Runner's macrocytosis: a clue to footstrike hemolysis. Runner's anemia as a benefit versus runner's hemolysis as a detriment

Changes in red blood cell parameters during incremental exercise in highly trained athletes of different sport specializations

Background

During physical exercise, the level of hematological parameters change depending on the intensity and duration of exercise and the individual's physical fitness. Research results, based on samples taken before and after exercise, suggest that hematological parameters increase during incremental exercise. However, there is no data confirming this beyond any doubt. This study examined how red blood cell (RBC) parameters change during the same standard physical exertion in athletes representing different physiological training profiles determined by sport discipline.

Methods

The study included 39 highly trained male members of national teams: 13 futsal players, 12 sprinters, and 14 triathletes. We used multiple blood sampling to determine RBC, hemoglobin (Hb), hematocrit value (Hct), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and red blood cell distribution width (RDW) before, during (every 3 min), and after (5, 10, 15, 20, and 30 min) an incremental treadmill exercise test until exhaustion.

Results

There were no significant exercise-induced differences in RBC parameters between athletic groups. No significant changes were recorded in RBC parameters during the low-intensity phase of exercise. RBC, Hb, and Hct increased significantly during incremental physical exercise, and rapidly returned to resting values upon test termination.

Conclusions

The general pattern of exercise-induced changes in RBC parameters is universal regardless of the athlete's physiological profile. The changes in RBC parameters are proportional to the intensity of exercise during the progressive test. The increase in hemoglobin concentration associated with the intensity of exercise is most likely an adaptation to the greater demand of tissues, mainly skeletal muscles, for oxygen.

Biological, Psychological, and Physical Performance Variations in Football Players during the COVID-19 Lockdown: A Prospective Cohort Study

This prospective cohort study aimed to evaluate whether COVID-19 lockdown caused biological, psychological, and/or physical performance variations in footballers. We compared the 2018/2019 and 2019/2020 seasons evaluating the plasma volume, hematological parameters, iron/ferritin, creatine kinase, vitamin D, cortisol, testosterone, and physiological state of players of the Italian football major league (Serie A). Measurements were performed before the preparatory period (T0), at the beginning (T1) and in the middle (T2) of the championship, and in March (T3) and at the end of season (T4). The results showed that in the 2019/2020 season affected by the lockdown, the weight, BMI, and fat mass percentage were higher than in the previous season. Hematocrit, hemoglobin, red blood cells, and ferritin decreased during both seasons, more significantly than in the regular season. During both seasons, creatine kinase increased from T2 whilst iron concentrations decreased in T3. Testosterone increased in both seasons from T0 to T3 and returned to initial levels at T4; cortisol increased in T2 and T3 during the 2018/2019 season but not during the COVID-19 season. Physical performance tests revealed differences associated with lockdown. Thus, although from a medical point of view, none of the evaluated changes between the two seasons were clinically relevant, training at home during lockdown did not allow the players to maintain the jumping power levels typical of a competitive period.

Thyroid Function and Nutrient Status in the Athlete

Thyroid disease is common in the general population, especially in women, and also may be prevalent among athletes. Autoimmune disorders are the most common cause of thyroid disorders in countries with iodine-fortification programs; however, thyroid dysfunction can be brought on by nutritional factors, including insufficient energy intake and iodine, selenium, iron, and vitamin D deficiency. Additionally, strenuous exercise may be associated with transient alterations in thyroid hormones. While the development of thyroid related disorders has the potential to impact health and peak performance, typical clinical manifestations are highly variable, lack specificity, and are frequently confused with other health problems. The assessment process should focus on anthropometric changes, biochemical tests (thyroid panel), personal and family history, examination for appropriate signs and symptoms, and diet and environmental assessment that includes adequacy of energy, iodine, iron, selenium, and vitamin D intake/status along with excess stress and exposure to environmental contaminants and dietary goitrogens.

