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Blood doping is a form of doping in which the number of red blood cells in the bloodstream is boosted in order to enhance athletic performance. Because such blood cells carry
oxygen Oxygen is the chemical element with the symbol O and atomic number 8. It is a member of the chalcogen group in the periodic table, a highly reactive nonmetal, and an oxidizing agent that readily forms oxides with most elements as wel ...
from the
lung The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of t ...
s to the
muscle Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of muscl ...
s, a higher concentration in the blood can improve an athlete's
aerobic capacity VO2 max (also maximal oxygen consumption, maximal oxygen uptake or maximal aerobic capacity) is the maximum rate of oxygen consumption attainable during physical exertion. The name is derived from three abbreviations: "V̇" for volume (the dot ap ...
(VO2 max) and
endurance Endurance (also related to sufferance, resilience, constitution, fortitude, and hardiness) is the ability of an organism to exert itself and remain active for a long period of time, as well as its ability to resist, withstand, recover from an ...
. Blood doping can be achieved by making the body produce more red blood cells itself using drugs, giving
blood transfusion Blood transfusion is the process of transferring blood products into a person's circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used whole blood, but mo ...
s either from another person or back to the same individual, or by using blood substitutes. Many methods of blood doping are illegal, particularly in professional sports where it is considered to give an artificial advantage to the competitor. Anti-doping agencies use tests to try to identify individuals who have been blood doping using a number of methods, typically by analysing blood samples from the competitors.


History

Blood doping is defined as the use of illicit products (e.g.
erythropoietin Erythropoietin (; EPO), also known as erythropoetin, haematopoietin, or haemopoietin, is a glycoprotein cytokine secreted mainly by the kidneys in response to cellular hypoxia; it stimulates red blood cell production (erythropoiesis) in the bo ...
(EPO), darbepoetin-alfa,
hypoxia-inducible factor Hypoxia-inducible factors (HIFs) are transcription factors that respond to decreases in available oxygen in the cellular environment, or hypoxia. They are only present in parahoxozoan animals. Discovery The HIF transcriptional complex w ...
(HIF) stabilizers) and methods (e.g. increase aerobic capacity by maximizing the uptake of O2) in order to enhance the O2 transport of the body to the muscles. The body undergoes aerobic respiration in order to provide sufficient delivery of O2 to the exercising skeletal muscles and the main determining factors are shown in figure 1. The rate of maximum O2 uptake (O2max) depends on cardiac output, O2 extraction and hemoglobin mass. The cardiac output of an athlete is difficult to manipulate during competitions and the distribution of cardiac output is at the maximum rate (i.e. 80%) during competitions. In addition, the O2 extraction is approximately 90% at maximal exercise. Therefore, the only method to enhance the physical performance left is to increase the O2 content in the artery by enhancing the hemoglobin mass. In other words, hemoglobin concentration and blood volume contribute to hemoglobin mass.


Methods


Drug treatments

Many forms of blood doping stem from the misuse of pharmaceuticals. These drug treatments have been created for clinical use to increase the oxygen delivery when the human body is not able to do so naturally.


Erythropoietin

Erythropoietin Erythropoietin (; EPO), also known as erythropoetin, haematopoietin, or haemopoietin, is a glycoprotein cytokine secreted mainly by the kidneys in response to cellular hypoxia; it stimulates red blood cell production (erythropoiesis) in the bo ...
(EPO) is a glycoprotein hormone produced by the interstitial fibroblasts in the kidney that signal for erythropoiesis in bone marrow. The increased activity of a hemocytoblast (RBC stem cell) allows the blood to have a greater carrying capacity for oxygen. EPO was first developed to counteract the effects of chemotherapy and radiation therapy for cancer patients. EPO also stimulates increased wound healing. Because of its physiological side effects, particularly increased hematocrit, EPO has become a drug with abuse potential by professional and amateur cyclists.


