Int J Sports Med 2012; 33(06): 502
DOI: 10.1055/s-0032-1312625
Letter to the Editor
© Georg Thieme Verlag KG Stuttgart · New York

Hbmass for Anti-Doping Purposes Should be Assessed in Combination with Hemoglobin and Blood Volume

F. Sanchis-Gomar
,
G. Lippi
Further Information

Publication History

Publication Date:
29 May 2012 (online)

In a recent article, Eastwood et al. showed that detraining decreases hemoglobin mass (Hbmass) in triathletes [3]. Recently, Hbmass assessment has been suggested as an anti-doping approach to identify blood doping including the use of erythropoiesis stimulating agents or autologous blood transfusions [4] [8] [9]. Hbmass is not sensitive to plasma volume changes and is crucial to detect cheating, since it is not affected by artificial hemodilution. Nevertheless, the decrease in hemoglobin [Hb] with training parallels the disproportionately large expansion in plasma blood volume that occurs in endurance sports [3] [7] [10]. As was shown in Table 2 of the Eastwood et al. manuscript [3], the decrease of Hbmass is mainly sustained by a reduction of blood volume since Hb increases from pre values at all study points.

Although important progress has been made on the appropriate application of Hbmass for anti-doping testing, so that this parameter appears sufficiently accurate to be introduced [1], some drawbacks still exist, such as the poor standardization and lack of quality control assessment which emerged recently. Interestingly, Garvican et al. showed that Hbmass remains stable over 6 days of racing in professional cyclists [5]. In another study, the same team of authors reported that Hbmass decreases by approximately 3% in female cyclists during a competitive season [6]. Eastwood et al. failed to observe any significant variation in Hbmass after 40 days of physical activity in previously untrained adults [2], while Ulrich et al. did not observe any difference in Hbmass in endurance-trained and non-endurance-trained adolescent athletes after 6, 12 and 18 months of regular training [11].

The identification of artificial hemodilution is critical to detect blood doping in sport, as it is the natural blood volume expansion induced by training. Thus, Hbmass is likely to become an important and crucial weapon in anti-doping testing. In our opinion, however, Hbmass measurement should be assessed in combination with [Hb] and blood volume to prevent misinterpretations due to blood volume changes induced by athletes training load or detraining, as shown by Eastwood and colleagues, as it would provide a reliable clue to discriminate between licit or illicit haemoglobin changes in elite athletes.

 
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