Epidemiological, biological and clinical update on exercise-induced hemolysis

Exercise-induced hemolysis can be conventionally defined as rupture and destruction of erythrocytes during physical exercise. The currently available epidemiologic information attests that a substantial degree of exercise-induced hemolysis is commonplace after short-, medium-, long- and ultra-long distance running, as reflected by significant decrease of serum or plasma haptoglobin and significant increase of plasma concentration (or overall blood content) of free hemoglobin. This paraphysiological intravascular hemolysis is typically mild (average variations of hemolysis biomarkers are usually comprised between 1.2- and 1.8-fold), almost self-limiting (completely resolving within 24-48 hours), with severity depending on athlete population, analytical technique used for detecting intravascular hemolysis, as well as on number, frequency and intensity of ground contacts, but not on running technique. Additional lines of evidence support the notion that both osmotic fragility and membrane structure of erythrocytes are considerably modified during endurance exercise. This fact goes hand in hand with findings that erythrocyte lifespan in runners is approximately 40% shorter than in sedentary controls. Direct mechanical injury caused by forceful ground contacts, repeated muscle contractile activity or vasoconstriction in internal organs are three potential sources of exercise-induced hemolysis, whilst metabolic abnormalities developing while exercising (e.g., hyperthermia, dehydration, hypotonic shock, hypoxia, lactic acidosis, shear stress, oxidative damage, proteolysis, increased concentration of catecholamines and lysolecithin) may actively contribute to trigger, accelerate or amplify this phenomenon. Although no systematic evidence is available, it seems also reasonable to hypothesize that patients bearing erythrocyte disorders may be particularly vulnerable to developing exercise-induced hemolysis.

Training-induced annual changes in red blood cell profile in highly-trained endurance and speed-power athletes

BACKGROUND

An extensive body of literature exists on the effects of training on hematological parameters, but the previous studies have not reported how hematological parameters respond to changes in training loads within consecutive phases of the training cycle in highly-trained athletes in extremely different sport disciplines. The aim of this study was to identify changes in red blood cell (RBC) profile in response to training loads in consecutive phases of the annual training cycle in highly-trained sprinters (8 men, aged 24±3 years) and triathletes (6 men, aged 24±4 years) who competed at the national and international level.

METHODS

Maximal oxygen uptake (VO2max), RBC, hemoglobin (Hb), hematocrit (Ht), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC) and RBC distribution width (RDW) were determined in four characteristic training phases (transition, general subphase of the preparation phase, specific subphase of the preparation phase and competition phase).

RESULTS

Our main findings are that: 1) Hb, MCH and MCHC in triathletes and MCV in both triathletes and sprinters changed significantly over the annual training cycle; 2) triathletes had significantly higher values than sprinters only in case of MCH and MCHC after the transition and general preparation phases but not after the competition phase when MCH and MCHC were higher in sprinters; and 3) in triathletes, Hb, MCH and MCHC substantially decreased after the competition phase, which was not observed in sprinters. The athletes maintained normal ranges of all hematological parameters in four characteristic training phases.

CONCLUSIONS

Although highly-trained sprinters and triathletes do not significantly differ in their levels of most hematological parameters, these groups are characterized by different patterns of changes during the annual training cycle. Our results suggest that when interpreting the values of hematological parameters in speed-power and endurance athletes, a specific phase of the annual training cycle should be taken into account.

Cyr JA. The systemic vascular resistance response: a cardiovascular response modulating blood viscosity with implications for primary hypertension and certain anemias

Without an active regulatory feedback loop, increased blood viscosity could lead to a vicious cycle of ischemia, increased erythropoiesis, further increases of blood viscosity, decreased tissue perfusion with worsened ischemia, further increases in red cell mass, etc. We suggest that an increase in blood viscosity is detected by mechanoreceptors in the left ventricle which upregulate expression of cardiac natriuretic peptides and soluble erythropoietin receptor. This response normalizes systemic vascular resistance and blood viscosity at the cost of producing ‘anemia of chronic disease or inflammation’ or ‘hemolytic anemia’ both of which are better described as states of compensated hyperviscosity. Besides its role in disease, this response is also active in the physiologic adaptation to chronic exercise. Malfunction of this response may cause primary hypertension.

