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Examiner
  • Lori Boyajian-O'Neill: What do you know about sickle cell trait?

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  • The verdict came in on July 1, 2011. The University of Central Florida was found negligent in the death of football player Ereck Plancher, who collapsed and died on March 18, 2008, while participating in a pre-season conditioning program. Mr. Plancher had sickle cell trait, known to be a risk factor for sudden death during extreme exertion. What can we learn from Mr. Plancher to make sports safer for our young athletes?
    Sickle cell trait and exertion, what do you know? T or F?
    1. Kids with sickle cell disease can play football.
    2. Kids with sickle cell trait can play all sports.
    3. There is medicine for sickle cell trait.
    September is Sickle Cell Awareness month, timely given the start of school athletics. According to the Sickle Cell Disease Association of America, approximately 1 in 12 African Americans carry the sickle cell trait (SCT). About 1 in 500 has sickle cell disease. Sickle cell trait is most common among those from original African descent. However, Caucasians and people of all ethnicities may have inherited sickle cell genes. It is safe to assume that every school district in the Kansas City area has athletes with SCT.
    Sickle cell trait is a herited condition where a person has one normal and one abnormal gene for hemoglobin. In sickle cell disease, both hemoglobin genes are abnormal. Hemoglobin carries oxygen in red blood cells (RBC). A person with SCT has normal hemoglobin but may pass the sickle cell gene to offspring. It is recommended that all athletes know their sickle cell status which can be obtained from newborn records or simple blood tests. The NCAA recommends that athletic departments confirm the sickle cell status of their student-athletes and all NCAA Division I schools are required to offer testing, which the athlete has a right to decline.
    Those with SCT can participate in all activities without restrictions but must be educated about risk for sickling crisis characterized by abnormal shaping of the RBCs. There have been 15 deaths in collegiate sports related to exertional sickling. Since 2000, there have been 10 reported cases in football, all during extreme conditioning without rest breaks. There are no reported cases during games because of the many breaks in play for huddles, changing offensive, defensive and kicking teams, halftime, etc. The NCAA recommends maintaining good conditioning through year round strength and conditioning programs and longer periods of rest and recovery between rigorous workouts.
    There are usually no symptoms with SCT. However, physical exertion in extreme environmental conditions can trigger RBC sickling causing blood clots leading to extreme pain and stroke. Sickling collapse may begin very early in the workout. The spleen can become loaded with blood clots. Muscle breaks down causing a condition called rhabdomyolysis. Kidney failure, and cardiac arrest can occur.
    This is what happened to Mr. Plancher that hot summer day on the practice field. Last season Pittsburgh Steelers’ safety Ryan Clark skipped a wild card playoff game in Denver because the altitude (low oxygen level) and exertion placed him at risk for a crisis. He had suffered a crisis in 2007 in Denver and then and wisely sat out a game in the Mile High city in 2009.
    Page 2 of 2 - A son of Haitian immigrants and an honor roll student, Mr. Plancher’s future was bright and his death unnecessary. Athletes should be able to report symptoms and certified athletic trainers must have the authority to intervene without fear of punishment or reprisal from coaches. UCF coach George O’Leary, knew Mr. Plancher had SCT, but did not allow the medical staff to assist his ailing player until he completely collapsed. A judge cited the, "egregious conduct of the UCFAA coaching staff. " So why does UCF football coach George O’Leary still have a job? We don’t need him or anyone like him in sports.
    Answer: 1. F; 2. T, 3. F.
    Dr. Lori Boyajian-O’Neill can be contacted at lori.boyajian-oneill@hcahealthcare.com.

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