Sickle Cell Trait, Rhabdomyolysis, and Mortality among U.S. Army Soldiers

In a study involving nearly 48,000 black soldiers tested for sickle cell trait, the risk of death was not higher among those with the trait than among those without, but the risk of exertional rhabdomyolysis was significantly higher. Exertional rhabdomyolysis is characterized by the severe breakdown of skeletal-muscle tissue that is precipitated by strenuous physical exertion, leading to systemic manifestations that typically include myoglobinuria. This syndrome has received considerable attention because of high-profile deaths involving exertional rhabdomyolysis in athletes and military personnel. 1 – 10 A number of such cases have been attributed to sickle cell trait, 11 – 15 a condition in which persons are heterozygous for the sickle cell mutation in the beta-globin gene. The beta-globin protein forms part of the tetrameric hemoglobin complex; heterozygous persons have wild-type hemoglobin A as well as hemoglobin S, hence the term hemoglobin AS . . .