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Pathophysiology of exertional death associated with sickle cell trait: can we make a parallel with vaso-occlusion mechanisms in sickle cell disease?
  1. Philippe Connes1,
  2. Kimberly G Harmon2,
  3. Michael F Bergeron3
  1. 1UMR Inserm 665, Université Antilles-Guyane, Pointe-à-Pitre, Guadeloupe
  2. 2Departments of Family Medicine and Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
  3. 3National Institute for Athletic Health & Performance, Sanford USD Medical Center, Sioux Falls, South Dakota, USA
  1. Correspondence to Philippe Connes, UMR Inserm 665, Université Antilles-Guyane, Pointe-à-Pitre 97159, Guadeloupe; pconnes{at}

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Whether sickle cell trait (SCT) carriers are at greater risk for exertional death has been a subject of intense debate.1 Large epidemiological studies in warfighters2 and athletes3 clearly show an increased risk for exercise-related sudden death in SCT carriers compared with non-SCT carriers.

The pathogenesis of exertional death in SCT carriers is unknown.4 However, the mechanisms initiating these adverse events could be parallel to the ones involved in the vaso-occlusion crises in sickle cell disease (SCD). Vaso-occlusion in patients with SCD involves haemorheological alterations, inflammation, vascular-adhesion processes and endothelial dysfunction.5 Comparisons of exercise responses between SCT carriers and non-SCT carriers demonstrated slightly decreased red blood cell deformability, increased …

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.