Study Subject(s) Exercise Symptoms Results Comments Bresolin et al. [15 ] 30 yrs man, pentathlon-trained athlete 12 km competitive run Loss of consciousness and pigmenturia during the last meters of run ↓BP, ↑HR, hypoglycaemia, ↑BT, ↑WBCs, metabolic acidosis, jaundice with ↑total & direct bilirubin, ↑SGOT & SGPT, ↑CK, ↑LDH; urine: Hb, myoglobin, ketone bodies; ECG: sinusoidal tachycardia G6PD activity: RBC 0.9%, PTLs 35%, WBCs 16.2%, muscle 1.3%, myoblasts 17.8%, myotubes 18.8%, and skin fibroblasts 18.4% of controls Kimmick & Owen [16 ] 34 yrs black man (G6PD deficiency and sickle cell trait; normal muscle G6PD levels) Vigorous exercise Severe oxidative haemolysis and rhabdomyolysis 24 hours after vigorous exercise; a total of three similar episodes within 21 months Malaise, myalgia, myoglobinuria, ↓haptoglobin, bite cells indicating oxidative haemolysis, anaemia The combination of two red blood cell defects (G6PD deficiency and sickle cell trait) may render RBC more susceptible to oxidative stress, resulting in severe haemolysis after intense exercise Demir et al. [17 ] 37 yrs man, elite long distance runner — No clinical sign of haemolysis ↓haptoglobin, ↑(slightly) unconjugated bilirubin over the years G6PD activity in RBC: ~9% of normal; G6PD activity in leukocytes: ~63% of normal
BP: blood pressure, HR: heart rate, BT: body temperature, WBCs: white blood cells, Hb: haemoglobin, RBC: red blood cells, SGOT: serum glutamic oxaloacetic transaminase, SGPT: serum glutamic pyruvic transaminase, CK: creatine kinase, LDH: lactate dehydrogenase, ECG: electrocardiogram, PTLs: platelets, EEG: electroencephalogram, Hct: haematocrit,
equation:
according to Ninfali et al. [
13 ].
