The Anemias of Athletes

In brief: Diagnosing anemia in athletes is complicated, because athletes normally have lower hemoglobin and serum ferritin concentrations than nonathletes. This dilutional pseudoanemia-a beneficial adaptation that enhances athletic performance-needs no treatment. Athletes can also develop true anemia from iron deficiency and/or footstrike hemolysis. True anemia can be treated with iron supplements and diet modification to increase absorbable iron; footstrike hemolysis can be minimized by paying attention to body weight, gait, shoes, and terrain. The widespread notion that depletion of iron stores without anemia limits performance is probably wrong, but even very mild iron deficiency anemia impairs maximal performance. The physician who recognizes and manages the diverse anemias of athletes performs a vital service.