Hypoxia-inducible factor (HIF) stabilizer

Hypoxia-inducible factor stabilizer (HIF stabilizer) is a pharmaceutical used to treat chronic kidney disease. Like most transcription factors, the HIF transcription factor is responsible for the expression of a protein. The HIF stabilizer activates the activity of EPO due to anemia induced hypoxia, metabolic stress, and vasculogenesis—the creation of new blood vessels. HIF stabilizers as used by cyclists in combination with cobalt chloride/desferrioxamine stimulate and de-regulate the natural production of erythropoietin hormone. At physiologically low PaO2 around 40 mmHg, EPO is released from the kidneys to increase hemoglobin transportation. The combination of drugs consistently releases EPO due to increased transcription at the cellular level. The effect wears off when the HIF stabilizers, cobalt chloride/desferrioxamine is excreted and/or decayed by the body.


Myo-inositol trispyrophosphate (ITPP)

Myo-inositol trispyrophosphate Myo-inositol trispyrophosphate (ITPP) is an inositol phosphate, a pyrophosphate, a drug candidate, and a putative performance-enhancing substance, which exerts its biological effects by increasing tissue oxygenation. Chemistry ITPP is a pyrophosp ...
(ITPP), also known as compound number OXY111A, is an
allosteric effector In biochemistry, an effector molecule is usually a small molecule that selectively binds to a protein and regulates its biological activity. In this manner, effector molecules act as ligands that can increase or decrease enzyme activity, gen ...
of hemoglobin which causes a rightward shift in the
oxygen–hemoglobin dissociation curve The oxygen–hemoglobin dissociation curve, also called the oxyhemoglobin dissociation curve or oxygen dissociation curve (ODC), is a curve that plots the proportion of hemoglobin in its saturated (oxygen-laden) form on the vertical axis against ...
, increasing the amount of oxygen released from red blood cells into surrounding tissue during each passage through the cardiovascular system. ITPP has been a subject of anti-doping research in both humans and
racehorses Horse racing is an equestrian performance sport, typically involving two or more horses ridden by jockeys (or sometimes driven without riders) over a set distance for competition. It is one of the most ancient of all sports, as its basic pr ...
.


Blood transfusion

Blood transfusions can be traditionally classified as
autologous Autotransplantation is the transplantation of organs, tissues, or even particular proteins from one part of the body to another in the same person ('' auto-'' meaning "self" in Greek). The autologous tissue (also called autogenous, autogenei ...
, where the blood donor and transfusion recipient are the same, or as
allogeneic Allotransplant (''allo-'' meaning "other" in Greek) is the transplantation of cells, tissues, or organs to a recipient from a genetically non-identical donor of the same species. The transplant is called an allograft, allogeneic transplant, o ...
/homologous, where the blood is transfused into someone other than the donor. Blood transfusion begins by the withdrawal of 1 to 4 units of blood (1 unit = 450 mL of blood) several weeks before competition. The blood is centrifuged, the plasma components are immediately reinfused, and the corpuscular elements, principally red blood cells (RBCs), are stored refrigerated at 4 °C or frozen at −80 °C.McArdle WD, Katch FI, Katch VL. "Exercise Physiology". In McArdle WD, Katch FI, Katch VL, Eds. ''Energy, Nutrition, and Human Performance''. 2nd Ed. pp. 409–411. Philadelphia: Lea and Febiger, 1986. As blood stored by refrigeration displays a steady decline in the number of RBCs, a substantial percentage, up to 40%, of the stored RBCs may not be viable. The freezing process, conversely, limits the aging of the cells, allowing the storage of the blood for up to 10 years with a 10% to 15% loss of RBCs. Stored RBCs are then reinfused, usually 1 to 7 days before a high-endurance event. As a significant amount of iron is removed by each autologous transfusion, an adequate time for recovery of not less than 3 days from the last donation, and appropriate iron supplements, are usually required for patients undergoing autologous donations. Nearly 50% of autologous donations are not used by the donor and are discarded, as current standards do not allow transfusion of these units to another patient for safety reasons.


