Diurnal and Exercise-Related Variability of Haemoglobin and Reticulocytes in Athletes

Abstract

Haemoglobin (Hb) and Reticulocytes (Ret) are measured as indirect markers of doping in athletes. We studied the diurnal variation, the impact of exercise, fluid intake and ambient temperature in athletes on these parameters. Hourly venous blood samples were obtained from 36 male athletes of different disciplines (endurance (END) and non-endurance (NON-END)) over 12 h during a typical training day. Seven inactive subjects served as controls (CON). Hb and Ret were determined. A mixed model procedure was used to analyse the data. At baseline, Hb was similar for all groups, END showed lower Ret than NON-END and CON. Exercise showed a significant impact on Hb (+0.46 g/dl, p<0.001), the effect disappeared ∼2 h after exercise. Hb decreased over the day by ∼0.55 g/dl (p<0.01). There was no relevant effect on Ret. Fluid intake and ambient temperature had no significant effect. Hb shows significant diurnal- and exercise related variations. In an anti-doping context, most of these variations are in favour of the athlete. Blood samples taken after exercise might therefore provide reliable results and thus be used for the longitudinal monitoring of athletes if a timeframe for the re-equilibration of vascular volumes is respected.

blood doping - athlete's biological passport - sports - circadian variation - plasma volume

