An analysis of serum enzyme changes and clinical biochemical abnormalities of the anemia in Olympic runners.

In order to assess the changes in the clinical biochemistry of runner's anemia and its evolution during a prolonged period of high-intensity training, 11 male international class distance runners (mean time for 1 mile 4 min, 2.5 sec) were followed over a 10-month period prior to the 1984 U.S. Olympic Trials. Mean values of hemoglobin, hematocrit, and mean corpuscular hemoglobin (MCH) decreased modestly over the period of study. Means of haptoglobin, iron, and total iron binding capacity (TIBC) remained roughly constant. Percentage of saturation of TIBC by iron (% sat) averaged 30% or less in 5 of 11 runners, suggesting mild iron deficiency. Most measured haptoglobin levels were below normal range throughout the study period. The cause of runner's anemia has been demonstrated to be multifactorial, including disordered iron metabolism, iron deficiency, and hemolysis. Other studies have shown absent bone marrow iron in male athletes, secondary to hematuria, ischemia of the intestinal mucosa with bleeding, and iron losses due to heavy perspiring. Cardiorespiratory fitness, evaluated through repetitive treadmill testing, was not adversely affected in our athletes. Total creatine kinase (CK) increased significantly after a training session, while the MB fraction of CK never exceeded 3%. Total lactate dehydrogenase (LD) also rose after exercise, but the fractions represented by isozymes 1-5 were unaltered; specifically, there was no change in the LD-1/LD-2 ratio. Enzyme elevations were thus derived from skeletal muscle and not from heart.