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Scientific publications & articles
16 May

The death of a runner – how to be sure you are not in danger?

 

News from the media concerning the deaths of long-distance runners are shrouded in the shadow of conjecture and the search for the guilty. Why was there no ambulance? Why help came so late? Why runner was allowed to run by the sports doctor? Cited cause of death is usually pulmonary embolism, blood clots, heart failure, etc. But why the embolism, blood clots, organ failure?

In the United States, the NCAA (National Collegiate Athletic Association) has implemented the optional genetic tests of HBB gene for SCT (Sickle Cell Trait) for young athletes. (Implementation of mandatory could be the cause of discrimination between players.) It was recommended to the trainers to take a detailed look at the medical literature regarding the SCT.

 

What is SCT?

 

In contrast to the SCD (Sickle Cell Disease), SCT is characterized by having only one copy of the HBB gene with single nucleotide mutation in the region coding β-chain of hemoglobin. This means that this person is a carrier of a sickle cell anemia gene.

 

 

Healthy person

Carrier (SCT)

A person suffering from sickle cell disease (SCD)

 

Hemoglobin protein

HbA

HbA HbS

HbS

Effect

Standard physicochemical features of the protein

Approx 45% of HbS proteins. Altered physicochemical features

100% of HbS protein

 

 

What SCT means for an athlete?

 

A person with sickle cell trait (a mutation in the gene HBB) normally does not feel its effects. This means that when leading lifestyle of moderate physical activity, there are no contraindications for sports. If, however, occurs

 

  • Long anaerobic exercise - eg. long-distance run
  • Exertion at high altitudes
  • Sudden significant increase in the intensity of workouts
  • Training in conditions characterized by high temperature and humidity
  • Training with the symptoms of disease (eg. fever)

 

then hemoglobin S begins to polymerize. It has a lower oxygen affinity and at the lower concentrations,  the shape of these proteins starts sickling. Consequently, takes place exertional rhabdomyolysis, meaning muscle breakdown, as a result of oxygen deficiency. Released from the muscle myoglobin forms conglomerates which can cause acute renal failure. Polymerized hemoglobin S forms blood clots which can lead to blockages of blood vessels and white infarctions.

When runner, despite emerging signs, decides to continue running – he falls down and without quick help - dies.

 

Statistics

 

In Poland, unfortunately, there are no statistics associated with a mutation in the gene HBB and mortality rate among athletes. The data available from studies in the USA say that over the last few years because of the SCT died 15 football players, 9 athletes, and among 136 "elsewhere unclassified deaths of athletes", 5% had a reason in the SCT.

A mutation in one copy of HBB gene is more common in black population. In white population, according to diverse sources, the frequency is presented as 1/600 to 1/600 000. Such a large statistical error can be explained by e.g. impossibility to accurately estimate the migration.

 

Does SCT mean I have to give up training?

 

Absolutely not. The most important, however, is knowledge of having HBB gene mutation and adjusting  to the following guidelines:

 

  • Take care of proper hydration during exercise
  • While training at high altitude, high temperature or environment with high humidity, ensure gradual acclimatization of the body - gradually increase the intensity of workouts
  • Gradually increase the intensity of workouts also under standard conditions. This should take several weeks.
  • Give up training while experiencing even light illness symptoms
  • When you experience unusual physical ailments immediately stop the training and get medical assistance

 

When I witness the fall of the runner...

 

  1. Check the vital functions
  2. Do CPR until the ambulance arrival
  3. If necessary, cool down his organism
  4. If you know that the victim has SCT - inform rescuers of possible rhabdomyolysis and severe metabolic complications. This information may save his life.

 

Summary

 

In recent years, running has become incredibly popular - it's hard to count the vastness of the benefits for the body and "spirit". Organized marathons, half marathons or extreme running attract entire families. It is without a doubt the phenomenon. If you plan to check your limits, then we keep fingers crossed for you! And by the way, please help us spreading the knowledge of the SCT, which in our country has not even got its proper Polish name.

 

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