Physiology – Is hemoglobin concentration important to athletes?

I recently came across a paper published in the Middlebury Journal of Microbiology examining the relationship between hemoglobin concentration ([Hb]) and a variety of parameters including gender, living altitude, and cross country ski race performance^[1]. Unfortunately the paper appears to be primarily oriented toward validation of a new hemoglobin device, however it did get me to think about the importance of [Hb] in athletes and especially those training and competing at high-altitude.

Hemoglobin Molecule. Photo By Richard Wheeler (Zephyris) 2007. This file is licensed under the Creative Commons Attribution ShareAlike 3.0 License.

There are certain clear uses for [Hb] measurements, especially in athletes. Because hemoglobin is essential for oxygen transport to tissues in the blood, low concentrations of [Hb] can result in performance decrements. Anemia is a common blood disorder where the oxygen transport capacity of blood is reduced, either by low numbers of red blood cells or by low levels of hemoglobin (among a few others). The world health organization (WHO) has published normative values for [Hb] to be used for diagnosis of anemia^[2].

WHO low limits for [Hb] in diagnosis of Anemia.


Training at high altitude (above 2000 meters) has been repeatedly shown to increase total hemoglobin mass (tHb) though potentially only in athletes with an already low tHb^[3].  A study on the effect of an altitude training program conducted by the German Biathlon Team found significant increases in tHb as soon as the 4th day. These increases were the result of increased erythropoietin (EPO) production; a hormone that is responsible for creating new red blood cells. Total hemoglobin remained elevated through the 20th day of the study. Interestingly, 16-days after the team returned to sea-level, tHb returned to normal levels^[4].

High-altitude training in Colorado.


After a little bit of reading, this article led me to a few main thoughts and questions.

• [Hb] appears to be a useful hematological monitoring parameter. It is easily evaluated with a pinprick of blood on a Hemocue Device. Most athletes should have relatively constant [Hb] values and values below this constant could indicate anemia for example, while increased values could be indicative of successful altitude acclimatization or the use of performance enhancing techniques (blood doping).
• Hematological effects of altitude training begin to show within a few days of arrival and only last several weeks upon return to sea-level. This could be useful in the lead up to skimo races in Colorado next season.
• If altitude training only increases tHb in those with low sea-level values, is there a similar increase in performance?
• Could pre-screening athletes for [Hb] or tHb prior to altitude exposure predict performance ability at altitude.

Most of these questions are probably already answered in the literature but just require a little more hunting.

Works Cited:

1. Dodge, D. Using an EasyTouch® Hemoglobin Meter to Measure Hemoglobin Concentration in Elite Cross-Country Skiers. Middlebury Journal of Microbiology (2011).
2. Benoist, B. de et al. Worldwide prevalence of anaemia 1993-2005: WHO global database on anaemia. (World Health Organization: 2008).
3. Robach, P. & Lundby, C. Is live high-train low altitude training relevant for elite athletes with already high total hemoglobin mass? Scandinavian Journal of Medicine & Science in Sports 22, 303–305 (2012).
4. Heinicke, K., Heinicke, I., Schmidt, W. & Wolfarth, B. A three-week traditional altitude training increases hemoglobin mass and red cell volume in elite biathlon athletes. Int J Sports Med 26, 350–355 (2005).