It’s a generally benign condition in which a person inherits from their parents one gene for the oxygen-carrying element in their red blood cells – hemoglobin – and one gene for sickle shaped hemoglobin. It is not the same as the more severe condition, sickle cell disease, in which both genes for sickle hemoglobin are inherited. Those with the trait experience normal healthy lives. Only in situations where the body is pushed to extreme conditions, as athletes do, can the trait sometimes cause red blood cells to sickle and block blood vessels, denying oxygen to muscles and organs. But in most cases, carriers of the trait live normal, healthy lives without incident.

Exercising with sickle cell trait is generally safe and with proper awareness and education poses no barriers to outstanding athletic performance. Most student-athletes complete their careers without any complications. But it can affect some during periods of intense exercise, when the inherited condition causes red blood cells to warp into stiff and sticky sickle shapes that block blood vessels and deprive vital organs and muscles of oxygen. The trait can affect athletes at all levels, including high school, collegiate, Olympic and professional. But through testing and proper examinations by a physician prior to competition, student-athletes can have a healthy career.

A student-athlete must provide their school with documented results from a previous sickle cell solubility test or they must undergo testing during their preparticipation medical examination. Tests for sickle cell trait are currently performed on all newborns in the United States and many other countries, but few are aware of a positive result because the condition is not considered life threatening in most of the population. The requirement to test or provide documented results of a prior test are to make coaches and athletic trainers aware that some athletes may need to take precautions.

There is no reason student-athletes with sickle cell trait shouldn’t be allowed to compete. Sickle cell trait only becomes a threat in certain rare situations in which athletes push the limits of their physical conditioning. Being aware of the trait and taking proper precautions can help trait carriers enjoy successful and healthy athletic careers.

Incidents of sudden death in athletes with sickle cell trait have been exclusive to conditioning sessions rather than game or skill practice situations. While the definite cause of collapse among athletes with sickle cell trait is not yet known, one hypothesis is that exercise intensity is a leading factor for sudden collapse, rather than the medical condition itself.

Coaches should conduct appropriate sport-specific conditioning based on sound scientific principles and be ready to intervene when student-athletes show signs of distress. Student-athletes can begin to experience symptoms after only one to three minutes of sprinting, or in any other full exertion of sustained effort, thus quickly increasing the risk of complications.

Coaches and staff should provide an environment where precautions can be activated, including gradual conditioning, adequate rest and recovery, hydration, alternatives for performance testing and immediate stopping of activity when symptoms occur.

Student-athletes with sickle cell trait can reduce risk by taking precautions during training and competition.

• Know your sickle cell trait status
• Engage in a slow and gradual preseason conditioning regimen
• Build up your intensity slowly while training
• Set your own pace. Use adequate rest and recovery between repetitions, especially during “gassers” and intense station or “mat” drills
• Avoid pushing with all-out exertion longer than two to three minutes without a rest interval or a breather
• If you experience symptoms such as muscle pain, abnormal weakness, undue fatigue or breathlessness, stop the activity immediately and notify your athletic trainer and/or coach
• Stay well hydrated at all times, especially in hot and humid conditions
• Avoid using high-caffeine energy drinks or supplements, or other stimulants, as they may contribute to dehydration
• Maintain proper asthma management
• Refrain from extreme exercise during acute illness, if feeling ill, or while experiencing a fever
• Beware when adjusting to a change in altitude, e.g., a rise in altitude of as little as 2,000 feet. Modify your training and request that supplemental oxygen be available to you
• Seek prompt medical care when experiencing unusual physical distress

Planned emergency response and prompt access to medical care are critical components to ensure adequate response to a student-athlete who collapses or is in distress. Knowledge of a student-athlete’s sickle cell trait status should facilitate prompt and appropriate medical care during a medical emergency.

Institutions should have an emergency action plan in place that is reviewed and rehearsed at least annually with all athletics personnel. All coaches and strength and conditioning staff should be certified in first aid and CPR.