Foot-strike haemolysis after a 60-km ultramarathon

doi:10.2450/2012.0167-11

Blood Transfus. 2012 July; 10(3): 377–383.

Published online 2012 May 17. doi: 10.2450/2012.0167-11

PMCID: PMC3417738

Foot-strike haemolysis after a 60-km ultramarathon

Giuseppe Lippi,¹ Federico Schena,² Gian Luca Salvagno,³ Rosalia Aloe,¹ Giuseppe Banfi,⁴ and Gian Cesare Guidi³

¹Unit of Diagnostic Blood-Chemistry, Department of Pathology and Laboratory Medicine, University Hospital of Parma;

²Section of Neurological, Neuropsychological, Morphological and Motor Sciences, University of Verona;

³Section of Clinical Chemistry, Department of Life Sciences and Reproduction, University of Verona;

⁴I.R.C.C.S. “Galeazzi” Orthopaedic Institute and University of Milan, Italy

Correspondence: Giuseppe Lippi, U.O. Diagnostica Ematochimica, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy, e-mail: glippi/at/ao.pr.it, Email: ulippi/at/tin.it

Received December 1, 2011; Accepted December 29, 2011.

This article has been cited by other articles in PMC.

Abstract

Background.

The various contributors to sport-related anaemia include increased plasma volume, exercise-induced oxidative stress, increased body temperature, acidosis, gastrointestinal bleeding, acute and chronic inflammation as well as compression and damage of red blood cells (RBC) in the capillaries within the contracting muscles. The effective contribution of foot-strike haemolysis is unclear.

Materials and methods.

We studied 18 Caucasian male athletes (mean age, 42 years; range, 34–52 years) before and immediately after a 60-km ultramarathon. Laboratory investigations included the haematological profile along with haptoglobin, potassium, aspartate aminotransferase (AST), creatine kinase (CK), lactate dehydrogenase (LDH) and albumin concentrations and a haemolysis index (HI).

Results.

No significant variations were found in post-exercise values of haemoglobin, RBC count and haematocrit. Mean corpuscular volume and haptoglobin were significantly decreased, whereas RBC distribution width was increased. The concentration of haptoglobin was reduced by approximately 50%, whereas enzyme concentrations were all remarkably increased. The HI remained below 0.5 g/L. After adjusting for plasma volume change, the increases were 1.7% for potassium (P=0.17), 30% for AST (P<0.01), 49% for LDH (P<0.01) and 2.39-fold for CK (P<0.01). A statistically significant association was found between haemoconcentration-adjusted variations of CK and those of AST (r=0.803; P<0.01) and LDH (r=0.551; P=0.02).

Discussion.

This is the first study demonstrating that long-distance running does not induce clinically significant changes in haemoglobin, haematocrit, RBC count or potassium concentration. The significant post-exercise decrease of haptoglobin reflects a certain degree of haemolysis, but the concentration of cell-free haemoglobin remaining below 0.5 g/L and the non-significant variation in RBC count both indicate that the foot-strike haemolysis is very modest or even clinically negligible.

Keywords: sport, physical exercise, marathon, haemolysis

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