Airplanes and Sickle Cell: Know the Precautions

**So here is an academic essay written for a science class of mine. It really explains the necessary precautions for flying on planes with sickle cell and why. Excuse all of the scientific jargon and fancy talk-- remember it was an essay for a class lol**Don't forget to comment b/c READERS DECIDE WHAT I PROVIDE!!! :)


Sickles in the Sky:
High Altitude & Air Pressures Negative Effect on Sickle Cell Disease

_____Picture this: blue skies, clear day, Fort Lauderdale airport, my third time flying on an airplane. I am very much use to the ups and downs, ins and outs, and pros and cons of flying on a commercial airplane. The flight that I always traveled was a relatively short one in nature-ranging from Fort Lauderdale, Florida to Bridgeport, Connecticut which only stretched out into a two and half to three hour flight. I went through the same ritual I always did when flying which included but was not limited to praying for safe travel, buying a pack of gum to counteract the inevitable ear popping, dress in comfortable clothes, come equipped with easy listening music and/or a book to keep me busy, and take a Benadryl to hopefully fall asleep when all else forms of entertainment fail. Despite weather conditions highly conducive to safe flying and me following my pre-flight rituals, this time was starting different and would definitely end differently. I boarded the plane with the same confidence I always did, took my seat, popped some Benadryl and Bubblicious bubble gum with my seat-belt securing me. I waited for the flight attendants to go over safety precautions and in-case of emergency protocol before plugging my ears with the raspy voice of Lauryn Hill on my iPod. Prior to ever flying I had always read that people with certain diseases or ailments should take special precautions, and I happened to fall into the category of people with “certain diseases”. On the internet, any site that included Sickle Cell Disease (SCD) said that SCD sufferers should travel after getting full physical and health clearance from a general doctor/hematologist and when in the process of flying should be equipped with oxygen on the plane. The two previous times I had been on Delta (or any airline) flights I had never flown with oxygen, nor got the “ok” from my pediatric hematologist. To my advantage I never became ill during or after the flight; the most I had to deal with was stopped up ears from high altitudes. Considering the previously mentioned, I felt invincible despite high altitudes/low pressure decreasing oxygen and thus negatively affecting Sickle Cell Disease. Boy was I in for a sickle surprise…
_____ When the engines roared, and the plane seemingly increased to a runway speed of an infinite amount of miles per hour my ears started to pop and get stuffy. I bit down on the bulk of the gum as hard as I could to balance the ear popping…needless to say, it did not work. Besides my ears giving me major trouble, I swear my brain was getting in on the action and partaking in some popping of its own and this was all before the plane even took off. I tried breathing deeply, participating in imagery exercises and muscle tensing/release to relieve some of this pain. I took a Tylenol 4 with codeine pill so that the active ingredients could start working immediately but within the next half hour the pain grew exponentially. My arms and legs started to hurt, I had a mind blowing migraine, and my breathing became freakishly shallow-all I could do is lay my head in my Aunt’s lap and hope for the plane ride to be over. Due to the mix of Benadryl and Tylenol 4 with codeine I fell into an uncomfortable sleep and woke up in the airport in Connecticut. By the time we reached my whole body was in unbearable pain and I started to vomit like I was possessed with the spawn of Satan. I had no clue why this was happening, but we will get into that next.
_____ To realize what the cause of the previous situation was, the disease Sickle Cell must be understood in entirety. I am definitely not a fan of “dumb-ing it down”, however, on the other end of the spectrum, I’m not a firm believer of “the bore”. With that said, I will search for some middle ground in between the two lands to accurately describe that which is Sickle Cell Disease. SCD is a hereditary blood disease which simply means it can not be passed from one person to the next by casual contact or sexual intercourse but through genetics (from parents). People not affected with the chronic illness have round, soft (jelly donut textured) red blood cells that carry out the expected duties of a red blood cell including spreading hemoglobin. Hemoglobin is just a fancy term for a protein in our bodies that carry oxygen, so in a non-sickler, cells pass through blood vessels with ease and provide organs, tissues, and organ systems with an ample amount of oxygen. On the other end, sicklers- as we are affectionately called have a deficiency in hemoglobin. Due to having a dysfunctional oxygen carrying protein, red blood cells become distorted in shape (sickle moon/crescent shaped), hard and sticky and texture and therefore gets stuck and clotted in vessels, cutting off oxygen supply to the body, causing chronic pain, tissue/organ damage/death and ultimately death in general. Sicklers are equipped with about one half of the oxygen normal people have meaning it takes twice as much oxygen energy to do the same simple tasks such as walking to class or tying one’s shoe. When a flare up of pain occurs, this is referred to as a sickle cell crisis. Logically, people affected with SCD know their bodies, so they know to stay hydrated at all times, eat healthily, stay away from strenuous activity, extreme weather changes, and anything that may be a crisis trigger.