Blood substitutes

Biochemical and biotechnological development has allowed novel approaches to this issue, in the form of engineered O2 carriers, widely known as "blood substitutes". The blood substitutes currently available are chiefly polymerized haemoglobin solutions or haemoglobin-based oxygen carriers (HBOCs) and perfluorocarbons (PFCs).


Hemoglobin-based oxygen carriers (HBOCs)

Hemoglobin-based oxygen carriers A blood substitute (also called artificial blood or blood surrogate) is a substance used to mimic and fulfill some functions of biological blood. It aims to provide an alternative to blood transfusion, which is transferring blood or blood-based ...
are intra/ inter-molecularly engineered human or animal hemoglobins, only optimized for oxygen delivery and longer intravascular circulation. The presence of 2,3-diphosphoglycerate within erythrocytes maintains the normal affinity of hemoglobin for oxygen. HBOCs do not contain erythrocytes and lose this interaction, thus, unmodified human HBOC solutions have a very high oxygen affinity which compromises their function. Chemical methods developed to overcome this problem have resulted in carriers that effectively release oxygen at the physiological pO2 of peripheral tissues. A common feature of all HBOCs is their resistance to dissociate when dissolved in media, which contrasts hemoglobin of natural dissociation under non-physiological conditions. HBOCs may hypothetically supply greater benefits to athletes than those provided by the equivalent hemoglobin in traditional RBC infusion. Recent developments have shown that HBOCs are not only simple RBC substitutes, but highly effective O2 donors in terms of tissue oxygenation. Additional effects include increases in blood serum iron,
ferritin Ferritin is a universal intracellular protein that stores iron and releases it in a controlled fashion. The protein is produced by almost all living organisms, including archaea, bacteria, algae, higher plants, and animals. It is the primary ' ...
, and Epo; up to 20% increased diffusion of oxygen and improved exercise capacity; increased CO2 production; and lower lactic acid generation in anaerobic activity. HBOCs have been shown in trials to be extremely dangerous in humans. Because HBOCs increase both the risk of death and risk of myocardial infarction clinical trials were ended. They are not commercially available in the US or Europe and there is no approved use for them.


Perfluorocarbons (PFCs)

PFCs, also known as
fluorocarbons Fluorocarbons are chemical compounds with carbon-fluorine bonds. Compounds that contain many C-F bonds often has distinctive properties, e.g., enhanced stability, volatility, and hydrophobicity. Fluorocarbons and their derivatives are commerci ...
, are inert, water-insoluble, synthetic compounds, consisting primarily of carbon and fluorine atoms bonded together in strong C–F bonds. PFCs are substantially clear and colorless liquid emulsions that are heterogeneous in molecular weight, surface area, electronic charge, and viscosity; their high content of electron-dense fluorine atoms results in little intramolecular interaction and low surface tension, making such substances excellent solvents for gases, especially oxygen and carbon dioxide. Some of these molecules can dissolve 100 times more oxygen than plasma. PFCs are naturally hydrophobic and need to be emulsified to be injected intravenously. Since PFCs dissolve rather than bind oxygen, their capacity to serve as a blood substitute is determined principally by the pO2 gradients in the lung and at the target tissue. Therefore, their oxygen transport properties differ substantially from those of whole blood and, especially, from those of RBCs. At a conventional ambient pO2 of 135 mmHg, the oxygen content of 900 mL/L perfluorocarbon is less than 50 mL/L, whereas an optimal oxygen content of 160 mL/L, which is still lower than that of whole blood in normal conditions, can be achieved only by a pO2 greater than 500 mmHg. In practice, at a conventional alveolar pO2 of 135 mmHg, PFCs will not be able to provide sufficient oxygenation to peripheral tissues. Due to their small size, PFCs are able to permeate circulation where erythrocytes may not flow. In tiny capillaries, PFCs produce the greatest benefit, as they increase local oxygen delivery much more efficiently than would be expected from the increase in oxygen content in larger arteries. In addition, as gases are in the dissolved state within PFCs, it pO2 promotes efficient oxygen delivery to peripheral tissues. Since the mid-1980s, improvements in both oxygen capacity and emulsion properties of PFCs have led to the development of second-generation PFC-based oxygen carriers; two PFC products are currently being tested in phase III clinical trials.