References

• 1 Banfi G. Reticulocytes in sports medicine.  Sports Med. 2008;  38 187-211
• 2 Banfi G, Del Fabbro M. Behaviour of reticulocyte counts and immature reticulocyte fraction during a competitive season in elite athletes of four different sports.  Int J Lab Hematol. 2007;  29 127-131
• 3 Banfi G, Dolci A. Preanalytical phase of sport biochemistry and haematology.  J Sports Med Phys Fit. 2003;  43 223-230
• 4 Convertino VA. Blood volume: its adaptation to endurance training.  Med Sci Sports Exerc. 1991;  23 1338-1348
• 5 Convertino VA, Brock PJ, Keil LC, Bernauer EM, Greenleaf JE. Exercise training-induced hypervolemia: role of plasma albumin, renin, and vasopressin.  J Appl Physiol. 1980;  48 665-669
• 6 Costongs GM, Janson PC, Bas BM, Hermans J, Brombacher PJ, van Wersch JW. Short-term and long-term intra-individual variations and critical differences of haematological laboratory parameters.  J Clin Chem Clin Biochem. 1985;  23 69-76
• 7 Dot D, Miro J, Fuentes-Arderiu X. Within-subject biological variation of hematological quantities and analytical goals.  Arch Pathol Lab Med. 1992;  116 825-826
• 8 Felding P, Tryding N, Hyltoft PP, Horder M. Effects of posture on concentrations of blood constituents in healthy adults: practical application of blood specimen collection procedures recommended by the Scandinavian Committee on Reference Values.  Scand J Clin Lab Invest. 1980;  40 615-621
• 9 Fellmann N. Hormonal and plasma volume alterations following endurance exercise.  A brief review. Sports Med. 1992;  13 37-49
• 10 Harrison MH. Effects on thermal stress and exercise on blood volume in humans.  Physiol Rev. 1985;  65 149-209
• 11 Harrison MH. Heat and exercise. Effects on blood volume.  Sports Med. 1986;  3 214-223
• 12 Harriss DJ, Atkinson G. International Journal of Sports Medicine – Ethical Standards in Sport and Exercise Science Research.  Int J Sports Med. 2009;  30 701-702
• 13 Jones AR, Twedt D, Swaim W, Gottfried E. Diurnal change of blood count analytes in normal subjects.  Am J Clin Pathol. 1996;  106 723-727
• 14 Kargotich S, Goodman C, Keast D, Morton AR. The influence of exercise-induced plasma volume changes on the interpretation of biochemical parameters used for monitoring exercise, training and sport.  Sports Med. 1998;  26 101-117
• 15 Kay B, O'Brien BJ, Gill ND. Exercise-induced hypervolemia may not be consequential to dehydration during exercise.  J Sports Sci Med. 2004;  3 50-55
• 16 Kristal-Boneh E, Froom P, Harari G, Shapiro Y, Green MS. Seasonal changes in red blood cell parameters.  Br J Haematol. 1993;  85 603-607
• 17 Kuipers H, Brouwer T, Dubravcic-Simunjak S, Moran J, Mitchel D, Shobe J, Sakai H, Stray-Gundersen J, Vanhoutvin S. Hemoglobin and hematocrit values after saline infusion and tourniquet.  Int J Sports Med. 2005;  26 405-408
• 18 Leppanen E, Dugue B. When to collect blood specimens: midmorning vs. fasting samples.  Clin Chem. 1998;  44 2537-2542
• 19 Leppanen EA, Grasbeck R. Experimental basis of standardized specimen collection: effect of posture on blood picture.  Eur J Haematol. 1988;  40 222-226
• 20 Malcovati L, Pascutto C, Cazzola M. Hematologic passport for athletes competing in endurance sports: a feasibility study.  Haematologica. 2005;  88 570-581
• 21 Mallorqui J, Segura J, de Bolos C, Gutierrez-Gallego R, Pascual JA. Recombinant erythropoietin found in seized blood bags from sportsmen.  Haematologica. 2008;  93 313-314
• 22 Morkeberg J, Belhage B, Ashenden M, Borno A, Sharpe K, Dziegiel MH, Damsgaard R. Screening for autologous blood transfusions.  Int J Sports Med. 2009;  30 285-292
• 23 Parisotto R, Gore CJ, Emslie KR, Ashenden MJ, Brugnara C, Howe C, Martin DT, Trout GJ, Hahn AG. A novel method utilising markers of altered erythropoiesis for the detection of recombinant human erythropoietin abuse in athletes.  Haematologica. 2000;  85 564-572
• 24 Pocock SJ, Ashby D, Shaper AG, Walker M, Broughton PM. Diurnal variations in serum biochemical and haematological measurements.  J Clin Pathol. 1989;  42 172-179
• 25 Robinson N, Sottas PE, Mangin P, Saugy M. Bayesian detection of abnormal hematological values to introduce a no-start rule for heterogeneous populations of athletes.  Haematologica. 2007;  92 1143-1144
• 26 Rocker L, Feddersen HM, Hoffmeister H, Junge B. Seasonal variation of blood components important for diagnosis.  Klin Wochenschrift. 1980;  58 769-778
• 27 Sawka MN, Convertino VA, Eichner ER, Schnieder SM, Young AJ. Blood volume: importance and adaptations to exercise training, environmental stresses, and trauma/sickness.  Med Sci Sports Exerc. 2000;  32 332-348
• 28 Schumacher YO, Schmid A, Grathwohl D, Bultermann D, Berg A. Hematological indices and iron status in athletes of various sports and performances.  Med Sci Sports Exerc. 2002;  34 869-875
• 29 Shapiro Y, Hubbard RW, Kimbrough CM, Pandolf KB. Physiological and hematologic responses to summer and winter dry-heat acclimation.  J Appl Physiol;. 1981;  50 792-798
• 30 Sharpe K, Ashenden MJ, Schumacher YO. A third generation approach to detect erythropoietin abuse in athletes.  Haematologica. 2006;  91 356-363
• 31 Sottas PE, Robinson N, Taroni F, Kamber M, Mengin P. Statistical classification of abnormal blood profiles in athletes.  Int J Biostat. 2006;  2 1011
• 32 Statland BE, Winkel P, Harris SC, Burdsall MJ, Saunders AM. Evaluation of biologic sources of variation of leukocyte counts and other hematologic quantities using very precise automated analyzers.  Am J Clin Pathol. 1978;  69 48-54
• 33 Walsh D (Ed) From Lance to Landis.. Inside the American Doping Controversy in the Tour de France. New York: Random House Publishing Group; 2007

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