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

Med Sci Sports Exerc. 2017 Aug;49(8):1711-1715. doi: 10.1249/MSS.0000000000001259.


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 for females and < 13.6 g·dL for male athletes. Iron deficiency was defined as Fer < 20 ng·mL 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.

MeSH terms

  • Anemia, Iron-Deficiency / diagnosis
  • Anemia, Iron-Deficiency / epidemiology*
  • Female
  • Ferritins / blood
  • Hemoglobins / analysis
  • Humans
  • Incidence
  • Male
  • Mass Screening* / economics
  • Prevalence
  • Retrospective Studies
  • Sports / statistics & numerical data*
  • United States / epidemiology


  • Hemoglobins
  • Ferritins