Cobalt chloride administration

Transition metal complexes are widely known to play important roles in
erythropoiesis Erythropoiesis (from Greek 'erythro' meaning "red" and 'poiesis' "to make") is the process which produces red blood cells (erythrocytes), which is the development from erythropoietic stem cell to mature red blood cell. It is stimulated by decrea ...
; as such, inorganic supplementation is proving to be an emerging technique in blood doping. Particularly of note is the cobalt complex,
cobalamin Vitamin B12, also known as cobalamin, is a water-soluble vitamin involved in metabolism. It is one of eight B vitamins. It is required by animals, which use it as a cofactor in DNA synthesis, in both fatty acid and amino acid metabolism. ...
(Vitamin B12) commonly used as a dietary supplement. Cobalamin is an important complex used in the manufacture of red blood cells and thus was of interest for potential use in blood doping. Experimental evidence, however, has shown that cobalamin has no effect on erythropoiesis in the absence of a red blood cell/oxygen deficiency. These results seem to confirm much of what is already known about the functioning of cobalamin. The signaling pathway that induces erythropoietin secretion and subsequently red blood cell manufacture using cobalamin is O2 dependent. Erythropoietin is only secreted in the kidneys when there is an O2 deficiency, as such, RBC manufacture is independent of the amount of cobalamin administered when there is no O2 deficiency. Accordingly, cobalamin is of little to no value in blood doping. More potent for use in blood doping is Co2+ (administered as
Cobalt(II) chloride Cobalt(II) chloride is an inorganic compound of cobalt and chlorine, with the formula . The compound forms several hydrates ·''n'', for ''n'' = 1, 2, 6, and 9. Claims of the formation of tri- and tetrahydrates have not been confirmed.M. T. Saug ...
, CoCl2). Cobalt chloride has been known to be useful in treating anemic patients. Recent experimental evidence has proved the efficacy of cobalt chloride in blood doping. Studies into the action of this species have shown that Co2+ induces hypoxia like responses, the most relevant response being erythropoiesis. Co2+ induces this response by binding to the
N-terminus The N-terminus (also known as the amino-terminus, NH2-terminus, N-terminal end or amine-terminus) is the start of a protein or polypeptide, referring to the free amine group (-NH2) located at the end of a polypeptide. Within a peptide, the ami ...
(loop helix loop domain) of the Hypoxia inducing transcription factors HIF-1α and HIF-2α, and thus stabilizes these protein complexes. Under normal O2 conditions, HIFs are destabilized as proline and asparagine residues are hydroxylated by HIF-α hydroxylases, these unstable HIFs are subsequently degraded following a ubiquitin-proteosome pathway, as such, they cannot then bind and activate transcription of genes encoding Erythropoietin (EPO). With Co2+ stabilization, degradation is prevented and genes encoding EPO can then be activated. The mechanism for this Co2+ N terminus stabilization is not yet fully understood. In addition to N-terminus binding, it has also been hypothesized that replacement of Fe2+ by Co2+ in the hydroxylase active site could be a contributing factor to the stabilizing action of Co2+. It is understood however, is that Co2+ binding permits Ubiquitin binding but prevents proteosomal degradation.


Detection of blood doping


Detection for homologous blood doping

In 2004, a test for detection allogeneic/homologous blood transfusion doping was implemented.
Flow cytometry Flow cytometry (FC) is a technique used to detect and measure physical and chemical characteristics of a population of cells or particles. In this process, a sample containing cells or particles is suspended in a fluid and injected into the flo ...
is the method of choice. 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. The test utilizes 12 antisera directed against the blood group antigens, obtained from donor plasma. The antigens are labeled with secondary antibodies, which are conjugated with phycoerythrin to label IgG or IgM-coated RBCs and enhance the detection by flow cytometry The
flow cytometry Flow cytometry (FC) is a technique used to detect and measure physical and chemical characteristics of a population of cells or particles. In this process, a sample containing cells or particles is suspended in a fluid and injected into the flo ...
is able to detect minor variance in blood group antigens. The assessment was able to distinguish the blood of subjects who had earlier received at least one unit of allogeneic blood. This technique is able to detect small (<5%) populations of cells that are antigenically distinct from an individual's own RBCs.


