by Tom Utescher

Chestnut Hill College Athletic Trainer Erin Fidler tends to a student athlete during a home soccer match for the Griffins. (Photo by Tom Utescher)

Confronted with significant new NCAA medical regulations, Chestnut Hill College’s Erin Fidler went online seeking advice and opinions on the issue from other professionals. Head Athletic Trainer at CHC and a former graduate trainer at Penn Charter, Fidler was researching the requirement for Division II colleges and universities to begin testing all student athletes for sickle cell trait (SCT) starting at the beginning of the 2012-2013 academic year.

Her efforts to learn about the trait and the new NCAA rules eventually led to her writing an article that was published in the June 2012 issue of the Journal of the National Strength and Conditioning Association.

Unlike sickle cell anemia, SCT is an inherited condition which does not prevent a person from participating in athletic activities. However, without an awareness of the trait and the observance of proper precautions when exercising, practicing, and competing, there can be severe complications, and in the extreme, death can occur.

“Basically, if you have the trait, in most cases it’s not going to keep you from doing anything,” Fidler said, “and they’ve found that you can gradually progress your workouts safely so that you can get used to it.

“Some can get SCT symptoms worse that others,” she continued, “but generally, you need recovery time between high-energy work, suicide sprints and so on, and you need to stay hydrated. A lot of the precautions are the same as any athlete should take, but you really need to observe them strictly.”

At the onset of “sickling,” the Griffins’ head trainer explained, “You would first start noticing it when you can’t get blood supply to your muscles. If you try to push through it, it’ll get worse until finally, your organs will start shutting down. You need to stop eight away, because the sickling effect may continue for awhile after you stop. If you act quickly, your body can get back to normal in 30 minutes, but you should still take it easy for a couple hours.”

The NCAA issued a requirement for Division I athletic programs to begin a screening process for SCT (through blood testing) in April of 2010.

“We knew it was going to trickle down the line, and this is the first year Division II has to do it,” said Fidler, who has a Bachelor’s degree in Athletic Training and a Master’s in Kinesiology. “I think you’ll see Division III schools required to do the testing in the near future.”

She began to look into the issue not long after the Division I mandate.

“When I began to do some research, I found there wasn’t a lot of information available,” she related. “I did a lot of digging, and I thought it would be good to put something out there for the actual strength coaches, the ones who are directly training the athletes. I thought I would share what I found, and hopefully it would help other people.”

While she has not received an overwhelming response to her article so far, she revealed, “I’ve gotten some feedback from other Division II schools, and someone from Chicago called me about it, so I know it’s being read.”

Fewer people have heard of sickle cell trait than sickle cell anemia, and Fidler differentiated the two disorders in her published piece.

“Sickle cell trait is a condition acquired through inheritance, not ethnicity. It is the inheritance of one gene for normal hemoglobin (A) and one gene for sickle hemoglobin (S), giving the genotype AS. Sickle cell trait is not sickle sell anemia. Sickle cell anemia is a disease formed by two abnormal sickle genes (SS), causing regular health problems. Sickle cell trait will not turn into the disease.”

Basically, those with SCT carry one copy of the sickle mutation, inherited from just one of their parents, while the presence of the gene in both parents leads to sickle cell anemia in their offspring.

Her piece goes on to point out that approximately eight percent of African Americans are carriers of the gene. Also at risk, to a lesser extent, are persons of Mediterranean, Middle Eastern, Indian, Caribean, and South and Central American ancestry. However, no ancestral or ethnic group appears to be entirely immune, hence the importance of the testing.

“Now that we do the screening, we found that four of our athletes have it,” Fidler said. “Two of them had no idea that they had it, and one of them is actually Caucasian.”

“To my knowledge, we had not dealt with complications from sickle cell trait at CHC,” added Fidler, who began to work at the college in the fall of 2005 and became Head Athletic Trainer four years later. “No one knew they had it coming in to Chestnut Hill and experienced a problem while they were here.”

As one might deduce from the demographic groups among whom SCT is most prevalent, there is a connection with tropical and sub-tropical climates. The development of the trait is believed to be a form of natural defense against the disease that is a widespread scourge in those areas, malaria.

Recent research at the Instituto Gulbenkian de Ciência (IGC) in Portugal has linked the presence of sickle hemoglobin with an enzyme that confers protection against the disease. The Malarial parasite, Plasmodium, is still present in the blood but, as the scientific journal Cell quoted IGC researcher Miguel Soares, “sickle hemoglobin makes the host tolerant to the parasite.”

It’s nice to know that SCT has at least one benefit, but Fidler and her peers must concern themselves with its possible negative effects. Her article explained how this can occur.

“During intense maximum exercise, a decrease in oxygen levels can cause some of the red blood cells to change from their normal disc shape to a sickle or quarter moon shape. These sickled cells will adhere and block blood vessels in the muscles, kidneys, and other organs, leading to tissue death and failure. The harder and faster the athlete works, the earlier and greater the chance sickling will occur.”

The symptoms are often similar to those found with heat exhaustion, but sickling and its effects occur more quickly than heat-related problems.

“This is a little different, where you don’t have to be outside for very long in the heat,” Fidler pointed out.
Sickling can produce sensations of muscle cramping and tenderness, fatigue, and an inability to catch one’s breath. SCT difficulties are very common when an athlete with the trait abruptly embarks upon a rigorous training regime after a period of relatively light physical activity. Many cases occur at military boot camps, and in the earliest summer practices for football players.

At colleges, Fidler said, “It’s probably most prevalent in Division I football, but it can happen anywhere, really.”

At the Division I level, schools can often afford to bring in medical personnel to do their own testing on campus, but at schools like Chestnut Hill the blood tests are usually arranged through a family physician.

“If someone tests positive, we’ll sit down with them and counsel them,” Fidler noted. “We’ll let them know what this means, that they have to be careful when they’re doing a lot of sprinting and those kinds of things, and that if they feel a certain way they should let us know. We keep the coaches informed, as well.”

“There are some people who refuse to be tested, and in that case they can sign a legal waiver,” said the CHC trainer. “When they do that, the policy is to treat them as if they have the trait.”

Increased awareness of the disorder will eventually take some of the testing burden off of college athletic programs.

“Nowadays, all babies in the U.S. are tested at birth, and some states started it as far back at the 1970’s,” Fidler explained. “So as those children get older, before long everyone coming into college will already know their status.”