Autopsy and Case Reports
https://autopsyandcasereports.org/article/doi/10.4322/acr.2021.297
Autopsy and Case Reports
Autopsy Case Report

Fatal sickling-associated microvascular occlusive crisis in a young with sickle cell trait

Deepti Mutreja; Benjith Paul K; Tilak TVSVGK

Downloads: 0
Views: 127

Abstract

  Sickle cell trait (SCT), a heterozygous state characterized by hemoglobin AS, occurs commonly in sub-Saharan Africa, South America, Central America, India, and the Mediterranean countries. SCT is compatible with a normal lifespan and is not commonly regarded as a cause of morbid illness or death compared to its homozygous counterpart. We describe a case of fatal sickling-associated microvascular crisis, identified on post mortem evaluation in a previously undiagnosed 21-year-old military recruit with sickle cell trait. The individual presented with repeated syncope episodes during his training and was autopsied in the pursuit of cardiac anomalies and heat syncope. During the terminal episode, he collapsed and died of severe metabolic complications as he struggled to complete an organized run during routine training activities. To our knowledge, this is the first report of fatal sickling-associated crisis in a military recruit with sickle cell trait from India. This case serves to remind all armed forces and sports physicians of the importance of screening a recruit who is unable to complete exertional physical training for the presence of sickle cell trait.

Keywords

Sickle Cell Trait, Autopsy, Military Personnel, Physical Exertion

References

1 Pearson HA. Sickle cell trait and competitive athletics: is there a risk? Pediatrics. 1989;83(4):613-4. PMid:2928004.

2 El-Hazmi MAF, Al-Hazmi AM, Warsy AS. Sickle cell disease in Middle East Arab countries. Indian J Med Res. 2011;134(5):597-610. http://dx.doi.org/10.4103/0971-5916.90984. PMid:22199098.

3 Rao VR. Genetics and epidemiology of sickle cell anemia in India. Indian J Med Sci. 1988;42(9):218-22. PMid:2907511.

4 Colah R, Mukherjee M, Ghosh K. Sickle cell disease in India. Curr Opin Hematol. 2014;21(3):215-23. http://dx.doi.org/10.1097/MOH.0000000000000029. PMid:24714525.

5 Kark JA, Posey DM, Schumacher HR, Ruehle CJ. Sickle-cell trait as a risk factor for sudden death in physical training. N Engl J Med. 1987;317(13):781-7.

6 Anzalone ML, Green VS, Buja M, Sanchez LA, Harrykissoon RI, Eichner ER. Sickle cell trait and fatal rhabdomyolysis in football training: a case study. Med Sci Sports Exerc. 2010;42(1):3-7. http://dx.doi.org/10.1249/MSS.0b013e3181ae0700. PMid:20010136.

7 Thogmartin JR, Wilson CI, Palma NA, Ignacio SS, Shuman MJ, Flannagan LM. Sickle cell trait-associated deaths: a case series with a review of the literature. J Forensic Sci. 2011;56(5):1352-60. http://dx.doi.org/10.1111/j.1556-4029.2011.01774.x. PMid:21480898.

8 Weisman IM, Zeballos RJ, Martin TW, Johnson BD. Effect of Army basic training in sickle-cell trait. Arch Intern Med. 1988;148(5):1140-4. http://dx.doi.org/10.1001/archinte.1988.00380050144021. PMid:3365081.

9 Sears DA. The morbidity of sickle cell trait: a review of the literature. Am J Med. 1978;64(6):1021-36. http://dx.doi.org/10.1016/0002-9343(78)90458-8. PMid:655188.

10 Eichner ER. Sickle cell trait in sports. Curr Sports Med Rep. 2010;9(6):347-51. http://dx.doi.org/10.1249/JSR.0b013e3181fc73d7. PMid:21068567.

11 Mitchell BL. Sickle cell trait and sudden death--bringing it home. J Natl Med Assoc. 2007;99(3):300-5. PMid:17393956.

12 Nelson DA, Deuster PA, Carter R III, Hill OT, Wolcott VL, Kurina LM. Sickle Cell Trait, Rhabdomyolysis, and Mortality among U.S. Army Soldiers. N Engl J Med. 2016;375(5):435-42. http://dx.doi.org/10.1056/NEJMoa1516257. PMid:27518662.

13 Connes P, Reid H, Hardy-Dessources MD, Morrison E, Hue O. Physiological responses of sickle cell trait carriers during exercise. Sports Med. 2008;38(11):931-46. http://dx.doi.org/10.2165/00007256-200838110-00004. PMid:18937523.

14 Scoville SL, Gardner JW, Magill AJ, Potter RN, Kark JA. Nontraumatic deaths during U.S. Armed Forces basic training, 1977-2001. Am J Prev Med. 2004;26(3):205-12. http://dx.doi.org/10.1016/j.amepre.2003.12.003. PMid:15026099.
 


Submitted date:
04/01/2021

Accepted date:
05/28/2021

Publication date:
08/20/2021

611fa34fa9539558a6075cd4 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections