Post on 14-Dec-2015
HAEMATOLOGICAL HAEMATOLOGICAL PARAMETERS IN PARAMETERS IN
SWIMMERSSWIMMERS
Daniel Gerrard BMedLabSciDaniel Gerrard BMedLabSci
David Gerrard MBChBDavid Gerrard MBChB
Dunedin School of Medicine, U of Dunedin School of Medicine, U of OtagoOtago
New ZealandNew Zealand
APPLIED SCIENCE APPLIED SCIENCE CLINICAL INTERFACECLINICAL INTERFACE
““Coaches and Coaches and scientists seeking scientists seeking measures of enhanced measures of enhanced performance balanced performance balanced by clinicians searching by clinicians searching for indicators of for indicators of failing adaptation and failing adaptation and consequent ill-consequent ill-health...”health...”
INTRODUCTORY COMMENTSINTRODUCTORY COMMENTS
Endurance Endurance trainingtraining
Red Blood Red Blood Cell (RBC) Cell (RBC) genesis, genesis, turnoverturnover
AnaemiaAnaemia Haptoglobin Haptoglobin
functionfunction
POSTULATEPOSTULATE
““That endurance-trained athletes show That endurance-trained athletes show haematological evidence of enhanced haematological evidence of enhanced oxygen transport.”oxygen transport.”
POSTULATEPOSTULATE
““That endurance training is That endurance training is characterised by a younger RBC characterised by a younger RBC
population”population”
STUDY AIMSSTUDY AIMS
To establish haematological To establish haematological parameters for two, age-dependent parameters for two, age-dependent cohorts of male swimmers & cohorts of male swimmers & compare these with established compare these with established laboratory normal values.laboratory normal values.
SUBJECTSSUBJECTS Endurance-trained Endurance-trained
malesmales Masters group “M” Masters group “M”
(n=11, mean age (n=11, mean age 58yrs)58yrs)
Youth group “Y” Youth group “Y” (n=20, mean age (n=20, mean age 22.1yrs)22.1yrs)
Pooled group Pooled group “M+Y” (n=31, “M+Y” (n=31, mean age 35yrs)mean age 35yrs)
METHODS METHODS Venous blood Venous blood
samples drawnsamples drawn Participants Participants
recruited from recruited from local swim squads.local swim squads.
Endurance training Endurance training criteria appliedcriteria applied
University of University of Otago ethical Otago ethical approval approval
HAEMATOLOGICAL HAEMATOLOGICAL MEASURES MEASURES
Venous samplesVenous samples RBC indices RBC indices Hb concentrationHb concentration HaematocritHaematocrit TWCCTWCC Reticulocyte Reticulocyte
countcount Serum Serum
HaptoglobinHaptoglobin
RESULTSRESULTS Significant inter-age Significant inter-age
differences differences Compared to “normal” Compared to “normal”
values there was:values there was: Decrease in RBC Decrease in RBC
parameters, parameters, Hb,Hct,haptoglobin Hb,Hct,haptoglobin levelslevels
Increase in MCV Increase in MCV (“runners’ (“runners’ macrocytosis”)macrocytosis”)
Reduced reticulocytesReduced reticulocytes
ENDURANCE TRAININGENDURANCE TRAINING (1)(1)
Physiological Physiological adaptations…adaptations…
Influence on Influence on cardio-respiratory cardio-respiratory efficiency… efficiency…
Improved Improved efficiency of efficiency of oxygen delivery oxygen delivery
ENDURANCE TRAINING ENDURANCE TRAINING (2)(2)
Mechanical trauma Mechanical trauma to RBCsto RBCs
Altered cell Altered cell membrane fragilitymembrane fragility
HaemolysisHaemolysis Reduced Reduced
Haptoglobin levelsHaptoglobin levels Younger RBC Younger RBC
populationpopulation
RED BLOOD CELL ROLERED BLOOD CELL ROLE OO22 transport transport Haemoglobin Haemoglobin
(Hb)(Hb) 4 globin subunits 4 globin subunits
(alpha + beta)(alpha + beta) Porphyrin Porphyrin
molecule = Haemmolecule = Haem Binds ironBinds iron 4 haeme 4 haeme
molecules per Hb molecules per Hb moleculemolecule
RBC PRODUCTIONRBC PRODUCTION
Regulated by Regulated by Erythropoietin (EPO)Erythropoietin (EPO)
Reticulocytes from bone Reticulocytes from bone marrowmarrow
RBC lifespan 117.3 daysRBC lifespan 117.3 days 1% replaced daily1% replaced daily Haemolysis = Haemolysis =
erythropoiesiserythropoiesis Constant RBC massConstant RBC mass
INFLUENCES on RBCsINFLUENCES on RBCs Metabolic, Metabolic,
mechanical, oxidative mechanical, oxidative stressesstresses
Reduced lifespanReduced lifespan Increased immature Increased immature
population of RBCspopulation of RBCs Anaemia (hypoxia) Anaemia (hypoxia)
Destruction > Destruction > synthesissynthesis
? Optimal ? Optimal haematological haematological parameters for parameters for athletesathletes
ANAEMIAANAEMIA Decrease in RBC Decrease in RBC
massmass Link with diminished Link with diminished
athletic performanceathletic performance Dilutional anaemiaDilutional anaemia Intravascular Intravascular
haemolysis haemolysis (mechanical)(mechanical)
Dietary iron Dietary iron (nutritional)(nutritional)
Haeme & non-haeme Haeme & non-haeme sourcessources
HAPTOGLOBINHAPTOGLOBIN Acute phase plasma Acute phase plasma
proteinprotein Binds Hb from Binds Hb from
haemolysed RBCshaemolysed RBCs Hapt-Hb complexesHapt-Hb complexes Hepatic removalHepatic removal Resultant decreased Resultant decreased
serum Hapt levelsserum Hapt levels Inversely related to Inversely related to
intravascular intravascular haemolysishaemolysis
CONCLUSIONS (1)CONCLUSIONS (1)
That the dilutional anaemia of That the dilutional anaemia of exercise is the result of more than exercise is the result of more than a simple expanded plasma volume.a simple expanded plasma volume.
CONCLUSIONS (2)CONCLUSIONS (2)
That rising haptoglobin levels That rising haptoglobin levels may provide a useful index of may provide a useful index of endurance training.endurance training.
CONCLUSIONS (3)CONCLUSIONS (3)
An increased RBC turnover may explain An increased RBC turnover may explain the association between a younger RBC the association between a younger RBC population & increased oxygen delivery.population & increased oxygen delivery.
CONCLUSIONS (4)CONCLUSIONS (4)
Further research is indicated to determine Further research is indicated to determine the effects of endurance training & age on the effects of endurance training & age on haematological parameters.haematological parameters.
THANK YOUTHANK YOU
FOR YOUR ATTENTIONFOR YOUR ATTENTION