An elite rower experienced a dramatic decrease of physiological performance in an incremental rowing exercise test and VO2max was decreased. Subsequently, iron deficiency anaemia was detected. As the rower was regularly evaluated physiologically, time course of iron status, erythropoesis and physical performance can be reported. Material and Methods: Measurements included 4 pre-anaemia values that were averaged (PRE). 2nd measurement was 6 months later during peak of anaemia (ANM). 3rd measurement (POST) took place 10 months later, 8 months after normalization of [Hb]. Blood Volume (BV), Red Cell Volume (RCV), total Haemoglobin mass (tHb) were determined using the optimised CO-rebreathing method, VO2max was measured breath-by-breath. Ferritin and soluble transferrin receptor (sTr) were measured in serum. Results: The anaemia caused a dramatic decrease of tHb from 1267 g (PRE) to 917 g (ANM) (-27.6 %), RCV (-20.9 %), [Hb] (-30.8%). VO2max decreased from 5.8 to 4,8 l/min (-17.5 %). This was accompanied by an increase of PV from 4359 ml (PRE) to 5254 ml (20.5 %) resulting in a normovolemic BV-situation. At POST, haematological values increased compared to PRE: tHb 1377 g (8 %), BV (6.2 %), EV (2 %) and PV 4820 ml (9.6%). VO2max was 6.0 l/min. Ferritin values were (PRE - ANM - POST): 38 - 24 - 41 mg/l. sTr were 1.7 - 3.5 - 1.6 ìg/l. Discussion: The diagnosis revealed a hp-negative gastritis, possibly induced by intake of non-steroidal antiphlogistics due to back pain. Subsequently, gastritis was treated with a protone pump inhibitor and iron was substituted intravenously after ANM. The PRE values showed a critical iron status. When gastritis induced blood loss and iron resorption disturbance occurred, erythropoiesis failed. Despite the decrease in VO2max and performance, ferritin levels barely decreased below clinical relevant values. Only sTR and direct tHb-measurement definitely indicated iron deficiency anaemia. The increase of PV at ANM did not compensate the loss of oxygen transport capacity. After successful treatment, tHb and BV were 8%, and VO2max was 3 % higher compared to PRE. The VO2max-levels at PRE and POST support the finding, that a change of 1g tHb in healthy conditions is associated with a change in VO2max of 4.4 ml. The borderline sTr in POST may indicate again increased iron demand. Conclusion: Ferritin-levels are of limited value for diagnosing iron deficiency in highly trained athletes, since ferritin behaves also as an acute phase protein and may be elevated by training related acute phase reactions. [Hb] may be falsely negative influenced by hemoconcentration. The anaemia was definitely detected by sTr level and tHb-measurements. After successful treatment of anaemia, tHb increased to the highest level observed in this athlete.
© Copyright 2009 14th annual Congress of the European College of Sport Science, Oslo/Norway, June 24-27, 2009, Book of Abstracts. Veröffentlicht von The Norwegian School of Sport Sciences. Alle Rechte vorbehalten.