Establishment of Blood Screening Protocols for Collegiate and Endurance Athletes The goal of this action research proposal is to establish blood screening for endurance athletes at the college, which the researcher is employed at as there is currently no system in place by which the athletic department, athletic training room, and health center work together to screen athletes that exhibit symptoms of non-anemic iron deficiency.

The standard testing protocols to determine anemia at most health centers do not adequately diagnose non-anemic iron deficiency in elite endurance athletes.

There is a need for standard testing protocols at the college health centers for accurate diagnosis of non-anemic iron deficiency in elite endurance athletes.

Literature Review

The work of Eichner (2001) entitled "SSE #81: Anemia and Blood Boosting" states that athletes, "especially endurance athletes, tend to have slightly low hemoglobin levels as judged by general population norms." Eichner reports that low blood hemoglobin concentration "…defines anemia, this has been called sports anemia. But sports anemia is a misnomer because in most such athletes -- especially men -- the low hemoglobin level is a false anemia. The total volume of red cells in the body is normal, not low. Hemoglobin level is decreased because aerobic exercise expands the baseline plasma volume; this reduces the concentration of red cells, which contain the hemoglobin. In other words, the naturally lower hemoglobin level of an endurance athlete is a dilutional pseudoanemia." (Eichner, 2001) Pseudoanemia is stated to be "…an adaptation to hemoconcentration that occurs during workouts. Vigorous exercise acutely reduces plasma volume by 10-20% in three ways. One, a rise in blood pressure and muscular compression of venules boost the fluid pressure inside the capillaries of the active muscles. Two, generation of lactic acid and other metabolites in muscle increases tissue osmotic pressure. These forces drive plasma fluid, but not red cells, from blood to tissues. Three, some plasma water is lost in sweat." (Eichner, 2001) Renin, aldosterone and vasopressin are released which conserve water and salt. In addition, albumin is added to the blood. The result is that baseline plasma volume expands and even one single round of intense exercise may expand the plasma volume up to 10% in a 24-hour period. (Eichner, 2001) According to Eichner it is common for an endurance athlete to have a hemoglobin concentration of "1 g/dL or even 1.5 g/dL below 'normal'." (2001) The recognition of this as pseudoanemia is dependent on the setting as well as exclusion of other anemias. Plasma volume changes quickly depending on the level of exercise therefore athletes who are in training the most have the lowest levels of hemoglobin's when daily workouts cease they have a rising hemoglobin level. Stated as key to aerobic fitness is pseudonanemia since the rise in plasma volume in addition to the athlete's heart adapting increasing the cardiac stroke volume which is stated to compensate for the fall...

Sports anemia is reported to be a false anemia and it is stated that exertional hemolysis nearly never causes anemia therefore iron deficiency is the leading cause of anemia in athletes and as well is reported to be a common cause of fatigue in female athletes. Insufficient can lead to low hemoglobin as it is a "critical component of hemoglobin." (Eichner, ) Eichner (2001a) reports that patients with anemia "feel fatigued only with exertion." When anemia is mild in nature, Eichner reports that the only thing that will unmask the anemia is strenuous exercise. Eichner and Scott (1998) report
"This was the case in three college athletes, all initially difficult to diagnose (Eichner & Scott, 1998). One was an elite runner who began losing races. Another was a softball player who saw a cardiologist for spells of fast heartbeat and breathlessness in training. The third was a basketball player who fell behind in training and was called an underachiever. In each case, the culprit was loss of stamina from iron deficiency anemia." (Eichner and Scott, 1998)

Reported as well by Eichner (2001) is that in a recent survey of 25,000 individuals in the United States findings show that 10% of young women are iron deficient and another 3 to 5% of young women are anemic. Iron deficiency among young men is reported to be rare. The survey is stated to have "…defined anemia in women as hemoglobin 12 g/dL were given iron or placebo for 6 weeks as they trained. Those on iron grew fitter and cycled faster. Hemoglobin tended to rise on iron, and this rise improved "energetic efficiency." Conclusion: Women with hemoglobin >12 g/dL may be "functionally anemic." (Hinton, et al., 2000 in Eichner, 2001) Reported as well is that researchers "…also gauged VO2 max in two groups of young women called "nonanemic" because hemoglobin was >12 g/dL (Zhu et al., 1997). One group was iron depleted (ferritin 12 g/dL, they were anemic compared to the iron-replete women." (Eichner, 2001) Anemia is stated to be "relative" in that in the studies described "…slight differences in hemoglobin levels, all >12 g/dL, affected athletic performance. Anemia is best defined as a subnormal hemoglobin level for the individual. For example, a female athlete with hemoglobin 13 g/dL is anemic if her normal value is 14 g/dL. No firm cutoff value defines anemia." (Eichner, 2001) Iron deficiency anemia is reported to be "more common than surveys suggest. The more an athlete asks of her body, the more likely she is to feel exertional fatigue if she has mild anemia. Because of this, female athletes can benefit from regular screening. At the University of Oklahoma, we screen all female athletes yearly for hemoglobin and ferritin. We find up to 10-20% or more of first-year female athletes iron deficient. Many of these are anemic, some with hemoglobin 12 g/dL." (Eichner, 2001) It is reported that the iron deficiency was found in 20% of varsity female volleyball and basketball players with hemoglobin