Blood doping
Encyclopedia
Blood doping is the practice of boosting the number of red blood cells (RBCs) in the bloodstream in order to enhance athletic performance. Because such blood cells carry oxygen
from the lung
s to the muscle
s, a higher concentration in the blood can improve an athlete’s aerobic capacity (VO2 max) and endurance
.
with blood, i.e. the transfusion
of RBCs. RBCs are uniquely suited to this process because they can be concentrated, frozen and later thawed with little loss of viability or activity. There are two possible types of transfusion: homologous and autologous. In a homologous transfusion, RBCs from a compatible donor are harvested, concentrated and then transfused into the athlete’s circulation prior to endurance competitions. In an autologous transfusion, the athlete's own RBCs are harvested well in advance of competition and then re-introduced before a critical event. For some time after the harvesting the athlete may be anemic
.
Both types of transfusion can be dangerous because of the risk of infection and the potential toxicity of improperly stored blood. Homologous transfusions present the additional risks of communication of infectious diseases and the possibility of a transfusion reaction. From a logistical standpoint, either type of transfusion requires the athlete to surreptitiously transport frozen RBCs, thaw and re-infuse them in a non-clinical setting and then dispose of the medical paraphernalia.
In the late 1980s, an advance in medicine led to an entirely new form of blood doping involving the hormone erythropoietin
(EPO). EPO is a naturally occurring hormone growth factor
that stimulates the formation of RBCs. Recombinant DNA technology made it possible to produce EPO economically on a large scale and it was approved in US and Europe as a pharmaceutical product for the treatment of anemia
resulting from renal failure
or cancer
chemotherapy
. Easily injected under the skin, pharmaceutical EPO can boost hematocrit
for six to twenty-four weeks, or longer. The use of EPO is now believed by many to be widespread in endurance sports.
EPO is not free of health hazards: Excessive use of the hormone can raise hematocrit above 70% which can cause polycythemia
, a condition wherein the level of RBCs in the blood is abnormally high. This causes the blood to be more viscous than normal, a condition that strains the heart. Some elite athletes who died of heart failure — usually during sleep, when heart rate is naturally low—were found to have unnaturally high RBC concentrations in their blood.
. In 2004, British cyclist David Millar
was stripped of his world time-trial championship after pharmaceutical EPO
was found in his possession. Because athletes sometimes inject
or infuse
non-banned substances such as vitamin B
or electrolyte
s, the possession of syringe
s or other medical equipment is not necessarily evidence of doping.
A more modern approach, which has been applied to blood doping with mixed success, is to test the blood or urine of an athlete for evidence of a banned substance or practice, usually EPO. This approach requires a well-documented chain of custody of the sample and a test method that can be relied upon to be accurate and reproducible. Athletes have, in many cases, claimed that the sample taken from them was misidentified, improperly stored or inadequately tested.
Yet another detection strategy has been to regard any apparently unnatural population of RBCs as evidence of blood doping. RBC population in the blood is usually reported as hematocrit
(HCT) or as the concentration of hemoglobin (Hb). HCT is the fraction of blood by volume occupied by red blood cells. A normal HCT is 41-50% in adult men and 36-44% in adult women. Hemoglobin
(Hb) is the iron
-containing protein
that binds oxygen
in RBCs. Normal Hb levels are 14-17 g/dL of blood in men and 12-15 g/dL in women. For most healthy persons the two measurements are in close agreement.
There are two ways in which HCT and Hb measurements can suggest that the blood sample has been taken from a doping athlete. The first is simply an unusually high value for both. The Union Cycliste Internationale
(UCI), for example, imposes a 15-day suspension from racing on any male athlete found to have an HCT above 50% and hemoglobin concentration above 17 gram
s per deciliter
(g/dL). A few athletes naturally have high RBC concentrations (polycythemia
), which they must demonstrate through a series of consistently high hematocrit and hemoglobin results over an extended period of time.
A recent, more sophisticated method of analysis, which has not yet reached the level of an official standard, is to compare the numbers of mature and immature RBCs in an athlete's circulation. If a high number of mature RBCs is not accompanied by a high number of immature RBCs—called reticulocyte
s--it suggests that the mature RBCs were artificially introduced by transfusion. EPO use can also lead to a similar RBC profile because a preponderance of mature RBCs tends to suppress the formation of reticulocytes. A measure known as the "stimulation index" or "off-score" has been proposed based on an equation involving hemoglobin and reticulocyte concentrations. A normal score is 85-95 and scores over 133 are considered evidence of doping. (The stimulation index is defined as Hb (g/L) minus sixty times the square root of the percentage of RBCs identified as reticulocytes.)
