Blood Doping

Blood Doping and its Risks

11OutlineIntroductionDiscussion of Papers RisksConclusion ReferencesQuestions 2

What is blood doping?Method of extracting ones own blood (or donor blood) only to reinsert it at a later date, usually before a big race or event.

Doping can also be used to describe any sort of injections into the body (hormones, steroids, etc.). Specifically Erythropoietin (EPO).

Athletes hope that the increase in red blood cells (RBCs) will increase the oxygen intake level in their body and lead to greater performance. 3

4Three types of blood dopingBlood transfusions

EPO

Artificial Oxygen Carriers (AOCs)55Blood TransfusionsAutologous

Homologous

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6Does it work? Seminal study by Buick et al. (1980) assessed the effect of increasing red blood cells on aerobic work capacity.

Methods: Blood was drawn from 11 highly trained male track athletes . Blood immediately separated into its cell and plasma components. Plasma returned to each subject and red blood cells are frozen.

For infusion, approximately 900 ml of autologous blood were introduced over a 1 h-period.

77Buick et al. (1980) 3 Exercise tests: Submaximal runEndurance performanceSupramaximal run

Measured expired gas to determine VO2 max, and monitored HR

Blood samples taken after termination and then at 4, 6, and 8 minutes into recovery to access Hb, Hct, and peak lactate concentration.

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Buick et al. (1980)

9Results: Significant increase in Hb, about 1g/dL or 7%, a 5% increase in VO2 max, and a 34% increase in treadmill run to exhaustion at 95% V02max

Analogous StudiesResults supported by analogous studies

Williams and Branch (2000) summarized the results of several two other studies supporting increased performance due to blood transfusion. (1) Doping cut 10km race time by 69seconds.(2)Doping cut mean 5-mile run time by 45 seconds.

1010EPOIn 1987, recombinant human erythropoietin (EPO) appeared in Europe (Eichner, 2007).

The hormone was synthetically produced originally to treat anemia.

Glycoprotein hormone produced by the kidney in response to hypoxia, including exercised induced hyperoxaemia. EPO binding its specific EPO receptor stimulates erythrocyte production in the bone marrow (Bishop-Bailey, 2013).

Consequently, the EPO increases the production of oxygen-carrying blood cells

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Does it work? Durussel et al. (2013) addressed the impact on hemoglobin mass and running performance after recombinant human erythropoietin was administered.

Methods: 19 trained men received rHuEPO injections of 50 IUxkg^-1 body mass every two days for 4 weeks. Hbmass was determined weekly using optimized carbon monoxide rebreathing method until 4 weeks after administration. VO2 max and 3,000 m time trial performance were measured pre, post administration and at the end of the study. 13Durussel et al. (2013)14

Durussel et al. (2013)

15Results Running performance was improved following 4 weeks of rHuEpo and remained elevated 4 weeks after administration compared to baseline. These field performance effects coincided with rHuEpo-induced elevated VO2 max and Hbmass. 1616Artificial Oxygen Carriers (AOCs)These are man-made substances that can bind and transport oxygen throughout the body. There are two kinds of AOCs . They are hemoglobin-based oxygen carriers (HBOCs) and perflourocarbons (PFCs).

HBOCs use chemically altered purified hemoglobin. PFCs are capable of carrying dissolved oxygen (Henkel-Hanke and Oleck, 2007).

These substances perform the same job as hemoglobin in the body except they are not limited in their amount. The bodys RBCs can only carry 4 molecules of hemoglobin where AOCs are practically limitless.17Does it work? Ashenden et al.(2007) determined the effects of Hemopure on maximal oxygen uptake and endurance performance on humans. Methods: 12 male subjects performed an exercise trial immediately after receiving Hemopure or an equivalent volume of plasma-volume expander (control).Measured oxygen uptake (VO2max), ventilation, pulse, and blood pressure. Exercise test commenced 30 minutes after infusion

18Ashenden et al. (2007)19

Ashenden et al. (2007)20

Ashenden et al. (2007)21

Results Hemopure did not increase VO2max, the most commonly used indicator of endurance performance..

Cardiovascular response(1) Decrease in heart rate(2) Increase in mean and diastolic blood pressure

2222What are the costs? In 1987, the first year of EPO release in Europe, 5 Dutch cyclists died of unexplained reasons. Between 1997 and 2000, 18 cyclists died from stroke, myocardial infarction, or pulmonary embolism (Tokish and Kosher, 2004).

The main side effect that all these types of blood doping presents is increased blood viscosity.

Blood becomes too saturated with RBCs and thickens resulting in possible blood clots. Stroke, multi-organ failure, acute respiratory distress syndrome, myocardial infarction, death, vasoconstriction with resulting hypertension (Henkel-Hanke and Oleck, 2007).

The intravenous process also carries the risk of the needles or equipment being shared, and the consequent exposure to contagious blood-borne disease such as HIV (Tokish and Kosher, 2004).

The likelihood of dehydration occurring during an endurance event is high; dehydration reduces fluid levels, with a corresponding impact on blood volume, which makes the increased viscosity, or thickness, of the blood more pronounced.

2323ConclusionBlood doping covers a range of programs, all designed to increase the number of red blood cells in the body. Blood doping aims to increase the number of red blood cells. Large increases in hematocrit can lead to dangerous increases in blood viscosity. Athletes will continue to use if any competitive advantage exists. 24References Ashenden M.J, Schumacher, Y.O., Sharpe, K., Varle-Marie, E., Audran, M.,2007. Effects of Hemopure on Maximal Oxygen Uptake and Endurance Performance in Healthy Humans. International Journal of Sports Medicine 28, 381385.

Bishop-Bailey, D., 2013. Mechanisms governing the health and performance benefits of exercise. British Journal of Pharmacology 170, 11531166.

Buick, F.J., Gledhill, H., Froese, A.B., Spriet, L., Meyers, E.C., 1980. Effect of induced erythrocythemia on aerobic capacity. Journal of Applied Physiology 48, 636642. Deligiannis, A., Bjrnstad, H., Carre, F., Heidbchel, H., Kouidi, E., Panhuyzen-Goedkoop, N.M., Pigozzi, F., Schnzer, W., Vanhees, L., 2006. ESC Study Group of Sports Cardiology Position Paper on adverse cardiovascular effects of doping in athletes; European Journal of Cardiovascular Prevention and Rehabilitation 13,687694.

Durussel, J., Daskalaki, E., Anderson, M., Chatterji, T., Wondimu, D.H., Padmanabhan, N., Patel, R.K., McClure, J., Pitsiladis, P., 2013. Haemoglobin Mass and Running Time Trial Performance after Recombinant Human Erythropoietin Administration in Men. PLoS ONE 8, e56151.

Eichner, E.R., 2007. Blood Doping: Infusions, Erythropoietin and Artificial Blood. Sports Medicine 37, 389391.

Henkel-Hanke, T., Oleck, M., 2007. Artificial oxygen carriers: A current review. American Association of Nurse Anesthetists Journal 75, 205211.

Tokish, J.M., Kocher, M.S., 2004. Ergogenic Aids: A Review of Basic Science, Performance, Side Effects, and Status in Sports. The American Journal of Sports Medicine 32, 15431553.

Williams, M.H., Branch, J.D., 2000 .Ergogenic aids for improved performance. In: Garrett, W.E., Kirkendall, D.T., (Eds). Exercise and Sport Science. Lippincott Williams and Wilkins, Philadelphia, pp.373384.

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