Assessment of hematological profiles of adult male athletes from two different air pollutant zones of West Bengal, India

Health effects from air pollution are severe concern of today's world. The study was undertaken to assess the effects of air pollution on hematological profiles of trained and untrained males of West Bengal. The sample consisted of 60 sprinters, 60 footballers, and 120 untrained males, subdivided into two groups from two zones, namely, Tollygunge and Sonarpur. Suspended particulate matter (SPM), respirable particulate matter (RPM), oxides of sulfur (SOx), and oxides of nitrogen (NOx) of ambient air were monitored for both zones. Height and weight of all the subjects were measured. Venous blood sample was drawn from the cubital vein, and the red blood cell count (TC), packed cell volume (PCV), hemoglobin (Hb) concentration, mean corpuscular volume (MCV), and mean corpuscular hemoglobin concentration (MCHC) were determined by standard methods. Results revealed that SPM, RPM, SOx, and NOx concentrations were significantly higher in the Tollygunge area than Sonarpur. TC, PCV, and Hb concentration of untrained males were significantly higher than footballers in both regions but no significant difference were observed when compared with sprinters, except the Hb concentration in the Tollygunge zone. On the other hand, all hematological parameters of both trained and untrained males were significantly higher in the Sonarpur area than Tollygunge. It was concluded that environmental air pollutants might influence hematological profile adversely both in trained and sedentary males. However, further investigation in this area is needed.

Changes in erythropoiesis, iron metabolism and oxidative stress after half-marathon

OBJECTIVE

In marathon runners changes in red blood cell count, haematocrit and haemoglobin in relation to haemodilution have been reported. Moreover, it has been hypothesized that strenuous exercise induces oxidant stress through several different mechanisms. This study investigated the haematological variables, iron status and oxidative indices before, immediately and 48 h after a race in 8 healthy trained males aged 33-44 years running a 21-km marathon in 79 +/- 3 min.

METHODS

The haematological parameters were determined by standard procedures. Erythropoietin and soluble-transferrin receptor were evaluated immunoenzymatically. Nontransferrin-bound iron (NTBI) was assayed by high-performance liquid chromatography after nitrilotriacetic acid chelation. Malonyldialdehyde (MDA) concentration was assayed colorimetrically.

RESULTS

The total number of reticulocytes rose significantly after the run with a significant increase in the high-RNA-content fraction (14 +/- 5, p < 0.0006). Erythropoietin rose by 26% (15.0 +/- 2.8 mU/ml, p < 0.004) and by 25% (14.9 +/- 2.13 mU/ml, p < 0.02) immediately and 48 h after the race, respectively. Serum iron and serum ferritin remained unchanged but NTBI and serum MDA increased significantly immediately after running (1.16 +/- 0.40 mmol/l, p < 0.0008; 0.76 +/- 0.16 mmol/l, p < 0.0001). Significant positive correlations at any time between MDA and polymorphonuclear neutrophils (p = 0.0005), MDA and NTBI (p = 0.0018), polymorphonuclear neutrophils and NTBI (p = 0.0008) and between lactate dehydrogenase and NTBI (p = 0.0212) were observed.

CONCLUSIONS

The erythropoietic changes observed in marathon runners are the results of several interacting mechanisms that involve either the haemopoietic system per se or erythrocyte haemolysis and oxidative stress.

