Routine Blood Parameters in Elite Soccer Players: Authors A Liation
Routine Blood Parameters in Elite Soccer Players: Authors A Liation
Routine Blood Parameters in Elite Soccer Players: Authors A Liation
Affiliation University of Saarland, Institute of Sports and Preventive Medicine, Saarbrücken, Germany
Meyer T, Meister S. Routine Blood Parameters in … Int J Sports Med 2011; 32: 875–881
876 Clinical Sciences
B 18 19 22
C 18 20 21 Blood sampling and processing
D 6 21 10 Samples were taken by an experienced phlebotomist (either the
E 2 14 15
team physician or one of the investigators) in the morning (08.00
F 16 23 21 25 10
to 11.00 a. m.) after overnight fasting from an antecubital vein in
G 15 24 20 1 1
the supine position. Samples were divided into 2.7 ml EDTA
H 21 24 25 24 11
I 9 blood for the blood count and 9 ml whole blood (serum gel
J 18 20 18 tubes). Whole blood was centrifugated within 20 min after sam-
K 15 21 1 pling and serum separated from the other compounds for all
L 24 21 5 17 further determinations. Players had to fill in questionnaires
M 19 about their present health condition and other factors possibly
N 21 21 interfering with the determination and/or interpretation of the
O 26 27 24 24 18 blood parameters.
P 23 19 They covered
Q 22 27 21
▶ infections and other internal diseases within the last 4 weeks
R 16 22 20
▶ intramuscular injections within the last 2 weeks
total 216 323 240 187 40
Meyer T, Meister S. Routine Blood Parameters in … Int J Sports Med 2011; 32: 875–881
Clinical Sciences 877
thyroid-stimulating hormone [TSH] – (enzyme immunoassay; the reasons for eliminations. Anthropometric data of the remain-
2.5 %; 4.6 %) ing 467 players (45 % of the registered players during the season
Reference ranges were adopted from the national standard text- 2008/09) were: age 24.9 ± 4.4 years; height 1.83 ± 0.07 m; weight
book [36]. No such ranges are presented for total cholesterol and 78.7 ± 9.6 kg; BMI 23.6 ± 6.9 kg/m2.
its subfractions because target values (in the context of cardio-
vascular risk management) are more meaningful than popula- Median values, 95 % confidence intervals,
tion means for the evaluation of blood lipids. Certain parameters intraindividual variability
were excluded from analysis whenever one of the following con- ●▶ Fig. 2 displays the course of erythrocyte count, hemoglobin,
founders was present: and hematocrit values together with 95 % confidence intervals.
infection – leukocytes, CRP, ferritin CK results are shown in ●▶ Fig. 3. All other parameters are listed
intramuscular injection – CK in ●
▶ Table 2 together with their mean intraindividual coefficient
supplementation of iodine, intake of thyroxine – TSH of variation (CV) between T1 and T2 as well as between T1, T2,
intake of allopurinol – uric acid and T3 (number of eligible players for T1 and T2 obviously higher
iron supplementation – ferritin than for all 3 sampling dates from T1 to T3; therefore slightly
magnesium supplementation – magnesium higher mean CVs can be expected for T1–T3). The mean CVs for
creatine intake – creatinine erythrocytes, hemoglobin, and hematocrit were 2.6, 2.2, and 2.4
(T1 and T2), and 2.8, 2.5, and 2.7 (T1, T2, and T3), respectively.
Statistics For CK, CVs were 36.7 (T1 and T2) and 39.9 (T1, T2, and T3).
The statistical analysis was performed with the package Statis- Confidence intervals of T0–T3 overlap widely with each other
tica 6.1. Data are presented as medians and quartiles (in figures and with the population reference range. T1 might serve as the
for longitudinal analyses) or 95 % confidence intervals (for best reference sampling date because the number of players was
the professional soccer players in Germany as possible to come together with the number of players eligible for this analysis (at
as close to a complete sample as possible. A calculation of the all sampling dates).
necessary sample size was, thus, not carried out.
