Exertional or "foot strike" hemolysis is another problem often encountered in athletes. Exertional hemolysis was initially described in endurance runners but is also seen in swimmers, rowers, and weightlifters. Hypothesized mechanisms for red blood cell (RBC) destruction include trauma secondary to impact, turbulence in the blood vessel, acidosis, and elevated temperature encountered in working muscles. Diagnosis is made with an elevated mean corpuscular volume (MCV) and reticulocyte count and a low haptoglobin level. Treatment consists of mitigating impact by having the athlete run in biomechani-cally correct shoes and on cushioned surfaces and by recommending slow, incremental increases in training (Telford et al., 2003).
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