Hematologic Disorders in the Athlete

Optimal athletic performance depends on proper function of many organs, including the blood. This is underscored by the focus of endurance athletes on increased hemoglobin through training at altitude or exogenous erythropoietin. Several other aspects of the hematologic system can also affect or be influenced by physical activity. In this article, the authors briefly discuss inherited abnormalities of the blood that can manifest themselves in athletes. We then discuss the effects of exercise on the blood, and acquired abnormalities of blood cells or coagulation parameters that occur in athletes, and that can influence performance or cause other symptoms.

Hematological indices and iron status in athletes of various sports and performances

PURPOSE

Alterations of the red blood cell system and iron metabolism can influence physical performance. On the other hand, exercise can influence hematological variables. The purpose of this epidemiological study was to investigate the characteristics of the red blood cell system and the iron metabolism in athletes of different sporting disciplines and at different levels of performance.

METHODS

We studied 851 male subjects (747 athletes, 104 untrained controls). Hemoglobin (Hb), hematocrit (Hct), red blood cell count (RBC), iron, transferrin, ferritin (Fer), and haptoglobin were analyzed in standardized blood samples, obtained after 2 d of rest, considering levels of performance (internationally, nationally, locally competitive, and leisure time), distinctive sporting category (endurance- (END), strength- (POW), and mixed-trained (MIX)), and, within endurance athletes, distinctive disciplines (cycling (CYC) and running (RUN)).

RESULTS

No difference was found between athletes and controls in Hb and Hct. Reduced Hb, Hct, and RBC levels were observed in END compared with POW and MIX. These findings can mainly be attributed to exercise-induced plasma volume expansion, and only to a lesser degree and in selected athlete populations to hemolysis, as low haptoglobin is only observed in RUN, not in CYC, suggesting that not exercise itself but the "traumatic" movement of running might trigger the destruction of red blood cells. Physical activity of increasing duration and workloads (leisure time compared with competitive athletes) leads to decreased Fer levels in athletes, disregarding their discipline, but more pronounced in RUN.

CONCLUSION

Physical training itself has no significant effect on selected hematological variables in athletes compared with untrained controls. The specific type and duration of exercise is of major importance in the adaptations of the blood cell system and the iron metabolism.

Nonorthopaedic problems in the aquatic athlete

This article discusses a number of medical conditions that are common to aquatic athletes. Exercise-induced asthma is particularly prevalent in swimmers because swimming is among the activities tolerated best by asthmatics. The healthcare professional frequently must evaluate and manage respiratory infections and infectious mononucleosis in swimmers, particularly in regard to the safe timing of return to training and competition. Dilutional sports pseudoanemia must be differentiated from the true anemias that are due mostly to iron-deficiency and intravascular hemolysis. Finally, the evaluation, management, and prevention of otitis externa, external auditory canal exostoses, and dermatologic disorders in swimmers are reviewed.

Iron status in women aerobic dance instructors

This investigation evaluated the iron and nutritional status of 12 highly trained aerobic dance instructors who did not take iron supplements (ANS) and 8 who did (AS). A control group (C) consisted of 10 age matched controls. The aerobic instructors had exercised for approximately 3.8 days/wk, 56 min/session for the past 7 yrs. There were no significant differences among groups for energy intake, carbohydrate, protein, fat, nonheme iron, heme iron, or total iron intake (excluding supplemental iron). But both exercise groups had lower ferritin values than the control group. There was also a significant difference in mean cell volume (MCV), with both exercise groups having greater values than the control group. There were no differences among groups for serum iron, total iron binding capacity, transferrin saturation, hematocrit, or hemoglobin. One in three aerobic dance instructors had serum ferritin values below 12 micrograms.L-1. Results indicate that women exercise leaders have iron profiles that are similar to other groups of female athletes. The increased MCV values suggest runners' macrocytosis or an exercise induced macrocytosis.

