Prolonged running + intravascular haemolysis

Griff · Aug 23, 2011

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Intravascular haemolysis during prolonged running on asphalt and natural grass in long and middle distance runners.
J Sports Sci. 2011 Jul 13. [Epub ahead of print]

Surface features such as uneven playing surfaces, low impact absorption capacity and inappropriate friction/traction characteristics are connected with injury prevalence whereas force impact during foot strike has been suggested to be an important mechanism of intravascular haemolysis during running. We aimed to evaluate intravascular haemolysis during running and compare the effect of running on two different types of surfaces on haemolysis. We selected two surfaces (asphalt and grass) on which these athletes usually run. Participants were randomly assigned to group A (asphalt) or group B (grass) with 10 athletes in each group. Each athlete completed one hour of running at the calculated target heart rate (60-70%). Venous blood samples were collected before and immediately after running. We measured unconjugated bilirubin (UBR) (mg · dl(-1)), lactate dehydrogenase (LDH) (μ · ml(-1)), haemoglobin (g · l(-1)) and serum ferritin (ng · ml(-1)) as indicators of haemolysis. Athletes who ran on grass demonstrated an increase in the haematological parameters (UBR: P < 0.01, LDH: P < 0.05) when compared to athletes who ran on asphalt (UBR: P < 0.05, LDH: P = 0.241). Our findings indicate that intravascular haemolysis occurs significantly after prolonged running. Furthermore, we conclude that uneven grass surface results in greater haemolysis compared to asphalt road.
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Admin2 · Aug 23, 2011

Related thread:
Inoles and hemolysis in long distance running

Simon Spooner · Aug 23, 2011

Why??

NewsBot · Jun 12, 2012

Foot-strike haemolysis after a 60-km ultramarathon.
Lippi G, Schena F, Salvagno GL, Aloe R, Banfi G, Guidi GC.
Blood Transfus. 2012 May 17:1-7.

BACKGROUND:
The various contributors to sport-related anaemia include increased plasma volume, exercise-induced oxidative stress, increased body temperature, acidosis, gastrointestinal bleeding, acute and chronic inflammation as well as compression and damage of red blood cells (RBC) in the capillaries within the contracting muscles. The effective contribution of foot-strike haemolysis is unclear.

MATERIALS AND METHODS:
We studied 18 Caucasian male athletes (mean age, 42 years; range, 34-52 years) before and immediately after a 60-km ultramarathon. Laboratory investigations included the haematological profile along with haptoglobin, potassium, aspartate aminotransferase (AST), creatine kinase (CK), lactate dehydrogenase (LDH) and albumin concentrations and a haemolysis index (HI).

RESULTS:
No significant variations were found in post-exercise values of haemoglobin, RBC count and haematocrit. Mean corpuscular volume and haptoglobin were significantly decreased, whereas RBC distribution width was increased. The concentration of haptoglobin was reduced by approximately 50%, whereas enzyme concentrations were all remarkably increased. The HI remained below 0.5 g/L. After adjusting for plasma volume change, the increases were 1.7% for potassium (P=0.17), 30% for AST (P<0.01), 49% for LDH (P<0.01) and 2.39-fold for CK (P<0.01). A statistically significant association was found between haemoconcentration-adjusted variations of CK and those of AST (r=0.803; P<0.01) and LDH (r=0.551; P=0.02).

DISCUSSION:
This is the first study demonstrating that long-distance running does not induce clinically significant changes in haemoglobin, haematocrit, RBC count or potassium concentration. The significant post-exercise decrease of haptoglobin reflects a certain degree of haemolysis, but the concentration of cell-free haemoglobin remaining below 0.5 g/L and the non-significant variation in RBC count both indicate that the foot-strike haemolysis is very modest or even clinically negligible.
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NewsBot · Dec 1, 2015

A comparison of haemolytic responses in fore-foot and rear-foot distance runners.
Caulfield S et al
J Sports Sci. 2015 Nov 30:1-6

This study examined the haemolytic effects of an interval-based running task in fore-foot and rear-foot striking runners. Nineteen male distance runners (10 fore-foot, 9 rear-foot) completed 8 ? 3 min repeats at 90% vVO2peak on a motorised treadmill. Pre- and post-exercise venous blood samples were analysed for serum haptoglobin to quantify the haemolytic response to running. Vertical ground reaction forces were also captured via a force plate beneath the treadmill belt. Haptoglobin levels were significantly decreased following exercise (P = 0.001) in both groups (but not between groups), suggesting that the running task created a haemolytic stress. The ground reaction force data showed strong effect sizes for a greater peak force (d = 1.20) and impulse (d = 1.37) in fore-foot runners, and a greater rate of force development (d = 2.74) in rear-foot runners. The lack of difference in haptoglobin response between groups may be explained by the trend for fore-foot runners to experience greater peak force and impulse during the stance phase of their running gait, potentially negating any impact of the greater rate of force development occurring from the rear-foot runners' heel strike. Neither type of runner (fore-foot or rear-foot) appears more susceptible to technique-related foot-strike haemolysis.
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NewsBot · Dec 15, 2017

Foot-strike haemolysis in an ultramarathon runner.
Fazal AA et al
BMJ Case Rep. 2017 Dec 13;2017. pii: bcr-2017-220661. doi: 10.1136/bcr-2017-220661.

This case report describes mild anaemia and intravascular haemolysis in an otherwise healthy 41-year-old ultramarathon runner. In long-distance endurance athletes, trace gastrointestinal bleeding and plasma volume expansion are recognised sources of mild anaemia, often found incidentally. However, repetitive forceful foot striking can lead to blood cell lysis in the feet, resulting in a mild macrocytic anaemia and intravascular haemolysis, as was demonstrated in the patient described herein. Mild anaemia in runners, often called 'runner's pseudoanaemia', is typically clinically insignificant and does not require intervention. However, an unexplained anaemia can cause undue worry for otherwise healthy patients and lead to costly further testing, providing an argument against routine testing with complete blood counts in healthy, asymptomatic patients.
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