Iron Deficiency Anemia Among Collegiate Athletes

Abstract

PURPOSE: To characterize the iron status of student-athletes during participation in intercollegiate athletics at an NCAA Division I institution. METHODS: In this retrospective medical record review, hemoglobin (Hgb), hematocrit (Hct) and ferritin (Fer) lab values were obtained for student-athletes on active team rosters between 2002 and 2014. The labs were collected either as part of the institution’s pre-participation exam (PPE) (all female athletes), routine screening (cross country teams) or as needed for medical work-up (symptomatic student-athletes). Anemia was defined as low Hgb, < 11.6 g/dL for females and < 13.6 g/dL for males. Iron deficiency was defined as Fer < 20 ng/mL for all student-athletes. In addition to descriptive statistical analysis of iron status among genders and sports, a mixed effects linear regression was utilized to evaluate the trends of iron status through the course of student-athletes’ careers. RESULTS: A total of 5,705 lab draws were obtained for 2,749 unique individuals from 24 different teams (56% female). Of the 12,590 combined Hgb, Hct and Fer lab values, 8.0% were found to be outside the normal ranges established by the clinical laboratory. The incidence of low Hgb among female athletes at PPE was 5.6% (95% CI 4.4%-6.9%). No female sports had a significantly higher incidence of anemia at PPE compared to the group mean. For males, 9.3% of all Hgb measurements were low (95% CI 8.1%-10.5%). Among the 395 instances of Fer < 20 ng/mL, only 7.1% of student-athletes were found to be anemic. Fer values tended to improve over time for all student-athletes, with an average increase of 8% per year (p < 0.001). CONCLUSION: Iron deficiency, with or without anemia, has been and continues to be a concern in collegiate athletics, which is supported by the incidence of anemia detected by routine screening of incoming female student-athletes at our institution. The higher proportion of male student-athletes found to be anemic in our retrospective review was not surprising since they were typically evaluated only when symptomatic. Given the impact of iron status on athletic performance, informed iron screening and supplementation practices are warranted.