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When 15-year-old Olivier Louis collapsed on the field during football practice at his Florida high school Sept. 7, excessive heat or undiagnosed heart problems were among the factors blamed for the seemingly healthy freshman’s death.
But an autopsy released after the teenager’s death revealed another cause that is starting to become better known in school athletics: exertional sickling, a complication of sickle cell trait that turns oxygen-carrying red blood cells into sickle-shaped cells that clog blood vessels and restrict blood flow.
According to the Dallas-based National Athletic Trainers’ Association, sickling has killed nine young athletes over the past seven years: five college football players in training, two high school athletes, and two 12-year-old boys training for football. Of 136 sudden, nontraumatic sports deaths in high school and college athletes from 1983 to 1993, seven were from exertional sickling, according to a 1995 study published in the journal Medicine & Science in Sports & Exercise. That places the trait among the top four causes of nontraumatic deaths for the athletes studied, along with heat illness, asthma, and cardiac disorders.
And often, these deaths occur early in the sports season, when the athlete is still in training, said Scott Galloway, the head athletic trainer for the 8,900-student DeSoto Independent School District in DeSoto, Texas.
“It tends to be a case of too much, too soon,” said Mr. Galloway, who gave a presentation on the topic at the second Youth Sports Safety Summit held in early December in Washington. The summit was sponsored by the Youth Sports Safety Alliance, a coalition of groups led by the NATA.
Sickle cell trait is found in people from Africa, South or Central America (especially Panama), the Caribbean islands, Mediterranean countries (such as Turkey, Greece, and Italy), India, and Saudi Arabia. In the United States, the trait is believed to be carried by about 8 percent of the African-American population. Olivier Louis, a carrier, was from Haiti.
Roots of Disorder
People with sickle cell trait carry one abnormal gene for creating hemoglobin, an iron-rich protein that carries oxygen and gives blood its red color. Having one abnormal gene is generally benign—people who inherit an abnormal gene from each parent have full-blown sickle cell anemia, a serious illness—but extreme exertion in those with the trait can cause the blood cells to morph into the sickle shape.
The symptoms, such as muscle weakness and pain, can look like heat stroke to the untrained eye. But unlike with heat stroke, the onset of symptoms can come in cooler weather, and sometimes quite early in a workout session. Also, rapid cooling isn’t the right treatment. Stricken athletes respond best to rest, oxygen, and observation to make sure that organs and muscles aren’t being affected by reduced blood flow. As the player rests, the sickled cells regain oxygen and revert to normal shape.
Mr. Galloway’s interest in the trait comes from personal experience: he was the athletic trainer on duty at DeSoto High School in Texas in 2002 when a 14-year-old freshman basketball player, Kourtni Livingston, was carried in for treatment by her teammates when she collapsed after completing a timed mile.
Ms. Livingston didn’t know she had sickle cell trait, and neither did Mr. Galloway. She was taken to the hospital, where she later died from acute rhabdomyolysis, a rapid breakdown of muscle fibers due to sickled cells cutting off oxygen.
The National Collegiate Athletic Association approved mandatory sickle-trait testing starting in August 2010 for athletes in its Division I schools. Testing has some opponents among people who worry about privacy, or that the athlete’s playing or practice time will be curtailed.
But Yvette L. Coursey, the chief executive officer of the West Palm Beach, Fla.-based Sickle Cell Foundation of Palm Beach and Treasure Coast, says that testing is an important part of managing the disorder, along with educating coaches and the other adults who work around the students.
If coaches know the status of students “we’re not going to lose time, valuable time, putting you in a tub of ice because we think it’s heat stroke,” Ms. Coursey said.