Effects of aerobic long distance running training (up to 40 km.day-1) of 1-year duration on blood and endocrine parameters of female beagle dogs

The effects of long distance running training on blood parameters, hormone responses and bone growth were studied in young growing dogs. A genetically uniform group of female beagles matched with respect to age and body mass were used. The runner dogs (n = 10) underwent gradually increased running exercise up to 40 km.day-1 on a treadmill with 15 degrees uphill gradient 5 days each week during a period of 1 year, while the littermate control dogs (n = 10) were kept in their cages throughout the study. Low plasma lactate concentrations of the runners measured immediately after the running training indicated the aerobic metabolism of the dogs while running. Significant decreases of blood haemoglobin concentrations (11%), blood erythrocyte number (10%), and erythrocyte packed cell volume (12%) were found in the runner group. Throughout the experiment, the value of thyroxine was slightly lower (13%) in the runners but no changes were found in tri-iodothyronine, free thyroxine, or cortisol serum concentrations. Serum oestradiol concentration at 56 weeks was significantly lower (42%) in the runner group than in the control group but was not as low (27%) at 70 weeks. Somatomedin-C concentration had decreased significantly by 37% at the age of 56 weeks in the runner group but was again at the level of the control dogs at the end of experiment (at 70 weeks). Ulna and radius bone mass as a ratio to the body mass had significantly increased in the runners. It would seem from our study that long distance running has a positive effect on bone growth.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of shoe cushioning on the development of reticulocytosis in distance runners

We studied erythropoietic activity in relation to the rearfoot cushioning of shoes worn by 14 male runners before, during, and the morning after a 17-day period of increased training mileage. The percentage of reticulocytes in the red blood cell count (normal, less than 0.8%) served as the marker for erythropoietic activity. Each runner was assigned to either a firm-sole group (7) or a soft-sole group (7) according to the heel impact attenuation character (Peak g) of his shoes. Peak g was 18% greater in the firm-sole group (P less than 0.001). Otherwise, the groups were similar in physical characteristics, training mileage, and running ability. All subjects ran a total of 430 km, a distance that averaged 79% higher than their regular training distance for a 17-day period. Resting blood samples were obtained at baseline and on three mornings (Days 11, 13, and Day 18, which followed the completion of the increased training period). No significant differences were found between the groups in red blood cell count, hematocrit, or total hemoglobin, haptoglobin, plasma-free hemoglobin, and serum ferritin levels. The groups did not differ in percent reticulocytes at baseline (0.2% firm-sole versus 0.2% soft-sole), on Day 11 after running 280 km (0.8% firm-sole versus 0.8% soft-sole), or on Day 13 after 48 hours of rest (1.3% firm-sole versus 1.0% soft-sole). However, on Day 18 after running 430 km, reticulocyte counts were 29% higher (P less than 0.05) in firm-sole than soft-sole (2.2% versus 1.7%, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Intravascular haemolysis in the recreational runner

Intravascular haemolysis has been found to result from prolonged endurance competition, rigorous military training and participation in impact sports. Haematological research involving the recreational runner is sparse. Recreational runners frequently vary their training to avoid monotony and improve endurance capacity. This study investigated the haematological effects of a typical day of increased distance training in 15 male recreational runners (62.4(3.1) ml kg-1 min-1 treadmill VO2max; 44.6(8.4) km per week training (means(s.d.)). Venous blood samples were collected before, immediately after, 1 day, 4 days, and 10 days after a 13-km training run (about twice the subjects' typical running distance) and analysed for changes in bilirubin, serum potassium, haematocrit, haemoglobin, red blood cell count, haptoglobin, poikilocytosis and reticulocytosis. Urine samples were collected at the same times as the blood samples and analysed for urobilinogen. Significant (P less than 0.05) 1-day and 4-day decreases in mean haemoglobin, red blood cell count, and haptoglobin values, compared to before training venous blood values and significant (P less than 0.05) post-training increases in bilirubin, serum potassium, urobilinogen and poikilocytosis provided evidence for increased intravascular haemolysis. After 10 days the values for haematocrit, bilirubin, serum potassium, red blood cell count, urobilinogen and poikilocytosis were not significantly (P less than 0.05) different from pre-training values while haemoglobin remained significantly (P less than 0.05) lower, exhibiting a constant but not significant increase over the period from 1 to 10 days. The results indicate that mild intravascular 'footstrike' haemolysis can occur in the recreational runner when typical training distance is increased. This condition appears to be transient and benign.

