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Only few studies on tHb-mass have been conducted yet in the clinical field although many questions exist. Schumacher et al. (2009) showed that spinal cord injured elite endurance athletes posses less tHb-mass than able-bodied trained athletes but still significantly more than untrained spinal cord injured patients (trained injured: 10.3 ±1.3 vs. untrained injured: 7.9 ±2.0 g/kg). In contrast to tHb-mass cardiac volume does not adapt to endurance training in these patients.

Heart failure patients often develop a massive blood volume expansion and anaemia. Adlbrecht et al. (2008) determined red cell volume in these patients and found that in most cases the presence of anaemia is due to plasma volume expansion but not due to a reduction in red cells.

Case studies:
Schumacher et al. (2008) reported in a case study that a 4 week immobilization due to an accident of an elite cyclist reduced tHb-mass by 14%. After resuming training tHb-mass recovered to initial values after 2 months.
In another case report (Schumacher et al. 2008) on an endurance athlete with Hodgkin’s lymphoma tHb-mass dropped by 37% after six courses of chemotherapy although a simultaneous treatment with darbepoietin was provided.
Treff et al. (2009) showed a simultanous decrease in tHb-mass and VO2max by >25% due to the use of NSAID diclofenac in an elite rower.  After changing the medication the athlete recovered and overcompensated  tHb-mass and VO2max.