Detection for autologous blood doping

Autologous blood doping detection is done indirectly via CO rebreathing technique to measure the nonphysiologic increases in Hb mass. The principle of CO rebreathing method used currently requires an O2-CO gas mixture inhalation for about 10-15mins. By measuring the difference in
carboxyhemoglobin Carboxyhemoglobin (carboxyhaemoglobin BrE) (symbol COHb or HbCO) is a stable complex of carbon monoxide and hemoglobin (Hb) that forms in red blood cells upon contact with carbon monoxide. Carboxyhemoglobin is often mistaken for the compound fo ...
concentration (HbCO) before and after rebreathing, the volume of CO and the binding capacity of Hb for CO ( 1.39ml g-1), total Hb mass can be calculated. This detection method is problematic for an athlete as it is not desirable to breathe in CO shortly before a competition, which may potentially affect their performances.


Detection of blood hemoglobin-based oxygen carrier

Detection method for hemoglobin-based oxygen carriers (i.e. Oxyglobulin) is done in four separate steps. Step one involves the elimination of abundance proteins in the blood samples by immunodepletion (i.e. Proteo Prep 20 plasma immunodepletion kit). This process ensures that other proteins (i.e. albumin and immunoglobulin) do not interfere with
capillary electrophoresis Capillary electrophoresis (CE) is a family of electrokinetic separation methods performed in submillimeter diameter capillaries and in micro- and nanofluidic channels. Very often, CE refers to capillary zone electrophoresis (CZE), but other elect ...
(CE) separation by changing the ionization. Second step, CE separation is done under certain condition, in this case background electrolyte consisting of ammonium formate (75mM at pH 9.5) in order to provide sufficient resolution between HBOC and Hb. Third step, UV/Vis detection was performed at 415 nm to selectively detect HBOC and HB. Fourth step,
time-of-flight Time of flight (ToF) is the measurement of the time taken by an object, particle or wave (be it acoustic, electromagnetic, etc.) to travel a distance through a medium. This information can then be used to measure velocity or path length, or as a w ...
or
mass spectrometer Mass spectrometry (MS) is an analytical technique that is used to measure the mass-to-charge ratio of ions. The results are presented as a '' mass spectrum'', a plot of intensity as a function of the mass-to-charge ratio. Mass spectrometry is us ...
allowed increased accuracy in selectivity between hemoproteins and other proteins and definite determination of HBOC uptake. The detection limits for CE-UV/Vis at 415 nm and CE-ESI-TOF/MS results to be 0.20 and 0.45g/dL for plasma respectively.


Detection of cobalt concentration by utilizing the biokinetic model

Cobalt can be detected by laboratory blood analysis if the intake amount is greater than 400 μg per day. As the whole blood concentration is greater than 1 μg/L and the urinary concentration is greater than 10 μg/L after at least 10 days of administration. The dose, which increases the red blood cell production to approximately 16%-21%, is about 68 mg Co per day for at least 10 days of oral administration. The predicted whole blood concentration of cobalt exceeds 200 μg/L two hours after the last intake and the average urine concentrations of cobalt exceed 3000 μg/L within 24 hours of intake. A study was carried out where 23 subjects were to take 900 μg per day in the form of CoCl2 for 10 days. The model predictions were then compared to the study. The result shows that the model prediction for blood and urine are between the median concentration of the male and female groups, which indicate the model predictions sufficiently represent the test population as a whole.