Early adaptations in gas exchange, cardiac function and haematology to prolonged exercise training in man

In order to determine the effect of short-term training on central adaptations, gas exchange and cardiac function were measured during a prolonged submaximal exercise challenge prior to and following 10-12 consecutive days of exercise. In addition, vascular volumes and selected haematological properties were also examined. The subjects, healthy males between the ages of 19 and 30 years of age, cycled for 2 h per day at approximately 59% of pre-training peak oxygen consumption (VO2) i.e., maximal oxygen consumption (VO2max). Following the training, VO2max (l.min-1) increased (P less than 0.05) by 4.3% (3.94, 0.11 vs 4.11, 0.11; mean, SE) whereas maximal exercise ventilation (VE,max) and maximal heart rate (fc,max) were unchanged. During submaximal exercise, VO2 was unaltered by the training whereas carbon dioxide production (VE) and respiratory exchange ratio were all reduced (P less than 0.05). The altered activity pattern failed to elicit adaptations in either submaximal exercise cardiac output or arteriovenous O2 difference. fc was reduced (P less than 0.05). Plasma volume (PV) as measured by 125I human serum albumin increased by 365 ml or 11.8%, while red cell volume (RCV) as measured by 51chromium-labelled red blood cells (RBC) was unaltered. The increase in PV was accompanied by reductions (P less than 0.05) in haematocrit, haemoglobin concentration (g.100 ml-1), and RBCs (10(6) mm-3). Collectively these changes suggest only minimal adaptations in maximal oxygen transport during the early period of prolonged exercise training. However, as evidenced by the changes during submaximal exercise, both the ventilatory and the cardiodynamic response were altered.(ABSTRACT TRUNCATED AT 250 WORDS)

Erythrocytic system under the influence of physical exercise and training

It is obvious that physical performance, endurance capacity and resistance to fatigue in humans are dependent upon many different factors. One factor, the oxygen carrying capacity of blood, seems to be of particular importance. This factor is mainly determined by haemoglobin concentration, number of circulating erythrocytes and the efficiency of their functions. A single bout of physical effort and, even more, repeated exercise may change the morphological indices of blood and influence the erythropoietic processes in the bone marrow. That is why there is so great an interest now attached to the effects of physical exercise on the erythrocytic system. Although in recent years many papers have been published on the subjects their findings pertaining to the effects of single bouts of exercise and systematic training on the erythrocytic system are often contradictory. The haematological parameters in some top-class athletes, particularly those performing in endurance disciplines are lowered at rest. Anaemia has been described in sportsmen, even among the members of Olympic teams. This type of anaemia has been called 'sports anaemia', 'athletes' anaemia' or 'postexercise anaemia' in order to emphasise its character. Among many possible causes which may bring about the development of sports anaemia the most commonly recognised are: postexercise plasma expansion, intensified haemolysis during physical efforts, iron deficiency, losses of erythrocytes by the way of bleeding into the digestive and urinary systems and also some disturbances in erythropoiesis. However, there is evidence of the intensification of erythropoiesis by many factors occurring during physical exercise.

Preparticipation Screening of College Athletes: Value of the Complete Blood Cell Count

In brief: A retrospective study of 1,067 college athletes was done to determine the prevalence of certain abnormalities in their preseason complete blood cell count. The authors analyzed the values for white blood cell count, hemoglobin, mean corpuscular volume, and platelet count. In addition, they reviewed the literature to determine if an abnormality in any of these parameters alters athletic performance. Their conclusion: Only a hemoglobin level is useful in preseason evaluations.

