This protocol assesses iron status, oxygen transport capacity, and readiness for endurance load, heat, or altitude exposure. It supports safe training progression and helps identify deficiencies before they impact performance.
- Supports endurance, heat, and altitude readiness
- Flags iron deficiency, anaemia risk, or inflammation masking
- Guides nutrition, training load, and supplementation timing
- Provides context for fatigue, recovery, and adaptation
🧭 Planned / Seasonal Testing:
📅 Start-of-Base
🏔 Pre-Altitude
🏔 Post-Altitude
🔥 Pre-Heat
🔥 Post-Heat
🏕 Pre-Camp
🏕 Post-Camp
📊 Quarterly Health Check
📅 Start-of-Base
🏔 Pre-Altitude
🏔 Post-Altitude
🔥 Pre-Heat
🔥 Post-Heat
🏕 Pre-Camp
🏕 Post-Camp
📊 Quarterly Health Check
⚠️ Reactive / Other Reasons:
😴 Fatigue
🤒 Recurring Sickness
🩹 Injury Recovery
📉 Performance Drop
❓ Unexplained Symptoms
😴 Fatigue
🤒 Recurring Sickness
🩹 Injury Recovery
📉 Performance Drop
❓ Unexplained Symptoms
🚨 Red‑Flag Results — Seek Medical Review: Ferritin <30 µg/L • Hb below athlete range • Transferrin Saturation <15% • Persistent high CRP • Unexplained high ferritin
⏱ When to Test
- Morning draw (before 10 AM) — aligns with low hepcidin
- Rested 24–48 h post-hard training or racing
- Well hydrated, no acute illness
- Include CRP to interpret ferritin accurately
- Recommended scenarios: start-of-base, pre/post altitude, pre/post heat, quarterly check, post-sickness
🧬 Athlete Targets
| Marker | Standard Range | Athlete Target | Notes |
|---|---|---|---|
| Ferritin | 30–300 µg/L | >50 µg/L (endurance); 70–100 µg/L (heat/altitude) | Low ferritin = reduced iron stores |
| Haemoglobin | M: 130–180 g/L; F: 120–160 g/L | M: 145–165 g/L; F: 130–150 g/L | O₂ carrying capacity |
| Haematocrit | M: 0.40–0.52; F: 0.36–0.46 | M: 0.44–0.48; F: 0.38–0.45 | Supports Hb interpretation |
| Transferrin Saturation | 15–45% | >20%; avoid <15% | Iron availability |
| sTfR | 0.8–2.0 mg/L | Lower half of range | Iron demand marker |
| Hepcidin | Varies | Low in AM | Iron absorption regulator |
| CRP | <5.0 mg/L | <1.0 mg/L | Inflammation context |
🧭 Decision Protocol
- Check CRP: If >3.0 mg/L → defer ferritin interpretation unless urgent.
- Storage & Demand: Low ferritin = low stores; High sTfR = increased demand.
- Transport Pattern: Transferrin ↑ + TIBC ↑ + Sat <20% → likely deficiency.
- Classify:
- Absolute deficiency: Low ferritin, low Sat, high sTfR
- Functional deficiency: Normal ferritin, high sTfR, low Sat
- Inflammation-masked: Normal/high ferritin, high CRP, low Sat
🧍 Athlete Self‑Check
- Persistent fatigue not explained by training load
- Shortness of breath or dizziness
- Unusual mood changes or irritability
- Slow recovery after normal sessions
If these symptoms persist alongside abnormal labs → escalate to medical review.
🗒 Coach Notes
- Always interpret iron results in the context of training load, recovery, and recent illness — don’t isolate the numbers.
- Flag any athlete with ferritin <50 µg/L or Hb trending downwards for medical review, even if performance hasn’t dropped yet.
- Look for patterns: repeated low iron after altitude or heat blocks may signal inadequate recovery or nutrition support.
- Encourage athletes to log subjective fatigue, mood, and sleep alongside lab results — this builds a transparent picture of health.
- Never prescribe supplements yourself; your role is to highlight concerns and coordinate with medical staff.
Reminder: Your role is to protect athlete health first. Performance adjustments come only after medical clearance.
🛠 Role-Based Actions
| Role | Actions |
|---|---|
| 🧑🎓 Rider |
• Increase dietary iron (heme + non-heme + vitamin C) • Time iron intake when hepcidin is low (AM, away from training) • Monitor fatigue, mood, recovery • Avoid iron supplements unless advised |
| 🧑🏫 Coach |
• Adjust training load if symptoms present • Flag low ferritin or Hb for follow-up • Monitor performance drop, recovery lag, mood changes • Coordinate re-test in 6–8 weeks |
| 🧑⚕️ Doctor / Nutritionist |
• Confirm deficiency type (absolute, functional, masked) • Prescribe iron supplements if needed • Investigate persistent high ferritin or low Hb • Address inflammation or absorption blockers |
🔁 Feedback Loop
- Re-test 6–8 weeks after intervention
- Escalate if:
- No improvement
- Hb drops
- Unexplained high ferritin
- Persistent low Sat or high sTfR
- Symptoms persist despite dietary changes
Tip: Record test date and planned re-test date here for accountability.
📚 Source Note
Ranges and decision logic adapted from WHO guidelines, IOC consensus statements, and peer‑reviewed sports medicine literature. This protocol is designed for transparency and athlete safety — always escalate red‑flag results to a qualified medical professional.