These threshold levels, and their specific numeric values are sources of controversy. Establishment of incorrect threshold values is one way that false positive test results can be produced by a doping control program.
national anti-doping laboratory (LNDD) and endorsed by the World Anti-Doping Agency
(WADA) was introduced to detect pharmaceutical EPO by distinguishing it from the nearly identical natural hormone normally present in an athlete’s urine
. The test method relies on scientific techniques known as gel electrophoresis
and isoelectric focusing
. Although the test has been widely applied, especially among cyclists and triathletes, it is controversial, and its accuracy has been called into question. The principal criticism has been toward the ability of the test to distinguish pharmaceutical EPO from other proteins that may normally be present in the urine of an athlete after strenuous exercise.
The validity of a doping conviction based on the EPO test method was first challenged successfully by Belgian triathlete Rutger Beke
. Beke was suspended from competition for 18 months in March 2005 by the Flemish Disciplinary Commission after a positive urine test for EPO in September 2004. In August 2005, the Commission reversed its decision and exonerated him based on scientific and medical information presented by Beke. He asserted that his sample had become degraded as a result of bacterial contamination and that the substance identified by the laboratory as pharmaceutical EPO was, in fact, an unrelated protein indistinguishable from pharmaceutical EPO in the test method. He claimed, therefore, that the test had produced a false positive result in his case.
In May 2007, Bjarne Riis
, Rolf Aldag
, Erik Zabel
, and Brian Holm
, all former members of the Telekom cycling team, admitted to using EPO during their cycling careers in the mid-1990s. Riis also relinquished his title as champion of the 1996 Tour de France
. EPO was again a factor in the various doping scandals
at the 2007 Tour de France
, including the suspension of Spanish cyclist, Iban Mayo
. The IOC
found that athletes were using a new version of EPO, a chronic kidney disease drug called MIRCERA, and three athletes tested positive for the substance in April 2009.
At present there is no accepted method for detecting autologous transfusions (that is, using the athlete’s own RBCs), but research is in progress and the World Anti-Doping Agency
(WADA) has promised that a test will eventually be introduced. The test method and its introduction date are to be kept secret in order to avoid tipping off doping athletes. The test under development may be a measure of 2,3-bisphosphoglycerate (2,3-BPG) levels in an athlete's red blood cells. Because 2,3-BPG is degraded over time, the stored blood used in autologous transfusions will have less 2,3-BPG than fresh blood. A 2,3-BPG concentration lower than normal may therefore be an indication of autologous transfusion.
commanders at Fort Bragg
started experimenting with blood doping, also known as blood loading. Special forces operators would provide two units of whole blood, from which red blood cells would be extracted, concentrated, and stored under cold temperatures. Twenty-four hours before a mission or battle, a small amount of red blood cells would be infused back into the soldier. Military scientists believe that the procedure increases the soldiers' endurance and alertness because of the increase in the blood's capability to carry oxygen.
In 1998, the Australian Defence Forces approved this technique for the Special Air Service Regiment. Senior nutritionist at the Australian Defence Science and Technology Organization Chris Forbes-Ewan is quoted as saying that, unlike in sport, "all's fair in love and war." "What we are trying to gain is an advantage over any potential adversary," Forbes-Ewan said. "What we will have is a head-start."
In this study, over 50 performance-enhancing drugs and techniques were rejected. The six that were approved are caffeine
, ephedrine
, energy drinks, modafinil
, creatine
, and blood-loading.
also employed blood doping.
The Swedish cyclist Niklas Axelsson
tested positive for EPO in 2000.
The American cyclist Tyler Hamilton
failed a fluorescent-activated cell sorting test for detecting homologous blood transfusions during the 2004 Olympics. He was allowed to keep his gold medal because the processing of his sample precluded conducting a second, confirmatory test. He appealed a second positive test for homologous transfusion from the 2004 Vuelta a España
to the International Court of Arbitration for Sport
but his appeal was denied. Hamilton's lawyers proposed Hamilton may be a genetic chimera
or have had a 'vanishing twin
' to explain the presence of RBCs from more than one person. While theoretically possible, these explanations were ruled to be of 'negligible probability'.
The Operación Puerto case
in 2006 involved allegations of doping and blood doping of hundreds of athletes in Spain.
Tour de France
rider Alexander Vinokourov
, of the Astana Team
, tested positive for two different blood cell populations and thus for homologous transfusion, according to various news reports on July 24, 2007. Vinokourov was tested after his victory in the 13th stage time trial of the Tour on July 21, 2007. A doping test is not considered to be positive until a second sample is tested to confirm the first. Vinokourov's B sample has now tested positive, and he faces a possible suspension of 2 years and a fine equal to one year's salary. He also tested positive after stage 15.
Vinokourov's teammate Andrej Kashechkin also tested positive for homologous blood doping on August 1, 2007, just a few days after the conclusion of the 2007 Tour de France
(a race that had been dominated by doping scandals
). His team withdrew after the revelation that Vinokourov had doped.
According to Russian investigators, 19-year-old New York Rangers
prospect and Russian hockey player Alexei Cherepanov
was engaged in blood doping for several months before he died on October 13, 2008, after collapsing on the bench during a game in Russia. He also had myocarditis
.