Discussion
Results ▼
▼ Repeated standardized blood sampling has never been con-
There were considerably different numbers of subjects for the 4 ducted over an entire competitive season in such a large number
sampling times (● ▶ Table 1). The main reasons for this inequality of elite professional soccer players. The results of this study indi-
were scheduling difficulties (at the onset of the preparation cate that routine blood parameters are robust against the con-
period when many squads were still incomplete; similarly founding influences of regular intense training and competition.
towards the end of the season when several travelling duties and To avoid misinterpretation of abnormal blood results, soccer-
coaches’ training preferences interfered), injuries, and non-com- specific reference values have to be used for very few parame-
pliance with the study requirements (e. g., deviation from the ters: CK (vastly different), AST, urea, and creatinine (all with only
required one training sessions on the day prior to sampling). modest deviations from population reference values). A careful
Results from non-compliant subjects were strictly eliminated application of these 95 % confidence intervals in similar team
from all analyses. ●▶ Fig. 1 provides a flow sheet that illustrates sports (handball, basketball, field hockey) seems possible. The
results of this study may further help in demarcating a normal
Compliance flow sheet range for routine blood parameters in highly active male ath-
letes who consult physicians and for whom routine blood values
n = 532 are determined to rule out disease. They can thus be relevant for
Competition on pre-sampling day or early training on
sampling day any physician consulted by a highly active patient who shows
n = 522 suspicious blood parameters.
Chronic disease An important reason for high CK values in soccer players are the
n = 520 game’s specific movements with its stop-and-go character and
Rehabilitation process after injury many direction changes which impose high eccentric biome-
n = 494 chanical strain on the working muscles leading to microinjuries
Less or more than one team training on day before
sampling and the release of CK from the cytosol [25, 39]. Typical soccer
n = 467 training and competition is obviously more prone to such mus-
cle damage than training in other disciplines like swimming [24]
Fig. 1 Flow sheet indicating the reasons for the elimination of players
or cycling. Wide 95 % confidence intervals up to 1 200 IU/l are
from statistical analysis.
partly due to single individuals with overproportionate CK
Meyer T, Meister S. Routine Blood Parameters in … Int J Sports Med 2011; 32: 875–881
878 Clinical Sciences
5.8 1 400
1 327 U/I
5.6 5.71
5.07 5.63 5.64 1 200 308 U/I
1 217 U/I
5.56 107 U/I
4.51 4.92 4.91 331 U/I
5.4
Erythrocytes [×106/µL]
CK (U/L)
5.0
4.8 600
4.6 400
4.4
200
4.2
T0 T1 T2 T3 **
0
[n=215] [n=320] [n=226] [n=186] T0 T1 T2 T3
[n=211] [n=292] [n=221] [n=158]
17.5
17.0 Fig. 3 Course of creatine kinase (CK) during the season (sampling times
16.9 from baseline T0–T3). Open squares and hatched areas indicate median
16.5 15.4 16.8
15.1 16.6 and 95 % CI for each sampling date (n given at the x-axis). Open circles
13.5 16.5
Hemoglobin [g/dL]
16.0 13.7 15.1 and whiskers stand for median and quartils of those players eligible
14.9 13.4
13.6 for longitudinal analysis (n = 26) revealing a significant trend towards
38.9
elite athletes is their training volume associated with some
45 degree of glyconeogenesis that leads to degradation of structural
or functional proteins [12, 38]. Those amino acids that are not
utilized for energy metabolism are mainly eliminated through
40 the kidneys after metabolization to urea. Too low fluid intake
and kidney disease as alternative explanations seem unlikely –
*** *** *** even more without indications from medical history.
35 Slightly higher creatinine values than in the non-athletic popu-
T0 T1 T2 T3
[n=215] [n=320] [n=226] [n=186] lation are in line with existing literature [1]. Reasons for high
creatinine concentrations include increased muscle mass lead-
Fig. 2 Course of erythrocytes (top left), hemoglobin (top right), and ing to more creatinine turnover than usual [2, 35] and creatine
hematocrit (bottom) during the season (sampling times from baseline
intake [15]. It may be assumed that our recording of supplemen-
T0–T3). Open squares and hatched areas indicate median and 95 % CI
tal creatine intake was not complete because current reports
for each sampling date (n given at the x-axis). Open circles and whiskers
stand for median and quartils of those players eligible for longitudinal about creatine intake in athletic populations indicate more fre-
analysis (n = 39 for each parameter). A significant trend over the season quent use than self-reported in our study. Although not listed as
was detected for hematocrit only (p = 0.035; *** for sampling dates with a prohibited substance, creatine might enhance performance in
significantly different values from T0; Wilcoxon test). Erythrocytes and sports with repeated high-intensity character like soccer [16].
hemoglobin did not show significant changes during the season (p = 0.15 Given the present critical discussion about doping issues in elite
and p = 0.16, respectively). Numbers at the top of the hatched areas refer sport, some players might have been reluctant to admit creatine
to median (middle), upper (top) and lower (bottom) border of the 95 %
use (reported prevalence in the present study: only 0.6 %). How-
confidence interval.
