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march hemoglobinuria; runner's anemia; exercise-induced hemolysis

Pathology: - mechanical trauma to erythrocytes in the microvasculature during strenuous exercise - hemolysis from the pounding of feet on pavement [3] - hemoglobinuria due to prolonged & intense exertion - loss of iron through the urine & GI treact Clinical manifestations: 1) pain in back & thighs 2) dark urine Laboratory: 1) urinalysis: hemoglobin in urine without red cells 2) complete blood count with peripheral smear a) platelet count normal b) no erythrocyte fragments in peripheral smear c) anemia, microcytosis 3) iron studies consistent with iron-deficiency anemia - low serum ferritin 4) serum LDH elevated consistent with hemolysis 5) serum creatine kinase normal or minimally elevated

General

hemoglobinuria hemolytic anemia

References

  1. DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 893
  2. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 668
  3. Dang CV Runner's anemia. JAMA. 2001 Aug 8;286(6):714-6. PMID: 11495622
  4. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015