Sickle Cell Trait and Exertional Rhabdomyolysis

Pathophysiologic Mechanism

• The American Heart Association and American College of Cardiology recognize that sickle cell trait can cause exertional rhabdomyolysis under specific high-risk conditions, particularly during intense exercise when hemoglobin S polymerization triggers vascular occlusion, impaired muscular blood flow, and ischemic muscle breakdown, in individuals with sickle cell trait 1, 2
• Endothelial damage and impaired blood flow to muscles can occur due to sickled red blood cells, leading to ischemic rhabdomyolysis in individuals with sickle cell trait 1, 2
• Disseminated intravascular coagulation can progress to multi-organ failure in individuals with sickle cell trait 1, 2

High-Risk Clinical Scenarios

• The American Heart Association and American College of Cardiology explicitly recognize sickle cell trait as associated with rhabdomyolysis in military recruits and competitive athletes, predominantly college football players, especially during early training season or after periods of deconditioning 2
• Ambient temperatures ≥80°F, high altitude exposure, and intense, sustained exertion are high-risk conditions for exertional rhabdomyolysis in individuals with sickle cell trait 2

Critical Distinction from Other Causes

• The progression of exertional rhabdomyolysis in individuals with sickle cell trait involves intravascular sickling, vascular occlusion, impaired muscular blood flow, and ischemic rhabdomyolysis, which is distinct from typical exertional rhabdomyolysis 1, 2, 5, 6, 7

Emergency Management Protocol

• Immediate cessation of physical activity, supplemental oxygen administration, aggressive IV hydration, cooling measures, rapid transport to medical facility, and close monitoring for hyperkalemia, lactic acidosis, and hypocalcemia are recommended for individuals with sickle cell trait who experience exertional rhabdomyolysis 1, 2, 4, 8

Prevention Strategies

• The American Heart Association and American College of Cardiology recommend gradual conditioning, modified pace with adequate rest and hydration, and high index of suspicion to immediately cease activity when warning signs appear, to prevent exertional rhabdomyolysis in individuals with sickle cell trait 1, 2, 4