ever, neither from the questionnaires nor from additional club
physician information any indications for creatine use of rele-
vant scale have arisen.
increases. However, it is well known that higher permeability of There is no obvious explanation for the observed systematic
muscle cell membranes exists in certain individuals increase in potassium from T0 to all sample times during the
[11, 26, 27, 31]. Some ethnic groups seem to be more frequently season. It is well known that potassium levels are increased
affected, and athletes with high percentages of fast twitch (type acutely during and after exercise [18]. But little is known about
Meyer T, Meister S. Routine Blood Parameters in … Int J Sports Med 2011; 32: 875–881
Clinical Sciences 879
11
39
40
40
40
12
40
40
40
40
39
40
40
31
12
40
cell membranes has been observed in athletes but this finding
n
Trend would rather be compatible with lower potassium resting levels
0.119
0.032
α-error
[20]. On the other hand, the frequent use of electrolyte drinks
0.02
0.46
0.02
0.14
0.02
0.27
0.05
< 0.01
0.01
0.22
< 0.01
0.01
0.11
0.01
and improved food quality compared to off-season might favour
higher potassium blood levels. Although “seasonal pseudohy-
T1–T3
11.5
11.5
29.3
20.3
17.7
16.6
21.7
13.4
1.5
8.5
9.2
6.3
6.2
4.3
6.9
CV
10.7
10.5
20.5
18.8
10.0
16.8
15.6
15.3
11.8
1.6
8.1
9.0
6.6
5.8
3.9
6.5
CV
187
187
167
153
186
187
152
186
187
187
152
187
187
30.7–81.4
0.78–0.98
0.73–3.50
1.00–3.49
3.81–5.18
125–238
142–331
138–144
59–162
17–155
3.2–8.6
4.0–7.2
18–63
13–49
24–55
T3
49.3
1.00
4.34
0.87
1.66 son have been described [21]. It is likely that such seasonal
177
108
210
141
5.4
5.5
29
23
54
37
240
240
240
157
166
226
240
240
240
163
235
240
240
212
240
ble blood lipid profile. In this study, low total cholesterol was
0.77–1.31
28.3–85.8
1.00–5.89
3.86–5.27
0.79–1.01
0.58–4.68
137–148
56–166
18–157
3.7–9.0
4.0–7.4
95 % CI
20–63
13–53
25–53
T2
49.0
1.00
4.43
0.89
1.63
176
104
212
142
5.4
5.7
58
36
323
323
323
246
246
320
323
323
323
321
244
323
323
298
322
31.6–82.1
1.00–5.39
3.68–5.06
0.75–0.99
0.61–3.64
137–148
59–172
18–154
3.6–8.2
3.9–7.2
95 % CI
20–60
13–46
26–53
51.7
1.00
4.32
0.87
1.61
170
105
217
142
5.7
5.5
30
24
36
58
216
216
216
178
164
215
216
216
216
216
176
215
216
216
212
33.2–77.6
1.00–4.14
3.46–4.74
0.78–0.98
0.66–3.67
128–252
137–339
137–146
60–171
14–174
3.1–9.5
4.2–7.8
25–52
18–57
14–51
T0
1.06
51.9
1.00
3.93
0.88
1.66
104
222
140
5.9
5.8
35
26
24
60
140–360
135–145
4.0–10.0
0.75–1.0
18–360
3.6–8.2
3.6–4.8
0.4–4.2
to proceed.
19–44
< 5.1
< 50
< 50
▼
Within applied studies there is always some kind of trade-off
creatinine [mg/dL]
platelets [x103/μL]
Mg + + [mmol/L]
Na + [mmol/L]
ferritin [μg/L]
urea [mg/dL]
K + [mmol/L]
TSH [mIU/L]
Meyer T, Meister S. Routine Blood Parameters in … Int J Sports Med 2011; 32: 875–881
880 Clinical Sciences
longitudinally comparing routine blood results. This is why it clubs together with their medical staff who took care that on-
was decided to present uncorrected measurements. However, a site conduction of this study worked perfectly. Parts of this manu-
correction according to Dill and Costill ([5]; not presented) script have been presented in oral form at the German Congress
revealed no relevant differences from the reported results. In of Sports Medicine 2009 in Ulm, Germany.
addition, blood screening in professional soccer players is often
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