The German speed skater and five-fold Olympic gold medalist Claudia Pechstein
was banned for two years in 2009 for alleged blood doping, based on irregular levels of reticulocyte
s in her blood; these levels were always highest during competitions. This can be read in many newspapers. However, it is not true. Instead of, mean reticulocyte count of the ten years from 2000 to 2009 was 2.1% during top events like Olympic Games and during world championships. At world cup races the mean reticulocyte was 1.9% and during training phases 2.0%. The Court of Arbitration for Sport
confirmed the ban in November 2009.
On May 20, 2011 Tyler Hamilton turned in his 2004 Olympic Gold Medal to the U.S. Anti-Doping Agency after admitting to doping in a 60 Minutes interview.
samples to create a medical profile that could be compared to results of subsequent doping tests. Former World Anti-Doping Agency
(WADA) President Dick Pound
stated his belief that anti-doping passports would be in widespread use within three years.
Blood contamination during preparation or storage is another issue. Contamination was seen in 1 in every 500,000 transfusions of RBC in 2002. Blood contamination can lead to sepsis or an infection that affects the whole body.
Certain medications used to increase RBCs can reduce liver function and lead to liver failure, pituitary problems, and increases in cholesterol levels.
Oxygen
Oxygen is the element with atomic number 8 and represented by the symbol O. Its name derives from the Greek roots ὀξύς and -γενής , because at the time of naming, it was mistakenly thought that all acids required oxygen in their composition...
from the lung
Lung
The lung is the essential respiration organ in many air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located near the backbone on either side of the heart...
s to the muscle
Muscle
Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...
s, a higher concentration in the blood can improve an athlete’s aerobic capacity (VO2 max) and endurance
Endurance
Endurance is the ability for a human or animal to exert itself and remain active for a long period of time, as well as its ability to resist, withstand, recover from, and have immunity to trauma, wounds, or fatigue. In humans, it is usually used in aerobic or anaerobic exercise...
.
Methods
The term blood doping originally meant dopingDoping (sport)
The use of performance-enhancing drugs in sport is commonly referred to by the term "doping", particularly by those organizations that regulate competitions. The use of performance enhancing drugs is mostly done to improve athletic performance. This is why many sports ban the use of performance...
with blood, i.e. the transfusion
Blood transfusion
Blood transfusion is the process of receiving blood products into one's circulation intravenously. Transfusions are used in a variety of medical conditions to replace lost components of the blood...
of RBCs. RBCs are uniquely suited to this process because they can be concentrated, frozen and later thawed with little loss of viability or activity. There are two possible types of transfusion: homologous and autologous. In a homologous transfusion, RBCs from a compatible donor are harvested, concentrated and then transfused into the athlete’s circulation prior to endurance competitions. In an autologous transfusion, the athlete's own RBCs are harvested well in advance of competition and then re-introduced before a critical event. For some time after the harvesting the athlete may be anemic
Anemia
Anemia is a decrease in number of red blood cells or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin...
.
Both types of transfusion can be dangerous because of the risk of infection and the potential toxicity of improperly stored blood. Homologous transfusions present the additional risks of communication of infectious diseases and the possibility of a transfusion reaction. From a logistical standpoint, either type of transfusion requires the athlete to surreptitiously transport frozen RBCs, thaw and re-infuse them in a non-clinical setting and then dispose of the medical paraphernalia.
In the late 1980s, an advance in medicine led to an entirely new form of blood doping involving the hormone erythropoietin
Erythropoietin
Erythropoietin, or its alternatives erythropoetin or erthropoyetin or EPO, is a glycoprotein hormone that controls erythropoiesis, or red blood cell production...
(EPO). EPO is a naturally occurring hormone growth factor
Growth factor
A growth factor is a naturally occurring substance capable of stimulating cellular growth, proliferation and cellular differentiation. Usually it is a protein or a steroid hormone. Growth factors are important for regulating a variety of cellular processes....
that stimulates the formation of RBCs. Recombinant DNA technology made it possible to produce EPO economically on a large scale and it was approved in US and Europe as a pharmaceutical product for the treatment of anemia
Anemia
Anemia is a decrease in number of red blood cells or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin...
resulting from renal failure
Renal failure
Renal failure or kidney failure describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood...
or cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
. Easily injected under the skin, pharmaceutical EPO can boost hematocrit
Hematocrit
The hematocrit or packed cell volume or erythrocyte volume fraction is the percentage of the concentration of red blood cells in blood. It is normally about 45% for men and 40% for women...
for six to twenty-four weeks, or longer. The use of EPO is now believed by many to be widespread in endurance sports.
EPO is not free of health hazards: Excessive use of the hormone can raise hematocrit above 70% which can cause polycythemia
Polycythemia
Polycythemia is a disease state in which the proportion of blood volume that is occupied by red blood cells increases...
