An autopsy says sickle cell trait could have contributed to the Florida State linebacker's death during a workout.
By BRIAN LANDMAN
© St. Petersburg Times, published April 18, 2001
Florida State freshman Devaughn Darling, who collapsed after a strenuous February workout, might have died as a result of the rare sickle cell trait, according to a medical examiner's report.
Dr. David E. Craig, a Leon County pathologist, found red cell sickling in most blood vessels, including in the lungs, liver, stomach, kidneys and heart, and said that could have led to a massive, fatal cardiac arrest.
"Although rare, sudden unexpected death has been associated with healthy, athletic males with sickle cell trait," he wrote in the report released Tuesday, careful to add that there was "no definite morphologic cause of death."
FSU athletic department officials and the president's office are reserving comment until the school's police department concludes its investigation into the stunning death of the 18-year-old. FSU officials might hold a news conference Thursday.
Sickle cell trait shouldn't be confused with sickle cell disease. The trait is caused by the inheritance of one abnormal hemoglobin gene; sickle cell disease requires the presence of both abnormal genes. The Sickle Cell Disease Association of America, estimates that 2.5-million Americans, predominantly African-Americans, have the trait, and considers it fairly harmless.
"Someone with the sickle cell trait should lead a normal life," said Frank Reddick, the director of Florida's headquarters for the Sickle Cell Disease Association of America. He added that the most common complications he had heard of for someone with the trait have been bouts of shortness of breath, fatigue and some joint pain.
But a death from it?
"That would be news to me," he said.
The NCAA Committee on Competitive Safeguards and Medical Aspects of Sports, in a set of guidelines regarding the student athlete with sickle cell trait, doesn't recommend routine screening for it and calls the trait a "benign condition" that shouldn't restrict or limit the student-athlete.
While the guidelines also refer to anecdotal cases linking the trait to exercise-associated sudden death, that's tempered by a statement that as of June, 1998, there was no direct evidence for such occurrences and there's a "controversy in the medical literature."
Like so many other things, that depends on whom you ask.
"I have had cases of sickle cell trait causing death associated with exercise," said Dr. Jon R. Thogmartin, the new medical examiner for Pinellas-Pasco counties.
In a 1998 article for the Journal of Forensic Sciences, he detailed a case of a 13-year-old African-American who, after running from police, suddenly collapsed and died at the scene. The autopsy showed no abnormalities other than sickled cells in most blood vessels. The youngster had sickle cell trait.
"It definitely can kill," Thogmartin said. "Definitely."
Other sports medicine experts have found sickle cell trait-related deaths in military recruits and high school and college athletes, though the instances are rare.
Dr. Steven Van Camp, a San Diego cardiologist and past president of the American College of Sports Medicine, conducted one of the most exhaustive and authoritative studies of sports deaths in high school and colleges. Gathering information on 136 deaths of high school and college athletes in organized activities from 1983-93 (160 have been documented of an estimated 3-million annual participants), he said sickle cell trait was a likely factor in no more than seven cases. Then, he called that finding "unexpected." But now. "There's no question in my mind the sickle cell trait does increase the risk of rhabdomyolysis (an acute, sometimes fatal disease characterized by the destruction of skeletal muscle) and then cardiac arrest," Van Camp said.
"Especially vulnerable appear to be heavily muscled athletes with sickle cell trait who perform maximal exercise in preseason conditioning sessions. ... Who does that sound like?"
Darling was 6-foot-2 and a chiseled 220 pounds. According to the autopsy report, he had been diagnosed as having the trait -- which means his twin, Devard, a receiver at FSU, has it as well -- and had just completed a grueling morning workout, the "mat drills."
Doctors also point out the amount of water Darling drank could have been a key. Water is available at the drills, but players admit they only have time for a quick swig between stations.
Van Camp said proper hydration is important for anyone, regardless if he or she has the sickle cell trait. That's one reason he sees no reason to screen every player; just treat everyone the same. That's echoed by the NCAA guidelines: "All student-athletes, including those with known sickle cell trait, should be counseled to ... avoid dehydration."
Although FSU coach Bobby Bowden has used mat drills, difficult by design, for 40 years without serious incident, he has said he and his staff have to look at what they do and how they do it.
But even something as innocuous as the common cold could have been a contributing factor, doctors suggest. Darling was said to have been fighting a cold and the toxicology report showed only two drugs in his urine, acetaminophen and ephedrine, ingredients in over-the-counter remedies.
Of course, most players gut it out without saying a word to coaches, trainers or teammates. Rarely does something tragic occur, but when it does, people are left looking for answers.
"(Most) autopsies don't show anything (abnormal or drug-related) and they're either written off as an unexplained death," Van Camp said, "or somebody finds sickle cell trait and is sharp enough to pick this up. That sounds like the most likely explanation."
- Times researcher Caryn Baird and Times staff writer Stephanie Scruggs contributed to this report.