wolters-Kluwer publishers, and UpToDate. In addition, D.J.C. is a consultant/advisory board member for Quest (biomarkers, ended June 2016), Sports Innovation Lab, and Clif Bar. He has been an expert witness on legal cases (heat stroke, exertional sickening, dehydration). He receives honorarium from Gatorade. The other authors have no conflicts of interest related to this article to disclose.

Figures

Figure 1.
Figure 1.
Part of the renal cortex with intratubular pigmented granular casts (black arrows); note the presence of sickled red blood cells (white arrow), H&E, 400x.
Figure 2.
Figure 2.
Right calf muscle biopsy. Disintegrated myocytes, with muscle cells lysis (white stars) representing rhabdomyolysis. H&E, 400x.
See this image and copyright information in PMC

References

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