, a condition wherein the level of RBCs in the blood is abnormally high. This causes the blood to be more viscous than normal, a condition that strains the heart. Some elite athletes who died of heart failure — usually during sleep, when heart rate is naturally low—were found to have unnaturally high RBC concentrations in their blood.
Detection of blood doping
A time-honored approach to the detection of doping is the random and often-repeated search of athletes’ homes and team facilities for evidence of a banned substance or practice. Professional cyclists customarily submit to random drug testing and searches of their homes as an obligation of team membership and participation in the UCI ProTourUCI ProTour
The UCI ProTour was a series of road bicycle races in Europe, Australia and Canada organised by the UCI . Created by Hein Verbruggen, former president of the UCI, it comprises a number of 'ProTour' cycling teams, each of whom are required to compete in every round of the series...
. In 2004, British cyclist David Millar
David Millar
David Millar is a British road racing cyclist riding for . He has won three stages of the Tour de France, two of the Vuelta a España and one Stage of the Giro d'Italia. He was the British national road champion and the national time trial champion, both in 2007...
was stripped of his world time-trial championship after pharmaceutical EPO
Erythropoietin
Erythropoietin, or its alternatives erythropoetin or erthropoyetin or EPO, is a glycoprotein hormone that controls erythropoiesis, or red blood cell production...
was found in his possession. Because athletes sometimes inject
Injection (medicine)
An injection is an infusion method of putting fluid into the body, usually with a hollow needle and a syringe which is pierced through the skin to a sufficient depth for the material to be forced into the body...
or infuse
Infusion
An infusion is the outcome of steeping plants with desired chemical compounds or flavors in water or oil.-History:The first recorded use of essential oils was in the 10th or 11th century by the Persian polymath Avicenna, possibly in The Canon of Medicine.-Preparation techniques:An infusion is very...
non-banned substances such as vitamin B
B vitamins
B vitamins are a group of water-soluble vitamins that play important roles in cell metabolism. The B vitamins were once thought to be a single vitamin, referred to as vitamin B . Later research showed that they are chemically distinct vitamins that often coexist in the same foods...
or electrolyte
Electrolyte
In chemistry, an electrolyte is any substance containing free ions that make the substance electrically conductive. The most typical electrolyte is an ionic solution, but molten electrolytes and solid electrolytes are also possible....
s, the possession of syringe
Syringe
A syringe is a simple pump consisting of a plunger that fits tightly in a tube. The plunger can be pulled and pushed along inside a cylindrical tube , allowing the syringe to take in and expel a liquid or gas through an orifice at the open end of the tube...
s or other medical equipment is not necessarily evidence of doping.
A more modern approach, which has been applied to blood doping with mixed success, is to test the blood or urine of an athlete for evidence of a banned substance or practice, usually EPO. This approach requires a well-documented chain of custody of the sample and a test method that can be relied upon to be accurate and reproducible. Athletes have, in many cases, claimed that the sample taken from them was misidentified, improperly stored or inadequately tested.
Yet another detection strategy has been to regard any apparently unnatural population of RBCs as evidence of blood doping. RBC population in the blood is usually reported as hematocrit
Hematocrit
The hematocrit or packed cell volume or erythrocyte volume fraction is the percentage of the concentration of red blood cells in blood. It is normally about 45% for men and 40% for women...
(HCT) or as the concentration of hemoglobin (Hb). HCT is the fraction of blood by volume occupied by red blood cells. A normal HCT is 41-50% in adult men and 36-44% in adult women. Hemoglobin
Hemoglobin
Hemoglobin is the iron-containing oxygen-transport metalloprotein in the red blood cells of all vertebrates, with the exception of the fish family Channichthyidae, as well as the tissues of some invertebrates...
(Hb) is the iron
Iron
Iron is a chemical element with the symbol Fe and atomic number 26. It is a metal in the first transition series. It is the most common element forming the planet Earth as a whole, forming much of Earth's outer and inner core. It is the fourth most common element in the Earth's crust...
-containing protein
Protein
Proteins are biochemical compounds consisting of one or more polypeptides typically folded into a globular or fibrous form, facilitating a biological function. A polypeptide is a single linear polymer chain of amino acids bonded together by peptide bonds between the carboxyl and amino groups of...
that binds oxygen
Oxygen
Oxygen is the element with atomic number 8 and represented by the symbol O. Its name derives from the Greek roots ὀξύς and -γενής , because at the time of naming, it was mistakenly thought that all acids required oxygen in their composition...
in RBCs. Normal Hb levels are 14-17 g/dL of blood in men and 12-15 g/dL in women. For most healthy persons the two measurements are in close agreement.
There are two ways in which HCT and Hb measurements can suggest that the blood sample has been taken from a doping athlete. The first is simply an unusually high value for both. The Union Cycliste Internationale
Union Cycliste Internationale
Union Cycliste Internationale is the world governing body for sports cycling and oversees international competitive cycling events. The UCI is based in Aigle, Switzerland....
