Athletes with sickle cell trait have special considerations before and during their workout. Athletes can unknowingly predispose themselves to exertional sickling by beginning exercise without proper hydration, while physically exhausted, overheated, or while fighting off illness. Athletes with any of these risk factors should be encouraged to sit out or perform a reduced workout. Red blood cells deliver oxygen to the body's tissues through the circulatory system. The cells are disks shaped and flexible and can squeeze into small capillaries. During regulated physical exercise, the red blood cells in an athlete with sickle cell trait can deliver oxygen normally. Under stress from intense physical exertion, the red blood cells in an athlete with sickle cell trait can no longer hold on to oxygen. These blood cells change from their flexible, disk shape to a rigid, sickle shape.
This is called exertional sickling. These abnormal cells can get trapped in small capillaries, blocking healthy blood cells from bringing oxygen to the body's muscles and tissues. This is called a crisis. During a crisis, the athlete can have muscle cramping, pain, swelling, weakness, inability to catch their breath, and fatigue. If pushed past the point of crisis, a lack of oxygen can break down muscle tissue causing harmful proteins to flood into the bloodstream and leading to severe kidney damage. When combined with environmental factors such as heat stress, dehydration, illness, and altitude, even death can occur. It is important to recognize the signs and symptoms of exertional sickling in athletes before a crisis occurs.
When the athlete is allowed to rest between exercises, the sickled red cells regain oxygen inside the lungs and return to their normal shape. High flow oxygen helps the athlete's red cells recover faster. With enough oxygen, the athlete feels better and, in most cases, is ready to return to play.
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