Article : Sickle Cell Trait and Rhabdomyolysis

Allan S. Brett, MD reviewing Nelson DA et al. N Engl J Med 2016 Aug 4.

Sickle cell trait — and several other factors — were associated with exertional rhabdomyolysis in a U.S. Army cohort.

Sickle cell trait generally is a benign condition under normal physiological conditions, but it might predispose to exertional rhabdomyolysis — particularly with dehydration in hot weather. In this study, researchers determined risks for exertional rhabdomyolysis and death in a cohort of 48,000 active-duty black U.S. soldiers who had been tested for sickle cell trait. The prevalence of sickle cell trait in this cohort was 7.4%.

During 4 years (2011–2014), the incidence of exertional rhabdomyolysis was significantly higher in the sickle cell trait group than in the nontrait group (1.2% vs. 0.8%; adjusted hazard ratio, 1.54; P=0.008). Other significant risk factors for exertional rhabdomyolysis were obesity (HR, 1.4), tobacco use (HR, 1.5), and recent use of antipsychotic drugs or statins (HRs, ≈3.0 for both). All-cause mortality was the same in the sickle cell trait and nontrait groups (0.2%), and only one death in the entire cohort was attributed to rhabdomyolysis.


Nelson DA et al. Sickle cell trait, rhabdomyolysis, and mortality among U.S. Army soldiers. N Engl J Med 2016 Aug 4; 375:435.