(UCI), for example, imposes a 15-day suspension from racing on any male athlete found to have an HCT above 50% and hemoglobin concentration above 17 gram
Gram
The gram is a metric system unit of mass....
s per deciliter
Litre
pic|200px|right|thumb|One litre is equivalent to this cubeEach side is 10 cm1 litre water = 1 kilogram water The litre is a metric system unit of volume equal to 1 cubic decimetre , to 1,000 cubic centimetres , and to 1/1,000 cubic metre...
(g/dL). A few athletes naturally have high RBC concentrations (polycythemia
Polycythemia
Polycythemia is a disease state in which the proportion of blood volume that is occupied by red blood cells increases...
), which they must demonstrate through a series of consistently high hematocrit and hemoglobin results over an extended period of time.
A recent, more sophisticated method of analysis, which has not yet reached the level of an official standard, is to compare the numbers of mature and immature RBCs in an athlete's circulation. If a high number of mature RBCs is not accompanied by a high number of immature RBCs—called reticulocyte
Reticulocyte
Reticulocytes are immature red blood cells, typically composing about 1% of the red cells in the human body.Reticulocytes develop and mature in the red bone marrow and then circulate for about a day in the blood stream before developing into mature red blood cells. Like mature red blood cells,...
s--it suggests that the mature RBCs were artificially introduced by transfusion. EPO use can also lead to a similar RBC profile because a preponderance of mature RBCs tends to suppress the formation of reticulocytes. A measure known as the "stimulation index" or "off-score" has been proposed based on an equation involving hemoglobin and reticulocyte concentrations. A normal score is 85-95 and scores over 133 are considered evidence of doping. (The stimulation index is defined as Hb (g/L) minus sixty times the square root of the percentage of RBCs identified as reticulocytes.)
These threshold levels, and their specific numeric values are sources of controversy. Establishment of incorrect threshold values is one way that false positive test results can be produced by a doping control program.
Detection of EPO use
Some success has also been realized in applying a specific test to detect EPO use. An inherent problem, however, is that, whereas pharmaceutical EPO may be undetectable in the circulation a few days after administration, its effects may persist for several weeks. In 2000 a test developed by scientists at the FrenchFrance
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
national anti-doping laboratory (LNDD) and endorsed by the World Anti-Doping Agency
World Anti-Doping Agency
The World Anti-Doping Agency , , is an independent foundation created through a collective initiative led by the International Olympic Committee . It was set up on November 10, 1999 in Lausanne, Switzerland, as a result of what was called the "Declaration of Lausanne", to promote, coordinate and...
(WADA) was introduced to detect pharmaceutical EPO by distinguishing it from the nearly identical natural hormone normally present in an athlete’s urine
Urine
Urine is a typically sterile liquid by-product of the body that is secreted by the kidneys through a process called urination and excreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream...
. The test method relies on scientific techniques known as gel electrophoresis
Gel electrophoresis
Gel electrophoresis is a method used in clinical chemistry to separate proteins by charge and or size and in biochemistry and molecular biology to separate a mixed population of DNA and RNA fragments by length, to estimate the size of DNA and RNA fragments or to separate proteins by charge...
and isoelectric focusing
Isoelectric focusing
Isoelectric focusing , also known as electrofocusing, is a technique for separating different molecules by their electric charge differences...
. Although the test has been widely applied, especially among cyclists and triathletes, it is controversial, and its accuracy has been called into question. The principal criticism has been toward the ability of the test to distinguish pharmaceutical EPO from other proteins that may normally be present in the urine of an athlete after strenuous exercise.
The validity of a doping conviction based on the EPO test method was first challenged successfully by Belgian triathlete Rutger Beke
Rutger Beke
Rutger Beke is a retired Belgian triathlete living in Leuven. Beke competed for the Uplace Pro Triathlon Team until he announced his retirement from professional triathlon on May 31, 2011....
. Beke was suspended from competition for 18 months in March 2005 by the Flemish Disciplinary Commission after a positive urine test for EPO in September 2004. In August 2005, the Commission reversed its decision and exonerated him based on scientific and medical information presented by Beke. He asserted that his sample had become degraded as a result of bacterial contamination and that the substance identified by the laboratory as pharmaceutical EPO was, in fact, an unrelated protein indistinguishable from pharmaceutical EPO in the test method. He claimed, therefore, that the test had produced a false positive result in his case.
In May 2007, Bjarne Riis
Bjarne Riis
Bjarne Lykkegård Riis , nicknamed The Eagle from Herning , is a Danish former professional road bicycle racer who placed first in the 1996 Tour de France, and is now the team owner and manager of Danish UCI ProTour outfit Team Saxo Bank Sungard...
, Rolf Aldag
Rolf Aldag
Rolf Aldag is a former professional road bicycle racer who rode for Team Telekom from 1993 to 2005. He has raced in 10 Tour de France, 1 Giro d'Italia and 5 Vuelta a España...