Sports hematuria

Strenuous exercise makes extraordinary demands. The transition from rest to intensive physical activity can cause pathological changes in various organs, particularly in the urinary tract. Hematuria (microscopic or macroscopic) is one of the abnormalities commonly found after sports activity. This phenomenon can occur in noncontact sports (such as rowing, running and swimming) as well as in contact sports (boxing, football and so forth). The pathophysiology can be either traumatic or nontraumatic. Renal trauma and/or bladder injury due to repeated impact of the posterior bladder wall against the bladder base can cause vascular lesions and consequently hematuria. There are 2 mechanisms of nontraumatic injury. 1) Vasoconstriction of the splanchnic and renal vessels occurs during exercise in order that blood can be redistributed to the contracting skeletal muscles, thus causing hypoxic damage to the nephron. This results in increased glomerular permeability which would favor increased excretion of erythrocytes and protein into the urine. 2) A relatively more marked constriction of the efferent glomerular arterioli results in an increased filtration pressure, which favors increased excretion of protein and red blood cells into the urine. It must be noted that sports hematuria differs from other conditions that may cause reddish discoloration of the urine due to physical exercise, such as march hemoglobinuria and exercise myoglobinuria. In the latter 2 abnormalities there is excretion of hemoglobin and myoglobin molecules in the urine and not whole blood or intact red blood cells. Sports hematuria usually has a benign self-limited course. However, coexisting urinary tract pathological conditions should be excluded carefully.

Iron Status in Ultraendurance Triathletes

In brief: Using several hematologic indexes, researchers examined the iron status of 50 ultraendurance athletes participating in the 1988 Ironman Triathlon in Hawaii. Fifteen (30%) of the 50 triathletes had at least one suboptimal iron index: Two exhibited stage 2 iron deficiency in the presence of normal hemoglobin levels; eight had normal ferritin levels but subnormal levels of transferrin saturation and iron; three had abnormal levels of total iron-binding capacity; and two had low hemoglobin levels with all other iron indices normal, which indicated dilutional anemia. These data suggest that several indexes need to be examined when assessing the iron status of triathletes and that unusual values do not necessarily reflect actual iron deficiency.

Red blood cell morphology after a 100-km run

We studied the red blood cells of male athletes competing in a 100-km run. The RBC, haematocrit, and red cell indices were unaffected. The red cell morphology was studied in a wet preparation with light microscopy. A slight stomatocytosis was observed after the run compared to a control day (12.4 +/- 1.8% vs 4.3 +/- 1.8%, P less than 0.05). This difference persisted when runner red cells were incubated in buffer. Red cells from a normal donor did not undergo stomatocytic transformation when incubated in runner plasma. These data indicate that stomatocytosis after long-distance running is not caused by a plasmatic factor but is a change in the red cell membrane itself.

Training induced effects on blood volume, erythrocyte turnover and haemoglobin oxygen binding properties

The effect of three weeks ergometer training (Tr) 5 times a week for 45 min at 70% VO2max by 6 subjects on erythrocyte turnover and haemoglobin O2 affinity has been studied. Increased reticulocytosis could be observed from the second day after beginning Tr until a few days after its end, probably caused by increased erythropoietin release by the kidney. Erythrocyte destruction was most pronounced in the first and markedly reduced in the third week of Tr. Elevated glutamate oxalacetate transaminase activity and creatine as well as lowered mean corpuscular haemoglobin indicate a younger erythrocyte population in the first week of recovery. Total blood volume increased during the course of Tr by 700 ml, mainly caused by a raised plasma volume (74%). Red cell volume increased later with maximal values one week after Tr (+280 ml). In this week the standard oxygen dissociation curve was most shifted to the right (P50 increased from 3.77 +/- 0.05 kPa to 3.99 +/- 0.07 kPa) and the Bohr coefficients had their lowest values. Both effects are completely explainable by the haemoglobin O2 binding properties of young erythrocytes. After training, all parameters of physical performance (VO2max, maximal workload, heart rate during rest and exercise) were markedly improved, indicating fast adaptation mechanisms. The increased erythrocyte turnover, including higher erythropoiesis, seems to be one important part of these effects.

