Anemia in Athletes - An Overview

Introduction:

By definition, athletes are healthy subjects, but because of physical activity, training, physiological and psychological stress, environmental factors, etc., they frequently have abnormal hematological or biochemical characteristics. The pathophysiology of anemia in sports involves several overlapping pathways, primarily related to iron metabolism. There have been new insights into this intricate problem in recent years. The anemia in athletes deserves a careful and multifactorial approach because of factors such as hemodilution and redistribution, which are thought to contribute to the so-called "sports anemia," iron deficiency brought on by increased demands, dietary restrictions, decreased absorption, increased losses, hemolysis, and sequestration, and genetic determinants of various types of anemia (some linked to sport). Generally speaking, athletes have lower hemoglobin concentrations than the general population; this condition is mislabeled as "sports anemia."

What Is Sport Anemia?

"Sports anemia," a misnomer that refers to fake anemia, is the term used to explain the lower hemoglobin concentrations that athletes typically have compared to the general population. Exercise-induced plasma volume expansion occurs after a few days of intense training and accounts for the decrease in hematocrit (Hct), hemoglobin (Hb), and red blood cell (RBC) count caused by endurance training. Meanwhile, erythropoiesis is stimulated by physical effort, increasing the absolute Hb mass; nevertheless, this mechanism is surpassed by plasma expansion. Reduced hemoglobin concentration in a venous sample is known as anemia. It can be relative or dilutional when plasma volume is raised while maintaining normal red cell and total hemoglobin mass. Controversial are the iron cutoff values for the active population. Oral iron supplementation (100 mg FeSO4/day) administered in a randomized, placebo-controlled manner to iron-depleted female athletes increased their iron status and physical performance. A healthy gut microbiota also influences iron status.

According to a consensus of the Swiss Society of Sports Medicine, serum ferritin, mean cellular hemoglobin, mean cellular volume, baseline hemoglobin, and Hct all aid in monitoring iron insufficiency. Ferritin levels less than 15 μg in healthy male and female athletes over 15 suggest low iron stores, whereas values between 15 and 30 μg indicate empty iron stores. The recommended cutoffs are 15 and 20 μg/L for children aged 6 to 12 and adolescents aged 12 to 15 years, respectively. Given the rising demands in adult elite sports, 50 should be the cutoff point.

Hemolytic Anemia Associated with Sports

The term "exercise-induced hemolysis" refers to the breaking down and devastation of red blood cells during physical activity. The footstrike, primarily in running or power walking sports, causes intravascular hemolysis during running because of impact forces. Erythrocyte longevity in runners is 40 percent less than in non-athletes. Hematuria in runners is also a result of bladder contusion. Even in non-traumatic sports like endurance swimming, hemolysis can result in hyperbilirubinemia, primarily in endurance sports, because of renal vasoconstriction and muscle tension, which compress tiny blood vessels and cause red blood cell deformation. Acute kidney injury while running may be indicated by proteinuria and bilirubinuria. The following factors can cause hemolysis: mechanical injury from hard ground contact; repeated muscle contraction, vasoconstriction, and disturbances in metabolism, including heat shock, dehydration, hypoxia, hypotonia, shear stress, lactic acidosis, oxidative damage, proteolysis, elevated catecholamines, and lysolecithin.

Additionally, lipid profile alterations brought on by exercise adaptation include a rise in lysolecithin and a decrease in free cholesterol, which raises osmotic fragility. Hemolysis may also result from other factors such as acidosis, heat, and pre-existing erythrocyte abnormalities. Exercise-induced hemolysis produces low-quantity cell-free hemoglobin, cleared by haptoglobin and other scavenger proteins. Tests using urine dipsticks can help identify athletes at risk of acute renal injury.

Why Does Sports Anemia Occur?

While there are many potential reasons for sports anemia, the majority of scientists and medical professionals list the following ones:

• Hemolysis: The term "hemolysis" describes the lysis of red blood cells. Hemolysis, or the disintegration of red blood cells, can happen for several reasons:

• Repeated Trauma: Footfalls that strike hard surfaces frequently can cause capillary tears and elevated blood pressure, which can lead to the decomposition of red blood cells.

• Scavenging for Protein: During exercise, the body breaks down red blood cells for hemoglobin and other components to enable the muscles to handle the increased force. The resultant proteins are added to the muscle mass that already exists. Numerous research investigations have demonstrated increased muscle mass and decreased hemoglobin levels after extended endurance runs.

• Adrenaline: Excessive physical activity causes the adrenal gland to become more active, which increases the hormone's synthesis. The spleen, which is directly stimulated by adrenaline, releases substances that promote hemolysis, breaking down red blood cells.

• The disease known as hematuria causes intact red blood cells to leak into the urine. Hematuria in athletes is thought to be caused by several factors.

• Direct Renal Impact & Trauma: These injuries are rather common in sports like football, soccer, and wrestling that have the potential to be brutal. Hematuria may ensue from this, damaging the blood vessels in the kidneys.

What Are the Symptoms of Sports Anemia?

While the symptoms of sports anemia might vary from athlete to athlete, the following are often reported signs:

• Delayed onset of fatigue and impaired performance.

• Recurring weakness and susceptibility to burnout.

• Intolerance.

• Low endurance.

• Low hunger and undernourishment.

• Higher frequency of common infections, such as the common cold.

• Chest pain and rapid heartbeat.

• Heightened susceptibility to harm.

• Short attention spans, incoherence, and confusion.

How to Diagnose Anemia?

When it comes to sports anemia, diagnosing it is more complicated and may need several tests. The majority of tests are designed to determine the reason for sports anemia, and after completing the following examinations, a definitive diagnosis can be made:

• It is necessary to undertake a thorough physical examination and obtain a thorough medical and nutritional history.

• Vitamin Assay: It is necessary to determine the folate and vitamin B12 serum levels.

• Electrolyte and Mineral Analysis: It is necessary to test for concentrations of copper, zinc, iron, magnesium, sodium, and chloride.

• Whole Blood Count: Hematocrit, hemoglobin concentration, and red blood cell count must be determined.

• Finish the urine analysis and look for hematuria.

• Tests for liver function that measure the quantity of bilirubin in the bloodstream.

• If the athlete reports having digestive problems, an endoscopic evaluation is recommended.

What Are the Therapy for Athletic Anemia?

Treatment modalities are typically unnecessary, even though sports anemia is typically a self-limiting illness that resolves independently.

• Supplements and dietary changes to improve iron consumption.

• Lean and red meat, green leafy vegetables, beets, fish liver, almonds, fortified cereal, and legumes are all excellent natural sources of iron.

• Make sure to take balanced vitamins.

• Correcting posture and wearing healthier shoes will help prevent foot injuries.

• Exercise regimens that are well-planned and tapered to control hematuria and gastrointestinal bleeding.

Conclusion:

Even in situations when it appears severe, sports anemia can be properly managed, even if it may still be a difficult illness to treat. A remedy can be discovered for any condition, including injuries, pre-existing deficiencies, and endurance-induced plasma dilution, as long as one constantly follows the doctor's and physiotherapist's directions.