, Erik Zabel
Erik Zabel
Erik Zabel is a former German professional road bicycle racer who last raced with Milram. With over 200 professional wins he is considered by some one of the greatest German cyclists and best cycling sprinters of history...
, and Brian Holm
Brian Holm
Brian Holm Sørensen is a retired Danish professional rider in road bicycle racing from 1986 to 1998, and rode for Team Telekom from 1993 to 1997, and was part of the team that brought his fellow Dane Bjarne Riis to victory in the 1996 Tour de France...
, all former members of the Telekom cycling team, admitted to using EPO during their cycling careers in the mid-1990s. Riis also relinquished his title as champion of the 1996 Tour de France
1996 Tour de France
The 1996 Tour de France was the 83rd Tour de France, starting on June 29 and ending on July 21, featuring 19 regular stages, 2 individual time trials, a prologue and a rest day ....
. EPO was again a factor in the various doping scandals
Doping at the 2007 Tour de France
The 2007 Tour de France was affected by a series of scandals and speculations related to doping. By the end of the Tour, two cyclists were dismissed for testing positive, the wearer of the yellow jersey was voluntarily retired by his team for lying about his whereabouts and missing doping tests...
at the 2007 Tour de France
2007 Tour de France
The 2007 Tour de France, the 94th running of the race, took place from 7 July to 29 July 2007. The Tour began with a prologue in London, and ended with the traditional finish in Paris. Along the way, the route also passed through Belgium and Spain...
, including the suspension of Spanish cyclist, Iban Mayo
Iban Mayo
Iban Mayo Diez is a professional road bicycle racer. His successes have been overshadowed by doping....
. The IOC
International Olympic Committee
The International Olympic Committee is an international corporation based in Lausanne, Switzerland, created by Pierre de Coubertin on 23 June 1894 with Demetrios Vikelas as its first president...
found that athletes were using a new version of EPO, a chronic kidney disease drug called MIRCERA, and three athletes tested positive for the substance in April 2009.
Detection of blood transfusions
In the case of detecting blood transfusions, a test for detecting homologous blood transfusions (from a donor to a doping athlete) has been in use since 2000. The test method is based on a technique known as fluorescent-activated cell sorting. By examining markers on the surface of blood cells, the method can determine whether blood from more than one person is present in an athlete’s circulation.At present there is no accepted method for detecting autologous transfusions (that is, using the athlete’s own RBCs), but research is in progress and the World Anti-Doping Agency
World Anti-Doping Agency
The World Anti-Doping Agency , , is an independent foundation created through a collective initiative led by the International Olympic Committee . It was set up on November 10, 1999 in Lausanne, Switzerland, as a result of what was called the "Declaration of Lausanne", to promote, coordinate and...
(WADA) has promised that a test will eventually be introduced. The test method and its introduction date are to be kept secret in order to avoid tipping off doping athletes. The test under development may be a measure of 2,3-bisphosphoglycerate (2,3-BPG) levels in an athlete's red blood cells. Because 2,3-BPG is degraded over time, the stored blood used in autologous transfusions will have less 2,3-BPG than fresh blood. A 2,3-BPG concentration lower than normal may therefore be an indication of autologous transfusion.
Military use
In 1993, U.S. Special ForcesSpecial forces
Special forces, or special operations forces are terms used to describe elite military tactical teams trained to perform high-risk dangerous missions that conventional units cannot perform...
commanders at Fort Bragg
Fort Bragg, North Carolina
Fort Bragg is a major United States Army installation, in Cumberland and Hoke counties, North Carolina, U.S., mostly in Fayetteville but also partly in the town of Spring Lake. It was also a census-designated place in the 2010 census and had a population of 39,457. The fort is named for Confederate...
started experimenting with blood doping, also known as blood loading. Special forces operators would provide two units of whole blood, from which red blood cells would be extracted, concentrated, and stored under cold temperatures. Twenty-four hours before a mission or battle, a small amount of red blood cells would be infused back into the soldier. Military scientists believe that the procedure increases the soldiers' endurance and alertness because of the increase in the blood's capability to carry oxygen.
In 1998, the Australian Defence Forces approved this technique for the Special Air Service Regiment. Senior nutritionist at the Australian Defence Science and Technology Organization Chris Forbes-Ewan is quoted as saying that, unlike in sport, "all's fair in love and war." "What we are trying to gain is an advantage over any potential adversary," Forbes-Ewan said. "What we will have is a head-start."
In this study, over 50 performance-enhancing drugs and techniques were rejected. The six that were approved are caffeine
Caffeine
Caffeine is a bitter, white crystalline xanthine alkaloid that acts as a stimulant drug. Caffeine is found in varying quantities in the seeds, leaves, and fruit of some plants, where it acts as a natural pesticide that paralyzes and kills certain insects feeding on the plants...
, ephedrine
Ephedrine
Ephedrine is a sympathomimetic amine commonly used as a stimulant, appetite suppressant, concentration aid, decongestant, and to treat hypotension associated with anaesthesia....