Changes in serum enzymes, lactate, and haptoglobin following acute physical stress in international-class athletes

Skeletal muscle is rich in creatine kinase (CK), lactate dehydrogenase (LD), and other enzymes. Many reports describe changes in serum CK and LD following exercise. In our study, 11 male international-class medium-distance runners were followed over a 10-month period prior to the 1984 US Olympic Trials. Cardiorespiratory fitness, evaluated through repetitive treadmill testing, was unchanged in our athletes. Total CK increased significantly during the course of training, and the CK-MB activity was higher than that of sedentary individuals; CK-MB never rose to more than 3% of the total CK. Total LD also rose following acute exercise; however, the proportions of the five isoenzymes were unaltered. There was no change in the LD-1/LD-2 ratio from normal. The origin of the increased serum enzymes was believed to be primarily skeletal muscle. A decrease of serum haptoglobin following acute stress was attributed to intravascular hemolysis and binding of hemoglobin. As expected, serum lactate was dramatically increased immediately postexercise.

Endurance swimming, intravascular hemolysis, anemia, and iron depletion. New perspective on athlete's anemia

Swimmers were evaluated for the anemia, intravascular hemolysis, and iron deficiency reported in endurance runners. Plasma concentrations of ferritin, haptoglobin, and hemoglobin were measured in nine collegiate swimmers through the competitive season and in 23 adult swimmers before and after endurance races of 1.5 km to 10 km. About 10 percent of the swimmers had low hemoglobin concentrations. The severity of this "swimmer's anemia" correlated with the amount of swimming in both men and women. Intravascular hemolysis occurred during all the races; the fastest swimmers in the longest races had the greatest decreases in haptoglobin. About 25 percent of the swimmers had low baseline haptoglobin concentrations. Iron depletion was found in 11 percent of the men and 57 percent of the women, but their athletic performance was not notably impaired. Iron depletion, anemia, and intravascular hemolysis in athletes in a nontraumatic sport suggest that mechanisms other than footstrike are components of athlete's hemolysis.

Coagulability and Rheology: Hematologic Benefits From Exercise, Fish, and Aspirin. Implications for Athletes and Nonathletes

In brief: Physical activity makes the blood more fluid and less likely to clot. The healthy hematologic adaptations to exercise (enhanced fibrinolysis, expanded plasma volume, decreased hematocrit, increased red cell deformability, and decreased blood viscosity) seem to enhance the delivery of oxygen and decrease the risk of thrombosis. Regular exercise, then, by changing the blood, may offer the elite athlete enhanced performance and the general population reduced risk of heart attack. Increased amounts of fish in the diet and-for selected persons-low-dose aspirin, may be useful antithrombotic adjuncts to exercise.

The Anemias of Athletes

In brief: Diagnosing anemia in athletes is complicated, because athletes normally have lower hemoglobin and serum ferritin concentrations than nonathletes. This dilutional pseudoanemia-a beneficial adaptation that enhances athletic performance-needs no treatment. Athletes can also develop true anemia from iron deficiency and/or footstrike hemolysis. True anemia can be treated with iron supplements and diet modification to increase absorbable iron; footstrike hemolysis can be minimized by paying attention to body weight, gait, shoes, and terrain. The widespread notion that depletion of iron stores without anemia limits performance is probably wrong, but even very mild iron deficiency anemia impairs maximal performance. The physician who recognizes and manages the diverse anemias of athletes performs a vital service.

The Marathon: Is More Less?

The marathon, a legendary race and a supreme challenge, lures many to attempt it. The level of exercise required to prepare for and run in repeated marathons, however, may be injurious to middle-aged men and is in fact unnecessary for providing protection from heart attack among such men.