The athlete's hematological response to hypoxia: A meta-analysis on the influence of altitude exposure on key biomarkers of erythropoiesis

Louisa M. Lobigs, Ken Sharpe, Laura A. Garvican-Lewis, Christopher J. Gore, Peter Peeling, Brian Dawson, Yorck O. Schumacher

    Research output: Contribution to journalArticle

    7 Citations (Scopus)

    Abstract

    Altitude training is associated with changes in blood markers, which can confound results of the Athlete?s Biological Passport (ABP). This meta-analysis aims to describe the fluctuations during- and post-altitude in key ABP variables; hemoglobin concentration ([Hb]), square-root transformed reticulocyte percentage (sqrt(retic%)) and the OFF-score. Individual de-identified raw data were provided from 17 studies. Separate linear mixed effects analyses were performed for delta values from baseline for [Hb], sqrt(retic%) and OFF-score, by altitude phase (during and post). Mixed models were fitted with the hierarchical structure: study and subject within study as random effects. Delta values as response variables and altitude dose (in kilometer hours; km.hr = altitude (m) / 1000 x hours), sex, age, protocol and baseline values as fixed effects. Allowances were made for potential autocorrelation. Within two days at natural altitude [Hb] rapidly increased. Subsequent delta [Hb] values increased with altitude dose, reaching a plateau of 0.94 g/dL [95%CI (0.69, 1.20)] at ~1000 km.hr. Delta sqrt(retic%) and OFF-score were the first to identify an erythrocyte response, with respective increases and decreases observed within 100 to 200 km.hr. Post-altitude, [Hb] remained elevated for two weeks. Delta sqrt(retic%) declined below baseline, the magnitude of change was dependent on altitude dose. Baseline values were a significant covariate (p<0.05). The response to altitude is complex resulting in a wide range of individual responses, influenced primarily by altitude dose and baseline values. Improved knowledge of the plausible hematological variations during- and post-altitude provides fundamental information for both the ABP expert and sports physician.

    Original languageEnglish
    Pages (from-to)74-83
    Number of pages10
    JournalAmerican Journal of Hematology
    Volume93
    Issue number1
    DOIs
    Publication statusPublished - 1 Jan 2018

    Fingerprint

    Erythropoiesis
    Athletes
    Meta-Analysis
    Biomarkers
    Hypoxia
    Reticulocytes
    Sports
    Hemoglobins
    Erythrocytes

    Cite this

    Lobigs, Louisa M. ; Sharpe, Ken ; Garvican-Lewis, Laura A. ; Gore, Christopher J. ; Peeling, Peter ; Dawson, Brian ; Schumacher, Yorck O. / The athlete's hematological response to hypoxia : A meta-analysis on the influence of altitude exposure on key biomarkers of erythropoiesis. In: American Journal of Hematology. 2018 ; Vol. 93, No. 1. pp. 74-83.
    @article{2e7909935fa840e88b02db811cd444aa,
    title = "The athlete's hematological response to hypoxia: A meta-analysis on the influence of altitude exposure on key biomarkers of erythropoiesis",
    abstract = "Altitude training is associated with changes in blood markers, which can confound results of the Athlete?s Biological Passport (ABP). This meta-analysis aims to describe the fluctuations during- and post-altitude in key ABP variables; hemoglobin concentration ([Hb]), square-root transformed reticulocyte percentage (sqrt(retic{\%})) and the OFF-score. Individual de-identified raw data were provided from 17 studies. Separate linear mixed effects analyses were performed for delta values from baseline for [Hb], sqrt(retic{\%}) and OFF-score, by altitude phase (during and post). Mixed models were fitted with the hierarchical structure: study and subject within study as random effects. Delta values as response variables and altitude dose (in kilometer hours; km.hr = altitude (m) / 1000 x hours), sex, age, protocol and baseline values as fixed effects. Allowances were made for potential autocorrelation. Within two days at natural altitude [Hb] rapidly increased. Subsequent delta [Hb] values increased with altitude dose, reaching a plateau of 0.94 g/dL [95{\%}CI (0.69, 1.20)] at ~1000 km.hr. Delta sqrt(retic{\%}) and OFF-score were the first to identify an erythrocyte response, with respective increases and decreases observed within 100 to 200 km.hr. Post-altitude, [Hb] remained elevated for two weeks. Delta sqrt(retic{\%}) declined below baseline, the magnitude of change was dependent on altitude dose. Baseline values were a significant covariate (p<0.05). The response to altitude is complex resulting in a wide range of individual responses, influenced primarily by altitude dose and baseline values. Improved knowledge of the plausible hematological variations during- and post-altitude provides fundamental information for both the ABP expert and sports physician.",
    author = "Lobigs, {Louisa M.} and Ken Sharpe and Garvican-Lewis, {Laura A.} and Gore, {Christopher J.} and Peter Peeling and Brian Dawson and Schumacher, {Yorck O.}",
    year = "2018",
    month = "1",
    day = "1",
    doi = "10.1002/ajh.24941",
    language = "English",
    volume = "93",
    pages = "74--83",
    journal = "American Journal of Hematology",
    issn = "0361-8609",
    publisher = "John Wiley & Sons",
    number = "1",

    }

    The athlete's hematological response to hypoxia : A meta-analysis on the influence of altitude exposure on key biomarkers of erythropoiesis. / Lobigs, Louisa M.; Sharpe, Ken; Garvican-Lewis, Laura A.; Gore, Christopher J.; Peeling, Peter; Dawson, Brian; Schumacher, Yorck O.