, energy drinks, modafinil
Modafinil
Modafinil is an analeptic drug manufactured by Cephalon, and is approved by the U.S. Food and Drug Administration for the treatment of narcolepsy, shift work sleep disorder, and excessive daytime sleepiness associated with obstructive sleep apnea...
, creatine
Creatine supplements
Creatine supplements are athletic aids used to increase high-intensity athletic performance. Though researchers have known of the use of creatine as an energy source by skeletal muscles since the beginning of the 20th century, they were popularized as a performance-enhancing supplement in...
, and blood-loading.
Notable blood doping cases
Blood doping probably started in the 1970s but was not outlawed until 1986. While it was still legal, it was commonly used by middle and long-distance runners. The US cycling team at the 1984 OlympicsCycling at the 1984 Summer Olympics
The cycling competition at the 1984 Summer Olympics in Los Angeles consisted of three road cycling events and five track cycling events. For the first time, women's cycling events were included in the Olympic program, with a single event, the individual road race...
also employed blood doping.
The Swedish cyclist Niklas Axelsson
Niklas Axelsson
Niklas Axelsson is a Swedish professional road racing cyclist. Axelsson's finished sixth during the 1999 Giro d'Italia and third in the 2000 edition of Giro di Lombardia....
tested positive for EPO in 2000.
The American cyclist Tyler Hamilton
Tyler Hamilton
Tyler Hamilton is a former American professional road bicycle racer and former Olympic gold medalist. Hamilton became a professional cyclist in 1995, and during the 1999, 2000 and 2001 Tour de France was a teammate of Lance Armstrong who won those races.Hamilton appeared at the 2000 Summer...
failed a fluorescent-activated cell sorting test for detecting homologous blood transfusions during the 2004 Olympics. He was allowed to keep his gold medal because the processing of his sample precluded conducting a second, confirmatory test. He appealed a second positive test for homologous transfusion from the 2004 Vuelta a España
Vuelta a España
The Vuelta a España is a three-week road bicycle racing stage race that is one of the three "Grand Tours" of Europe and part of the UCI World Ranking calendar. The race lasts three weeks and attracts cyclists from around the world. The race is broken into day-long segments, called stages...
to the International Court of Arbitration for Sport
Court of Arbitration for Sport
The Court of Arbitration for Sport is an international arbitration body set up to settle disputes related to sport. Its headquarters are in Lausanne and its courts are located in New York, Sydney and Lausanne, Switzerland...
but his appeal was denied. Hamilton's lawyers proposed Hamilton may be a genetic chimera
Chimera (genetics)
A chimera or chimaera is a single organism that is composed of two or more different populations of genetically distinct cells that originated from different zygotes involved in sexual reproduction. If the different cells have emerged from the same zygote, the organism is called a mosaic...
or have had a 'vanishing twin
Vanishing twin
A vanishing twin, also known as fetal resorption, is a fetus in a multi-gestation pregnancy which dies in utero and is then partially or completely reabsorbed by the mother or twin....
' to explain the presence of RBCs from more than one person. While theoretically possible, these explanations were ruled to be of 'negligible probability'.
The Operación Puerto case
Operación Puerto doping case
Operación Puerto is the code name of a Spanish Police operation against the doping network of Doctor Eufemiano Fuentes, started in May 2006, which resulted in a scandal that involved several of the world most famous cyclists at the time.Media attention has focused on the small number of...
in 2006 involved allegations of doping and blood doping of hundreds of athletes in Spain.
Tour de France
Tour de France
The Tour de France is an annual bicycle race held in France and nearby countries. First staged in 1903, the race covers more than and lasts three weeks. As the best known and most prestigious of cycling's three "Grand Tours", the Tour de France attracts riders and teams from around the world. The...
rider Alexander Vinokourov
Alexander Vinokourov
Alexander Nikolaevich Vinokourov, also written Alexandre Vinokourov, is an ethnically Russian Kazakhstani professional road bicycle racer who currently competes with the UCI ProTeam Astana...
, of the Astana Team
Astana Team
Astana is a professional road bicycle racing team sponsored by the Astana group, a coalition of state-owned companies from Kazakhstan and named after its capital city Astana. Astana attained UCI ProTeam status in its inaugural year, 2007...
, tested positive for two different blood cell populations and thus for homologous transfusion, according to various news reports on July 24, 2007. Vinokourov was tested after his victory in the 13th stage time trial of the Tour on July 21, 2007. A doping test is not considered to be positive until a second sample is tested to confirm the first. Vinokourov's B sample has now tested positive, and he faces a possible suspension of 2 years and a fine equal to one year's salary. He also tested positive after stage 15.
Vinokourov's teammate Andrej Kashechkin also tested positive for homologous blood doping on August 1, 2007, just a few days after the conclusion of the 2007 Tour de France
2007 Tour de France
The 2007 Tour de France, the 94th running of the race, took place from 7 July to 29 July 2007. The Tour began with a prologue in London, and ended with the traditional finish in Paris. Along the way, the route also passed through Belgium and Spain...
