Key Points

• Sports anemia is a dilutional anemia caused by the expansion of plasma volume in the trained athlete.

• Exertional hemolysis occurs from increased destruction of red blood cells, and diagnosis is confirmed by low hemoglobin or hematocrit and low haptoglobin level.

• Low iron stores, even in the absence of anemia, can adversely affect performance in endurance athletes.

• Athletes with sickle cell trait, especially if poorly hydrated, exercising in hot conditions, at altitude, or unconditioned, have a higher risk of exertional rhabdomyolysis and sudden death; screening at-risk populations should be considered.

There are several hematologic issues specific to athletes. This section reviews dilutional pseudoanemia or sports anemia, exertional hemolysis, iron deficiency anemia and low iron stores without anemia, and special considerations regarding athletes who are sickle cell trait-positive.

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