_____ For the second part of this deadly combination we will elaborate in the form of cause and effect: the higher the altitude, the lower the air pressure; the lower the air pressure, the number of molecules per breath is reduced even though the concentration of oxygen is the same as at sea level which is about twenty-one percent. The average commercial plane flies at thirty thousand feet which converts into approximately 9144 meters. Logically speaking, if an individual with sickle cell has half of the oxygen a non-sickler has at ground level and oxygen decreases with the increase of altitudes, then at higher altitudes a sickler will be at deadly percentages of oxygen. Due to the previously mentioned fact, this is the reason it is strongly suggested by doctors, hematologists, and airplane lines that people with sickle cell make arrangements prior to boarding the plane to have a drop down oxygen bag available for the flight in entirety. With this extra aid in the form of an oxygen bag (usually reserved for emergency purposes, i.e. crashes, impromptu evacuation), the available oxygen will provide leverage to the body systems so that it counteracts the decrease of oxygen in the natural air at this low pressured high altitude. Of course with any health suggestions there are skeptical people who may question the validity of the facts or want to measure the precision point at when oxygen should be provided. For skeptics or people who just want to know their information is backed up by scientific means there is a way to measure decreasing amounts of oxygen. This method basically measures the decreasing amounts of oxygen at air in a low pressure (thus high altitude) atmosphere measuring from the point at sea level. For example an “oxygen altitude graph” would depict amounts of ambient oxygen and barometric pressure in relation to the top of Mt. Everest (high altitude). Mount Everest is just under thirty thousand feet, around 8848 meters which is about the height discussed earlier that commercial planes fly. Therefore, the graph would be a great depiction of the state of surrounding atmospheric oxygen and air pressure (as measured by a barometer) at the height we all fly. We would be able to see that there would be a direct correlation. As altitude increases so does “barometric (air) pressure”, and overall oxygen levels decrease.
_____ Now that we have all of the information needed to understand the basics of Sickle Cell Disease and how oxygen levels are affected by increasing altitudes we can do a bit of deductive reasoning. With that said, let’s get back to the story that fueled the topic for this paper. To recap, let’s look at quick facts: hemoglobin is an oxygen carrying protein, SCD is a hemoglobin deficient disease; therefore, SCD patients lack oxygen. In addition: anything above sea level can be considered a “higher altitude”, airplanes (such as Delta airways) travel at 9114 meters which is well above sea level, the higher the altitude the lower the air pressure, the lower the air pressure the less oxygen there is. So combining the two one would say: due to sicklers lacking oxygen, traveling at high altitudes decreases the amount of oxygen available; thus, other oxygen sources need to be used. When the previously mentioned situation was a reality to me, I was ignorant to the facts of oxygen even being affected by higher altitudes. In the mindset of a ten or eleven year old kid, I can truly say I thought that oxygen if anything would be increased because there was nothing but space in the air. Little did I know, that little piece of missing information could have nearly cost me my life. A normal person’s hemoglobin ranges from 12-15, my hemoglobin at a healthy level can get up to a 9 if I’m lucky; however, due to the preparation for travel I figure my hemoglobin to have dropped to around a 7. Upon boarding the plane of course I felt fine because my body is now tolerant to lower levels of the oxygen carrying protein. When we started to ascend for travel and my body was not getting extra oxygen, I’m pretty sure it went into reaction mode and dropped my hemoglobin. If I could picture the internal war my body was going through I can describe it as gruesome. Cells trying to get oxygen and failing, becoming shriveled up and crescent shaped, clustering together in blood vessels with jagged edges protruding and causing pain. My breathing became shallow, my heart rate increased and alternated between palpitations and my limbs suffered excruciating pain. Needless to say, I had to make a trip to the hospital as a first part to my vacation but I’m glad because I’ve now learned my lesson!

**Intellectual Property of Jasmine Bailey**