(a race that had been dominated by doping scandals
Doping at the 2007 Tour de France
The 2007 Tour de France was affected by a series of scandals and speculations related to doping. By the end of the Tour, two cyclists were dismissed for testing positive, the wearer of the yellow jersey was voluntarily retired by his team for lying about his whereabouts and missing doping tests...
). His team withdrew after the revelation that Vinokourov had doped.
According to Russian investigators, 19-year-old New York Rangers
New York Rangers
The New York Rangers are a professional ice hockey team based in the borough of Manhattan in New York, New York, USA. They are members of the Atlantic Division of the Eastern Conference of the National Hockey League . Playing their home games at Madison Square Garden, the Rangers are one of the...
prospect and Russian hockey player Alexei Cherepanov
Alexei Cherepanov
Alexei Andreyevich Cherepanov was a Russian professional ice hockey winger who played for Avangard Omsk of the Kontinental Hockey League . The New York Rangers of the National Hockey League drafted Cherepanov with their first selection, seventeenth overall, in the 2007 NHL Entry Draft...
was engaged in blood doping for several months before he died on October 13, 2008, after collapsing on the bench during a game in Russia. He also had myocarditis
Myocarditis
Myocarditis is inflammation of heart muscle . It resembles a heart attack but coronary arteries are not blocked.Myocarditis is most often due to infection by common viruses, such as parvovirus B19, less commonly non-viral pathogens such as Borrelia burgdorferi or Trypanosoma cruzi, or as a...
.
The German speed skater and five-fold Olympic gold medalist Claudia Pechstein
Claudia Pechstein
Claudia Pechstein is a German speed skater. With a total of five Olympic gold medals, two silver, and two bronze medals, she is the most successful German Winter Olympian of all time...
was banned for two years in 2009 for alleged blood doping, based on irregular levels of reticulocyte
Reticulocyte
Reticulocytes are immature red blood cells, typically composing about 1% of the red cells in the human body.Reticulocytes develop and mature in the red bone marrow and then circulate for about a day in the blood stream before developing into mature red blood cells. Like mature red blood cells,...
s in her blood; these levels were always highest during competitions. This can be read in many newspapers. However, it is not true. Instead of, mean reticulocyte count of the ten years from 2000 to 2009 was 2.1% during top events like Olympic Games and during world championships. At world cup races the mean reticulocyte was 1.9% and during training phases 2.0%. The Court of Arbitration for Sport
Court of Arbitration for Sport
The Court of Arbitration for Sport is an international arbitration body set up to settle disputes related to sport. Its headquarters are in Lausanne and its courts are located in New York, Sydney and Lausanne, Switzerland...
confirmed the ban in November 2009.
On May 20, 2011 Tyler Hamilton turned in his 2004 Olympic Gold Medal to the U.S. Anti-Doping Agency after admitting to doping in a 60 Minutes interview.
Preventive measures
It was revealed in autumn 2007, following another troubled year for professional cycling, that the sport's governing body (UCI) would introduce mandatory "blood passports" for all professional riders. The scheme, thought to be the first of its type in any sport, involves using blood and urineUrine
Urine is a typically sterile liquid by-product of the body that is secreted by the kidneys through a process called urination and excreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream...
samples to create a medical profile that could be compared to results of subsequent doping tests. Former World Anti-Doping Agency
World Anti-Doping Agency
The World Anti-Doping Agency , , is an independent foundation created through a collective initiative led by the International Olympic Committee . It was set up on November 10, 1999 in Lausanne, Switzerland, as a result of what was called the "Declaration of Lausanne", to promote, coordinate and...
(WADA) President Dick Pound
Dick Pound
Richard William Duncan Pound, is a Canadian lawyer, partner of the law firm Stikeman Elliott, the former president of the World Anti-Doping Agency based in Montreal, and former chancellor of McGill University...
stated his belief that anti-doping passports would be in widespread use within three years.
Negative effects
The simple act of increasing the number of RBCs in blood raises its viscosity, which can cause it to clot or coagulate more readily. This increases the chances of heart attack, stroke, and pulmonary embolism, which has been seen in cases where there is too much blood reintroduced into the blood stream. Among factors that govern blood flow, however, viscosity is of relatively minor importance except in extreme circumstances or in patients with vascular disease. The Hagen–Poiseuille equation for blood flow states that any change in blood viscosity affects blood flow 16-fold less than a proportionate change in vessel radius, and therefore polycythemia is unlikely to be harmful except in certain circumstances.Blood contamination during preparation or storage is another issue. Contamination was seen in 1 in every 500,000 transfusions of RBC in 2002. Blood contamination can lead to sepsis or an infection that affects the whole body.
Certain medications used to increase RBCs can reduce liver function and lead to liver failure, pituitary problems, and increases in cholesterol levels.