Several athletes, sportsmen, marathon runners, people on new fitness regimens, and even military personnel can encounter a condition called sports anemia. If you're wondering what is sports anemia, it's a reduction in iron content in an individual's blood as a result of strenuous exercise. This reduction of iron shows up in the blood work as low hemoglobin, a decreased RBC count, or a hematocrit tending toward the lower end of the normal range.

The reason most people are left flummoxed by the condition is that it appears in fit and healthy individuals that see regular exercise either as a part of their daily regimen, professions, or as dedicated hobbies. A variety of causes are attributed to sports anemia, however, there does not exist a conclusive consensus on the causes of sports anemia.

We look at a deeper understanding of the condition, its signs, how it's diagnosed, and how long it takes to recover from sports anemia. 

Understanding What is Sports Anemia

Anemia is caused by the depletion of iron reserves, of which over 60% is stored in the form of hemoglobin. Any hampering of iron reserves is bound to affect the transport of oxygen to different parts of the body, including the brain. Iron forms the basis of hemoglobin's capacity to bind to oxygen, and when the iron is lacking, the body's ability to transport iron is also affected. Strenuous and vigorous exercise as seen in the case of athletes has shown a reduction in hemoglobin counts, causing an anemic state.

This is thought to affect performance, and every athlete must undergo tests to ascertain the quantity of hemoglobin before they compete. This helps ensure their bodies are working at peak performance levels. Sports anemia is more prevalent in females than in males due to blood loss during menstruation. The extent of sports anemia is usually consistent with both short bursts of intense exercise and prolonged endurance workouts. 

What is the Cause of Sports Anemia?

Sports anemia is believed to be caused by several factors, most researchers and doctors cite the following causes: 

• Hemolysis: Hemolysis refers to the breakdown of red blood cells. Red blood cell breakdown or hemolysis can occur due to a variety of factors: 
• Repeated Trauma: Feet hitting the hard ground repeatedly can result in capillary tears and increased pressure that results in red blood cell breakdown. 
• Scavenging for Protein: To help the body's muscles deal better with the increased force during exercise, the body tends to break down red blood cells for hemoglobin and other components. The resulting proteins are used to add to the existing muscle mass. Several studies have shown gains in muscle mass following long endurance runs and a reduction in hemoglobin levels. 
• Adrenaline: Strenuous exercise stimulates the adrenal gland, leading to an increased synthesis of the hormone adrenaline. Adrenaline is directly responsible for stimulation of the spleen that in turn releases compounds that stimulate hemolysis, leading to red blood cell breakdown. 
• Hematuria: This is the condition where intact red blood cells are discharged in the urine. A variety of factors are believed to cause hematuria in athletes: 
• Direct Renal Impact & Trauma: In potentially rough sports like football, soccer, and wrestling, direct renal impact and trauma are quite commonplace. This can result in the damage of blood vessels in the kidneys leading to hematuria. 
• Prolonged Impact of the Bladder Wall: Certain studies suggest that prolonged periods of running, swimming, marching, and jogging can cause repeated impacts between the bladder wall and base, causing micro-traumas and tears leading to bleeding and finally hematuria. 
• Gastrointestinal bleeding: It is believed that repeated low-intensity traumas during strenuous exercise in the body cavity can cause small bleeds in the gastrointestinal space. These bleeds remove red blood cells from circulation and cause a dip in hemoglobin and iron counts. 
• Increase in Plasma Volume: Prolonged exercise leads to increased plasma volume that can dilute the blood. This causes even a normal concentration of iron and hemoglobin to show up as deficient on a test. 
• Inadequate Dietary Iron & Higher Bodily Demand: Sports anemia could also be a direct result of inadequate iron supply in the diet. Athletes require larger iron quantities in their food and a normal diet will not cut it. A diet rich in iron, other minerals like selenium, zinc, copper, magnesium, vitamins, and protein is necessary to maintain a steady level of hemoglobin. 

Symptoms of Sports Anemia

Sports anemia can present in different ways for different athletes, however commonly observed symptoms include: 

• Hampered performance and quick onset of fatigue. 
• Frequent bouts of weakness and easy burnout. 
• Irritability
• Low stamina 
• Poor appetite and malnutrition 
• Increased prevalence of frequent infections like cold. 
• Palpitations & high heart rate
• Increased vulnerability to injury 
• Confusion, incoherence, and short attention spans

How is Anemia Diagnosed

The answer to the question of how is anemia diagnosed in the case of sports anemia isn't as straightforward and can require an array of tests. Most tests are based on the rationale behind what causes sports anemia, and a final diagnosis can be achieved once the following tests have been performed: 

• A complete physical examination must be performed and a detailed medical and dietary history must be taken. 
• Vitamin Assay: Serum levels of vitamin B12 and folate must be ascertained. 
• Electrolyte & Mineral Analysis: Concentrations of Iron, Magnesium, Zinc, and Copper along with Sodium and Chloride must be tested for. 
• Complete Blood Count: Red blood cell count, hemoglobin concentration, and hematocrit must be assessed. 
• Complete urine analysis to check for hematuria. 
• Liver function tests for checking for the amount of circulating bilirubin. 
• Endoscopic examination in case the athlete complains of gastrointestinal issues. 

Treatment for Sports Anemia

Though sports anemia in most cases is a self-limiting condition and resolves by itself, treatment modalities are usually not required. Since sports anemia is mostly temporary, concerns like 'when do you need a blood transfusion for anemia' and 'can anemia cause high blood pressure' are not applicable. Instead, most of the treatment focuses on potential causes of sports anemia. Some of them entail: 

• Dietary modification and supplements for better iron intake. 
• Good natural sources of iron include lean and red meat, green leafy vegetables, beets, fish liver, nuts, fortified cereal, and legumes. 
• Ensure all vitamin intakes are balanced.
• Postural correction and usage of better shoes to avoid trauma to the feet. 
• Tapered and well-planned workout routines to manage gastrointestinal bleeding and hematuria. 

How Long Does It Take to Recover from Sports Anemia? 

The most common question posed by athletes is- 'how long to recover from anemia?', the answer again varies on a case-by-case basis. While small incidences of foot trauma and plasma dilution-related anemia are resolved in a few days, chronic cases of exercise-induced trauma, gastrointestinal bleeding, and hematuria can take longer to resolve. Much like the regular anemia caused by insufficient iron intake or other nutritional deficiencies, sports anemia in these cases can take between 1 to 3 months to be resolved entirely. Since sports anemia is still not completely understood, the condition entails several variables that must be dealt with based on the presenting symptoms of the athletes. 

Though sports anemia might still be an elusive condition, it can be managed effectively even in cases that seem severe. Whether it's a pre-existing deficiency, trauma, or endurance-induced plasma dilution, a solution can be found provided you always follow your physiotherapist's and doctor's instructions.