Fluctuations in hematological athlete biological passport biomarkers in relation to the menstrual cycle

Abstract

The interpretation of athlete biological passport (ABP) is strengthened by understanding the natural fluctuations in its biological parameters. Here we have assessed the influence of the menstrual cycle on the hematological module of the ABP. Seventeen women with regular menses were included. Blood samples were collected once a week for two consecutive cycles and analyzed for hematological parameters. Menstrual phases were hormonally determined. The intra‐individual variation in the hematological parameters was similar between the two cycles. Reticulocyte percentage was significantly lower in the follicle phase (median 0.95%) than in the ovulatory (median 1.10%) and luteal phases (median 1.16%), P = 0.006, whereas no differences were found in hemoglobin concentration, hematocrit, red blood cell count, or red blood cell indices. When the values were entered into the ABP model, findings outside the program‐calculated individual thresholds were identified in two participants. One woman showed an atypical low OFF‐score in the last sample collected, mainly because of increased reticulocyte percentage. This was likely a response to treated insufficient iron stores. One woman displayed an atypical hemoglobin value at the lower limit 2 weeks after ovulation, which was likely due to fluctuations in plasma volume. In conclusion, the ABP parameters in general are stable throughout the menstrual cycle. Significant differences between the menstrual phases were found in reticulocytes; however, the variation was not related to findings outside the individual thresholds, except in one individual. Moreover, our results highlight the importance of having information about iron supplementation available when evaluating hematological passports.

Hematological adaptations and detection of recombinant human erythropoietin combined with chronic hypoxia

“…However, as significant interactions of time × treatment were evident for all the hematological analyses, the required power was reached. In addition, we did not control for the menstrual cycle, which may affect reticulocyte percentage, 34 but as we did not observe any effect of sex on the hematological changes, it does not appear to constitute a limitation.…”

Annual banned‐substance review: Analytical approaches in human sports drug testing 2019/2020

“…Consequently, a seated position for 5–10 min is recommended to obtain ABP data exempt from activity‐ or supine‐induced plasma volume (PV) shifts 181 . Studies on the potential influence of the menstrual cycle on ABP parameters indicated merely negligible effects 182 ; hyperhydration was shown to have no impact on ABP readings 183 ; and likewise, exercise‐induced sweating dehydration with an average loss of up to 3.1% of body mass was reported to have no effect on [Hb] during ABP testing, 184 demonstrating the robustness of the hematological module. However, dehydration due to medical conditions such as, for example, secretory diarrhea (as simulated by the administration of diuretic drugs) was found to result in highly abnormal ABP profiles and needs consideration in ABP profile interpretations.…”

“…Consequently, a seated position for 5-10 min is recommended to obtain ABP data exempt from activity-or supine-induced plasma volume (PV) shifts. 181 Studies on the potential influence of the menstrual cycle on ABP parameters indicated merely negligible effects 182 ;…”

The intra‐individual stability of GH biomarkers IGF‐I and P‐III‐NP in relation to GHRH administration, menstrual cycle, and hematological parameters

“…The study cohort and sampling are thoroughly described in Mullen et al 14 Briefly, 17 women with regular menses, aged 18-41, participated in the study, and herein, eight of them were included (for demographic information, see Table 1). The women were nonpregnant, did not use any hormonal drugs, and had a body mass index (BMI) < 24.9.…”

“…Occasionally, intake of painkillers was reported. follicle-stimulating hormone (FSH) were performed as previously described 14 to biologically classify the menstrual phases. (Figure 2A).…”