Time course of the hemoglobin mass response to natural altitude training in elite endurance cyclists

To determine the time course of hemoglobin mass (Hbmass) to natural altitude training, Hbmass, erythropoietin [EPO], reticulocytes, ferritin and soluble transferrin receptor (sTfR) were measured in 13 elite cyclists during, and 10 days after, 3 weeks of sea level (n=5) or altitude (n=8, 2760 m) training. Mean Hbmass, with a typical error of 2%, increased during the first 11 days at altitude (mean +/- standard deviation 2.9 +/- 2.0%) and was 3.5 +/- 2.5% higher than baseline after 19 days. [EPO] increased 64.2 +/- 18.8% after 2 nights at altitude but was not different from baseline after 12 nights. Hbmass and [EPO] did not increase in sea level. Reticulocytes (%) were slightly elevated in altitude at Days 5 and 12 (18.9 +/- 17.7% and 20.4 +/- 25.3%), sTfR was elevated at Day 12 (18.9 +/- 15.0%), but both returned to baseline by Day 20. Hbmass and [EPO] decreased on descent to sea level while ferritin increased. The mean increase in Hbmass observed after 11 days ( 300 h) of altitude training was beyond the measurement error and consitent with the mean increase after 300 h of simulated live high:train low altitude. Our results suggest that in elite cyclists, Hbmass increases progressively with 3 weeks of natural altitude exposure, with greater increases expected as exposure persists.