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Effect of Marathon Running on Hematologic and Biochemical Laboratory Parameters, Including Cardiac Markers

Alexander Kratz MD, PhD, MPH, Kent B. Lewandrowski MD, Arthur J. Siegel MD, Kelly Y. Chun PhD, James G. Flood PhD, Elizabeth M. Van Cott MD, Elizabeth Lee-Lewandrowski PhD, MPH
DOI: http://dx.doi.org/10.1309/14TY-2TDJ-1X0Y-1V6V 856-863 First published online: 1 December 2002


Participants in marathon races may require medical attention and the performance of laboratory assays. We report the changes in basic biochemical parameters, cardiac markers, CBC counts, and WBC differentials observed in participants in a marathon before, within 4 hours, and 24 hours after a race. The concentrations of glucose, total protein, albumin, uric acid, calcium, phosphorus, serum urea nitrogen, creatinine, bilirubin, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, total creatine kinase, creatine kinase-MB, myoglobin, and the anion gap were increased after the race, consistent with the effects of exertional rhabdomyolysis and hemolysis. The increase in WBC counts was due mainly to neutrophilia and monocytosis, with a relative decrease in circulating lymphocytes, consistent with an inflammatory reaction to tissue injury. A significant percentage of laboratory results were outside the standard reference ranges, indicating that modified reference ranges derived from marathon runners might be more appropriate for this population. We provide a table of modified reference ranges (or expected ranges) for basic biochemical, cardiac, and hematologic laboratory parameters for marathon runners.

Key Words:
  • Laboratory
  • Clinical chemistry
  • Hematology
  • Marathon
  • Sports medicine
  • Reference values