Military use

As early as 1947, military research scientists were studying ways to increase fighter pilots' tolerance for hypoxia at high altitude. In one such study, red blood cells were transfused into ten males at the US Naval Research facility, resulting in increased oxygen capacity. In 1993, U.S. Special Forces 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. 24 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 Organisation The Defence Science and Technology Group (DSTG) is part of the Australian Department of Defence dedicated to providing science and technology support to safeguard Australia and its national interests. The agency's name was changed from Defenc ...
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. In this study, over 50 performance-enhancing drugs and techniques were rejected. The six that were approved are
caffeine Caffeine is a central nervous system (CNS) stimulant of the methylxanthine class. It is mainly used recreationally as a cognitive enhancer, increasing alertness and attentional performance. Caffeine acts by blocking binding of adenosine t ...
,
ephedrine Ephedrine is a central nervous system (CNS) stimulant that is often used to prevent low blood pressure during anesthesia. It has also been used for asthma, narcolepsy, and obesity but is not the preferred treatment. It is of unclear benefit in ...
, energy drinks, modafinil,
creatine Creatine ( or ) is an organic compound with the nominal formula (H2N)(HN)CN(CH3)CH2CO2H. It exists in various modifications (tautomers) in solution. Creatine is found in vertebrates where it facilitates recycling of adenosine triphosphate ( ...
, and blood-loading.


