Anemia Profile in Elite Israeli Olympic-Level Athletes-Is Screening Necessary?

Background: Screening blood tests are often collected from elite athletes in an effort to optimize performance. The purpose of the current study was to evaluate the yield of screening for anemia and anemia-related factors in elite athletes entering the Israeli Olympic team. Methods: We investigated hemoglobin levels, red blood cell count and indices and serum levels of iron, transferrin, ferritin, B12 and folic acid in 407 members of the Israeli Olympic team (179 females, 228 males) upon joining the team. Results: Forty-four (10.8%) athletes had abnormally lower Hb level (8.9% females and 12.3% males). Forty-two athletes (10.3%) had low RBC concentration (9.5% females and 11% males). Twenty-one athletes (5.2%) had low iron levels (7.9% in males and 1.7% in females) and only 14 athletes (7 males) had low ferritin levels (3.4%). Fourteen female athletes (7.8%) had ferritin levels of less than 20 ng/mL, and 43 (24%) had levels of less than 30 ng/mL. There were no cases of both anemia and low ferritin levels together. Twenty-five athletes (6.1%) had low levels of folic acid with higher prevalence (7%) in males. Only five athletes (1.2%) had low levels of vitamin B12, while 29 (7.1%) had levels higher than normal. None of them had abnormal Hb. In a multiple regression analysis, combat sports had significantly lower Hb levels. Conclusions: The yield of anemia screening and especially anemia-related biochemical abnormalities in adult elite athletes may be relatively low. Clearly, anemia should not be missed in the elite athlete, yet, if there are no signs or symptoms, Hb levels are close to normal and dilution is diagnosed, further frequent biochemical evaluation may be unnecessary.