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General Medical Questions
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Question : What is "athlete's anemia”?
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The Trusted Source
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Howard LeWine, M.D.

Howard LeWine, M.D., is chief editor of Internet Publishing, Harvard Health Publications. He is a clinical instructor of medicine at Harvard Medical School and Brigham and Women's Hospital. Dr. LeWine has been a primary care internist and teacher of internal medicine since 1978.

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October 18, 2013
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Athlete's anemia is not a medical term. And most often it is not a true anemia.

Here’s why: Anemia means a person has a blood hemoglobin level below the normal range. Hemoglobin is the iron-protein complex in red blood cells that carries oxygen to the tissues.

Blood is mainly a mix of red blood cells and water-containing chemicals and proteins (plasma). About 60% of blood volume is plasma. The rest of the blood volume is made up of red blood cells that contain hemoglobin.

Hemoglobin levels in the blood are measured within a specified volume of blood. So if the percent of blood that is water increases, the hemoglobin value will be reported as low. Even if the absolute amount of hemoglobin has not changed. 

A person with a true anemia has an absolute hemoglobin count that is below normal. But athletes are different.

Athletes — especially those that compete in very vigorous, prolonged exercise—  increase the total amount of water volume inside their blood vessels. This dilutes the amount of hemoglobin per milliliter of blood. But it does not change the ability of blood to deliver oxygen to exercising tissues. In fact, the extra volume helps athletic performance.

But it’s not that simple because athlete's anemia sometimes refers to anemia caused by additional factors. For example, women athletes are just as likely to become iron deficient from menstrual periods as other women. Also, some people make red blood cells that are more fragile and tend to break down during vigorous exercise.

If you have been told you have athlete's anemia, ask your doctor if you need to take iron. And discuss whether some other factor might be contributing to your anemia.

 

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