    In: American Journal of Hematology, Vol. 93, No. 1, 01.01.2018, p. 74-83.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - The athlete's hematological response to hypoxia

    T2 - A meta-analysis on the influence of altitude exposure on key biomarkers of erythropoiesis

    AU - Lobigs, Louisa M.

    AU - Sharpe, Ken

    AU - Garvican-Lewis, Laura A.

    AU - Gore, Christopher J.

    AU - Peeling, Peter

    AU - Dawson, Brian

    AU - Schumacher, Yorck O.

    PY - 2018/1/1

    Y1 - 2018/1/1

    N2 - Altitude training is associated with changes in blood markers, which can confound results of the Athlete?s Biological Passport (ABP). This meta-analysis aims to describe the fluctuations during- and post-altitude in key ABP variables; hemoglobin concentration ([Hb]), square-root transformed reticulocyte percentage (sqrt(retic%)) and the OFF-score. Individual de-identified raw data were provided from 17 studies. Separate linear mixed effects analyses were performed for delta values from baseline for [Hb], sqrt(retic%) and OFF-score, by altitude phase (during and post). Mixed models were fitted with the hierarchical structure: study and subject within study as random effects. Delta values as response variables and altitude dose (in kilometer hours; km.hr = altitude (m) / 1000 x hours), sex, age, protocol and baseline values as fixed effects. Allowances were made for potential autocorrelation. Within two days at natural altitude [Hb] rapidly increased. Subsequent delta [Hb] values increased with altitude dose, reaching a plateau of 0.94 g/dL [95%CI (0.69, 1.20)] at ~1000 km.hr. Delta sqrt(retic%) and OFF-score were the first to identify an erythrocyte response, with respective increases and decreases observed within 100 to 200 km.hr. Post-altitude, [Hb] remained elevated for two weeks. Delta sqrt(retic%) declined below baseline, the magnitude of change was dependent on altitude dose. Baseline values were a significant covariate (p<0.05). The response to altitude is complex resulting in a wide range of individual responses, influenced primarily by altitude dose and baseline values. Improved knowledge of the plausible hematological variations during- and post-altitude provides fundamental information for both the ABP expert and sports physician.

    AB - Altitude training is associated with changes in blood markers, which can confound results of the Athlete?s Biological Passport (ABP). This meta-analysis aims to describe the fluctuations during- and post-altitude in key ABP variables; hemoglobin concentration ([Hb]), square-root transformed reticulocyte percentage (sqrt(retic%)) and the OFF-score. Individual de-identified raw data were provided from 17 studies. Separate linear mixed effects analyses were performed for delta values from baseline for [Hb], sqrt(retic%) and OFF-score, by altitude phase (during and post). Mixed models were fitted with the hierarchical structure: study and subject within study as random effects. Delta values as response variables and altitude dose (in kilometer hours; km.hr = altitude (m) / 1000 x hours), sex, age, protocol and baseline values as fixed effects. Allowances were made for potential autocorrelation. Within two days at natural altitude [Hb] rapidly increased. Subsequent delta [Hb] values increased with altitude dose, reaching a plateau of 0.94 g/dL [95%CI (0.69, 1.20)] at ~1000 km.hr. Delta sqrt(retic%) and OFF-score were the first to identify an erythrocyte response, with respective increases and decreases observed within 100 to 200 km.hr. Post-altitude, [Hb] remained elevated for two weeks. Delta sqrt(retic%) declined below baseline, the magnitude of change was dependent on altitude dose. Baseline values were a significant covariate (p<0.05). The response to altitude is complex resulting in a wide range of individual responses, influenced primarily by altitude dose and baseline values. Improved knowledge of the plausible hematological variations during- and post-altitude provides fundamental information for both the ABP expert and sports physician.

    UR - http://www.scopus.com/inward/record.url?scp=85033241471&partnerID=8YFLogxK

    U2 - 10.1002/ajh.24941

    DO - 10.1002/ajh.24941

    M3 - Article

    VL - 93

    SP - 74

    EP - 83

    JO - American Journal of Hematology

    JF - American Journal of Hematology

    SN - 0361-8609

    IS - 1

    ER -