Notable blood doping cases

Blood doping started in the late 1960s but was not outlawed until 1986. While it was still legal, it was commonly used by middle and long-distance runners. The first known case of blood doping occurred at the
1980 Summer Olympics The 1980 Summer Olympics (russian: Летние Олимпийские игры 1980, Letniye Olimpiyskiye igry 1980), officially known as the Games of the XXII Olympiad (russian: Игры XXII Олимпиады, Igry XXII Olimpiady) and commo ...
in Moscow as
Kaarlo Maaninka Kaarlo Hannes Maaninka (born 25 December 1953) is a Finnish former long-distance runner who won a silver medal in the 10,000 metres and a bronze medal in the 5,000 metres at the 1980 Moscow Olympics. He later admitted that he had used blood tran ...
was transfused with two pints of blood before winning medals in the 5 and 10 kilometer track races, though this was not against the rules at the time. Cyclist
Joop Zoetemelk Hendrik Gerardus Joseph "Joop" Zoetemelk (; born 3 December 1946) is a Dutch former professional racing cyclist. He started and finished the Tour de France 16 times, which were both records when he retired. He also holds the distance record in T ...
admitted to receiving blood transfusions during the 1976 Tour de France, where he finished second, although he claimed that these were intended to treat his anaemia rather than enhance his performance. In the same year cyclist
Francesco Moser Francesco Moser ( or ; ; born 19 June 1951), nicknamed "Lo sceriffo" (The sheriff), is an Italian former professional road bicycle racer. He finished on the podium of the Giro d'Italia six times including his win in the 1984 edition. Moser wa ...
used blood transfusions to prepare for his successful attempt to break the
hour record The hour record is the record for the longest distance cycled in one hour on a bicycle from a stationary start. Cyclists attempt this record alone on the track without other competitors present. It is considered one of the most prestigious reco ...
. "Blood doping" was banned by the
International Olympic Committee The International Olympic Committee (IOC; french: link=no, Comité international olympique, ''CIO'') is a non-governmental sports organisation based in Lausanne, Switzerland. It is constituted in the form of an association under the Swiss ...
(IOC) in 1985, though no test existed for it at the time. The Swedish cyclist
Niklas Axelsson Niklas Axelsson (born 15 May 1972) is a Swedish former professional road racing cyclist. Axelsson finished sixth during the 1999 Giro d'Italia and third in the 2000 edition of Giro di Lombardia. He is banned from sports for life for doping. Dopin ...
tested positive for EPO in 2000. The American cyclist
Tyler Hamilton Tyler Hamilton (born March 1, 1971) is an American former professional road bicycle racer. He is the only American rider to win one of the five Monuments of cycling, taking Liège–Bastogne–Liège in 2003. Hamilton became a professional cycli ...
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 The Vuelta a España (; en, Tour of Spain) is an annual multi-stage bicycle race primarily held in Spain, while also occasionally making passes through nearby countries. Inspired by the success of the Tour de France and the Giro d'Italia, the ...
to the International
Court of Arbitration for Sport The Court of Arbitration for Sport (CAS; french: Tribunal arbitral du sport, ''TAS'') is an international body established in 1984 to settle disputes related to sport through arbitration. Its headquarters are in Lausanne, Switzerland and its c ...
but his appeal was denied. Hamilton's lawyers proposed Hamilton may be a genetic
chimera Chimera, Chimaera, or Chimaira (Greek for " she-goat") originally referred to: * Chimera (mythology), a fire-breathing monster of Ancient Lycia said to combine parts from multiple animals * Mount Chimaera, a fire-spewing region of Lycia or Cilici ...
or have had a '
vanishing twin A vanishing twin, also known as twin resorption, is a fetus in a multigestation pregnancy that dies '' in utero ''and is then partially or completely reabsorbed. In some instances, the dead twin is compressed into a flattened, parchment-like st ...
' to explain the presence of red blood cells from more than one person. While theoretically possible, these explanations were ruled to be of "negligible probability".
Tour de France The Tour de France () is an annual men's multiple-stage bicycle race primarily held in France, while also occasionally passing through nearby countries. Like the other Grand Tours (the Giro d'Italia and the Vuelta a España), it consists ...
rider Alexander Vinokourov, of the
Astana Team Astana Qazaqstan Team () is a professional road bicycle racing team sponsored by the Samruk-Kazyna, a coalition of state-owned companies from Kazakhstan and named after its capital city Astana. Astana attained UCI ProTeam status in its inaugural ...
, 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 two 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 The New York Rangers are a professional ice hockey team based in the New York City borough of Manhattan. They compete in the National Hockey League (NHL) as a member of the Metropolitan Division in the Eastern Conference. The team plays its home ...
prospect and Russian hockey player
Alexei Cherepanov Alexei Andreyevich Cherepanov (russian: Алексей Андреевич Черепанов; 15 January 1989 – 13 October 2008) was a Russian professional ice hockey winger who played for Avangard Omsk of the Kontinental Hockey League (KHL) ...
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 Reticulocytes are immature red blood cells (RBCs). In the process of erythropoiesis (red blood cell formation), reticulocytes develop and mature in the bone marrow and then circulatory system, circulate for about a day in the blood stream before ...
s in her blood and the assumption that these levels were always highest during competitions. Her mean reticulocyte count over 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 The Court of Arbitration for Sport (CAS; french: Tribunal arbitral du sport, ''TAS'') is an international body established in 1984 to settle disputes related to sport through arbitration. Its headquarters are in Lausanne, Switzerland and its c ...
confirmed the ban in November 2009 in stating: "...once the possibility of a blood disease has been safely excluded...". In September 2010, the Swiss Federal Supreme Court rejected the athlete's appeal, stating that Pechstein's inherited blood anomaly had been known before ("die vererbte Blutanomalie bekannt gewesen sei"). On May 20, 2011,
Tyler Hamilton Tyler Hamilton (born March 1, 1971) is an American former professional road bicycle racer. He is the only American rider to win one of the five Monuments of cycling, taking Liège–Bastogne–Liège in 2003. Hamilton became a professional cycli ...
turned in his 2004 Olympic Gold Medal to the U.S. Anti-Doping Agency after admitting to doping in a ''
60 Minutes ''60 Minutes'' is an American television news magazine broadcast on the CBS television network. Debuting in 1968, the program was created by Don Hewitt and Bill Leonard, who chose to set it apart from other news programs by using a unique styl ...
'' interview. On August 23, 2012,
Lance Armstrong Lance Edward Armstrong ('' né'' Gunderson; born September 18, 1971) is an American former professional road racing cyclist. Regarded as a sports icon for winning the Tour de France seven consecutive times from 1999 to 2005 after recovering fr ...
was stripped of his seven Tour de France titles and banned for life by cycling's governing body following a report from the U.S. Anti-Doping Agency that accused him of leading a doping program during his cycling career. He later admitted to using banned substances including blood doping with transfusions and EPO in an interview with Oprah Winfrey on January 17, 2013. In June 2014, UFC fighter
Chael Sonnen Chael Patrick Sonnen (; born April 3, 1977) is an American submission grappling promoter, mixed martial arts (MMA) analyst, and retired mixed martial artist. Beginning his MMA career in 1997, Sonnen competed for the Ultimate Fighting Champion ...
tested positive for EPO. One month later, another UFC fighter,
Ali Bagautinov Ali Shamilevich Bagautinov (russian: Али Шами́льевич Багаутинов; born June 10, 1985 in Dagestan) is a Russian professional mixed martial artist of Dargin origin who competed in the Flyweight division of the Ultima ...
also tested positive for EPO. In February 2018, Bahraini steeplechase and 3000m steeplechase world record holder
Ruth Jebet Ruth Jebet (born 17 November 1996) is a Kenyan-born long-distance runner and steeplechase specialist who competes internationally for Bahrain. She was the world record holder and was the 2016 Olympic gold medalist in the 3000 metres steeplechase, ...
tested positive for EPO and in the 4th of March, she was suspended for 4 years.


