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What is foot strike hemolysis?

Foot strike hemolysis, also known as march hemoglobinuria, is a condition characterized by the destruction of red blood cells during repetitive and prolonged foot impact activities, such as marching or running. This mechanical stress on the feet can lead to the rupture of red blood cells, resulting in the release of hemoglobin into the bloodstream. The released hemoglobin is then filtered by the kidneys, leading to the presence of hemoglobin in the urine (hemoglobinuria).

Foot strike hemolysis can contribute to iron deficiency anemia, as the breakdown of red blood cells leads to increased iron loss. A study was conducted on 60km ultramarathon runners and found that repetitive foot impacts can result in increased red blood cell destruction and subsequent iron depletion. It was, though, found that their RBC levels improved after some time. The data "indicate that acute foot-strike RBC injury might no longer be considered a major determinant of sports anemia in long-distance runners".

To mitigate the risk of iron deficiency anemia in individuals prone to foot strike hemolysis, it is crucial to ensure adequate iron intake through a balanced diet or consider iron supplementation, especially during periods of intense physical activity. Regular monitoring of iron levels and seeking medical advice are also recommended to manage and prevent iron deficiency anemia associated with foot strike hemolysis.


  1. Lippi, G., Schena, F., Salvagno, G. L., Aloe, R., Banfi, G., & Guidi, G. C. (2012). Foot-strike haemolysis after a 60-km ultramarathon. Blood transfusion = Trasfusione del sangue, 10(3), 377–383.

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