Background Regular physical activity and training induce physiological and metabolic adaptations that impact sports performance and overall health. Blood biomarkers serve as indicators for assessing training effects and detecting abnormalities in athletes. Aims Our aim was to study specific hematological profile in elite athletes of both sexes practicing different sporting disciplines. Methods Elite athletes who participated at Olympic Games (2012-2022) were submitted to a comprehensive blood analyses, including hematological parameters and biochemical markers. Sports disciplines were categorized into power (n = 440, 46.9%), skill (n = 184, 19.6%), and endurance (n = 313, 33.5%) according to latest ESC guidelines. Results We studied 937 athletes (male, n = 539; 57.5%), mean age 26.2 ± 5.1 years old. Skill athletes presented the highest cardiovascular risk profile characterized by highest fat mass percentage (p < 0.0001), prevalence of smokers (p < 0.0001), triglycerides (p = 0.009 in males and p = 0.025 in females), glycemia (p < 0.0001 in males and p = 0.012 in females), uricemia (p = 0.019 in males), and lowest Vitamin D (p = 0.002 in males). Power athletes specifically presented highest serum creatinine values (p < 0.0001). Endurance athletes presented the lowest anthropometric parameters (lowest body weight, body mass index and fat mass percentage, p < 0.0001), the highest high-density lipoprotein (HDL, p < 0.0001) and low-density lipoprotein (LDL)/HDL ratio (p < 0.0001) and hepatic enzymes (AST, p < 0.0001 and ALT p = 0.0006 in females); moreover, male endurance had highest mean corpuscular volume (MCV, p = 0.0005) and lowest ferritin (p = 0.0001). Conclusion Distinct hematological profiles were identified among Olympic athletes in different sports categories. Understanding hematological adaptations across different sports categories is crucial for optimizing training regimens and safeguarding athlete`s health.
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