Effect of marathon running on hematologic and biochemical laboratory parameters, including cardiac markers

  • Kratz A
  • Lewandrowski K
  • Siegel A
 et al. 
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A b s t r a c t Participants in marathon races may require medical attention and the performance of laboratory assays. We report the changes in basic biochemical parameters, cardiac markers, CBC counts, and WBC differentials observed in participants in a marathon before, within 4 hours, and 24 hours after a race. The concentrations of glucose, total protein, albumin, uric acid, calcium, phosphorus, serum urea nitrogen, creatinine, bilirubin, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, total creatine kinase, creatine kinase-MB, myoglobin, and the anion gap were increased after the race, consistent with the effects of exertional rhabdomyolysis and hemolysis. The increase in WBC counts was due mainly to neutrophilia and monocytosis, with a relative decrease in circulating lymphocytes, consistent with an inflammatory reaction to tissue injury. A significant percentage of laboratory results were outside the standard reference ranges, indicating that modified reference ranges derived from marathon runners might be more appropriate for this population. We provide a table of modified reference ranges (or expected ranges) for basic biochemical, cardiac, and hematologic laboratory parameters for marathon runners. The word marathon has its origin in the Greek legend of the professional runner Phidippides, who ran from Marathon to Athens to report the outcome of a battle. On arrival, Phidippides is claimed to have staggered and gasped " Rejoice! We conquer, " collapsed, and died. A 42.2-km (26.2-mile) marathon race was initiated in the first modern Olympic games and in Boston in 1896, with approximately 25 and 17 runners, respectively. Physicians with emergency medications followed the runners in carriages. Modern-day marathons draw thousands of contestants (50,000 entrants took part in the 100th Boston Marathon in 1996). Contem-porary recreational marathon runners are similarly chal-lenged by the course as Phidippides, a professional runner, was 2,500 years ago. Several hundred runners require urgent medical attention during or after the race for exercise-associ-ated collapse; several deaths have occurred in recent years. 1 At the last Boston Marathon, a runner died of hyponatremic encephalopathy; many runners were evaluated and had testing performed at the finish-line medical tent. Standard laboratory tests are performed as a part of the triage and evaluation of collapsed marathon runners and other athletes; for this reason, knowledge of expected or " normal " findings in runners is a condition for interpreting the results of labo-ratory tests. Changes in laboratory parameters in marathon runners were first reported in an article edited by Blake and Larrabee 2 in 1903. Their finding of leukocytosis after a race has since been confirmed by other groups. 3-5 Reports in the literature on other laboratory parameters in marathon runners are inconsistent. For example, while one group has reported a reduction in hematocrit after a marathon, 6 other investigators found no changes in this measurement, 3 while still others

Author-supplied keywords

  • Clinical chemistry
  • Hematology
  • Laboratory
  • Marathon
  • Reference values
  • Sports medicine

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