Adverse effects

The simple act of increasing the number of red blood cells in blood may be associated with hyperviscosity syndrome which is characterized by increased blood viscosity and decreased cardiac output and blood flow velocity which results in the reduction of peripheral oxygen delivery. For instance, an overdose of EPO can thicken blood into a highly viscous and artery-clogging sludge. This increases the chances of heart attack, stroke,
phlebitis Phlebitis (or Venitis) is inflammation of a vein, usually in the legs. It most commonly occurs in superficial veins. Phlebitis often occurs in conjunction with thrombosis and is then called thrombophlebitis or superficial thrombophlebitis. Unlike ...
, and
pulmonary embolism Pulmonary embolism (PE) is a blockage of an pulmonary artery, artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (embolism). Symptoms of a PE may include dyspnea, shortness of breath, chest pain p ...
, which has been seen in cases where there is too much blood reintroduced into the blood stream. Because blood doping increases the volume of red blood cells, it effectively introduces a condition called
polycythemia Polycythemia (also known as polycythaemia) is a laboratory finding in which the hematocrit (the volume percentage of red blood cells in the blood) and/or hemoglobin concentration are increased in the blood. Polycythemia is sometimes called eryth ...
, a blood disorder that has known adverse outcomes such as heart attacks or strokes. Blood contamination during preparation or storage is another issue. Contamination was seen in 1 in every 500,000 transfusions of red blood cells in 2002. Blood contamination can lead to
sepsis Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...
or an infection that affects the whole body. Certain medications used to increase red blood cells can reduce liver function and lead to liver failure, pituitary problems, and increases in cholesterol levels.


See also

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Use of performance-enhancing drugs in the Olympic Games This article is about the history of competitors at the Olympic Games using banned athletic performance-enhancing drugs. History The use of performance-enhancing tactics or more formally known as PEDs, and more broadly, the use of any extern ...
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Boosting (doping) Boosting is a method of inducing autonomic dysreflexia with the intention of enhancing performance in sport. It can be used by an athlete with a spinal cord injury to increase their blood pressure and is performed by causing a painful stimulus in ...
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Abortion doping Abortion doping refers to the rumoured practice of purposely inducing pregnancy specifically for athletic performance-enhancing benefits, and then aborting the pregnancy. Rumours and allegations began during international sporting events in the mid ...
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Altitude training Altitude training is the practice by some endurance athletes of training for several weeks at high altitude, preferably over above sea level, though more commonly at intermediate altitudes due to the shortage of suitable high-altitude locations. A ...


References

{{DEFAULTSORT:Blood Doping Doping in sport Drugs in sport