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Iron Deficiency and Anemia among Collegiate Athletes: A Retrospective Chart Review


Medicine & Science in Sports & Exercise: August 2017 - Volume 49 - Issue 8 - p 1711–1715
doi: 10.1249/MSS.0000000000001259
Applied Sciences

Purpose To describe the prevalence of anemia among incoming female college athletes and to characterize the results and expenses of iron-related testing at one National Collegiate Athletic Association Division I institution.

Methods In this retrospective medical record review, hemoglobin (Hgb) and ferritin laboratory values were obtained for student-athletes at a single institution, 2002 to 2014. Laboratories were collected either as part of the preparticipation examination (PPE) for female athletes, routine screening for cross-country athletes, or as needed for medical evaluation. Anemia was defined as Hgb < 11.6 g·dL−1 for females and < 13.6 g·dL−1 for male athletes. Iron deficiency was defined as Fer < 20 ng·mL−1 for both sexes.

Results A total of 5674 laboratory draws were obtained for 2749 individuals (56% female) from 25 different teams. The prevalence of low Hgb among female athletes at PPE was 5.7% (95% confidence interval, 4.4%–6.9%). At PPE, the incidence of anemia was not significantly higher for any sport when compared with the group mean. Ferritin and Hgb were collected together in approximately one third of all blood draws from females (n = 1059) and one sixth of blood draws from males (n = 411). For female athletes, 2.2% indicated iron deficiency anemia and 30.9% indicated iron deficiency without anemia. For male athletes, 1.2% indicated iron deficiency anemia and 2.9% indicated iron deficiency without anemia. The median cost of iron testing exceeded US $20,000 annually for the institution.

Conclusions One in 20 incoming female athletes was identified with anemia at the PPE. Given the costs of testing, screening practices at each institution should be thoughtfully selected and routinely reassessed.

1Division of Sports Medicine, Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI; and 2Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI

Address for correspondence: M. Alison Brooks, M.D., M.P.H., 1685 Highland Ave Madison, WI 53705; E-mail:

Submitted for publication August 2016.

Accepted for publication March 2017.

© 2017 American College of Sports Medicine