Haematological Testing to Fight Blood Doping Response - Letter to the Editors: Haematological Testing and Antidoping Policies

Dear Editors,

For nearly a decade, blood tests have been performed by some national/international federations before or during major competitions to fight blood doping and especially recombinant erythropoietin abuse (rhEPO) [[1]]. At the beginning, these tests were introduced mainly for health purposes to avoid athletes taking part in competitions with haematocrit levels well above normal and potentially dangerous to health. At that time, no urinary direct detection test was available and haematocrit determination was the easiest way to avoid and limit rhEPO abuse [[2]]. With the introduction in 2000 of the direct detection test of rhEPO in urine [[3]], blood tests have mostly been performed to identify and select athletes manipulating their blood formulae via rhEPO injections or blood transfusion [[4]]. In this way, it is possible to limit the amount of anti-doping tests being performed - these tests are very expensive and time consuming -, because mainly those athletes demonstrating abnormal haemograms or blood profiles (haemogram variations over time) are targeted and have to go through proper anti-doping tests.

In order to observe abnormal haemograms or blood profiles, the International Cycling Federation (UCI) notably has taken quite a few precautions to standardize as much as possible analytical and pre-analytical conditions. In summary, athletes have blood withdrawn usually before breakfast between 6.30 and 9.30 am [[5]]. UCI' s officials call the athletes to be tested and within less than 10 minutes, they must be in the collection room (usually a conference room located in the same hotel where the athletes are). The different phases of sample collection and the material used are highly standardized: athletes are in a sitting position [[6]], blood is drawn from the antecubital region, tourniquet placement is less than 45 s and two independent samples are withdrawn (K₂EDTA tubes: 2 × 2.7 ml; straight needle: 21-gauge, 0.8 × 38 mm Sarstedt®) [[7]]. Blood samples are then stored in a refrigerated bag and transported as quickly as possible to the hotel where the mobile laboratory is located [[8]]. Prior to the analyzes, all blood samples are homogenized for a minimum period of 15 minutes. The time delay between the blood collection and analysis is far less than two hours.

In the article recently published on this journal [[9]], we demonstrated the necessity of standardization of the whole analytical process. At that time, we did not talk about the delicate process of sample collection and handling and this was not a unacceptable omission, because this was not the aim of the article. On the other hand, this does not mean pre-analytical conditions were not standardized, because these latter eventually have more influence on the return of the results than a lack of analytical standardization. For that reason, and in agreement with the literature, special attention was spent on the period of blood collection, the position of the athlete during the venipuncture, the time of tourniquet placing, the blood drawing technique, sample conservation and time delay between blood collection and analysis. As we know, physical workload can also induce haematological variations; blood samples collected at different periods of the year, at the beginning or the end of stage races can potentially demonstrate significant variations [[10], [11]]. As most of the cyclists compete more than two hundred days a year, there would hardly be any optimal period for blood collection. As it is not reasonable to conduct blood controls only during let us call it the “optimal period”, UCI' s authorities take into consideration these variations notably at the time of blood profile analyses of specific athletes. In this way, the federation has a cheap and efficient screening tool to identify those athletes manipulating their blood formulae. This is certainly the future of anti-doping testing, that is to say have low cost targeting tests in blood or in urine and then perform proper validated anti-doping tests only for those athletes having abnormal values.

References

• 1 Casoni I, Ricci G, Ballarin E, Borsetto C, Grazzi G, Guglielmini C, Manfredini F, Mazzoni G, Patracchini M, De Paoli Vitali E. et al . Hematological indices of erythropoietin administration in athletes.  Int J Sports Med. 1993;  14 307-311
• 2 Berglund B. Development of techniques for the detection of blood doping in sport.  Sports Med. 1988;  5 127-135
• 3 Lasne F, de Ceaurriz J. Recombinant erythropoietin in urine.  Nature. 2000;  8 635
• 4 Gore C J, Parisotto R, Ashenden M J, Stray-Gundersen J, Sharpe K, Hopkins W, Emslie K R, Howe C, Trout G J, Kazlauskas R, Hahn A G. Second-generation blood tests to detect erythropoietin abuse by athletes.  Haematologica. 2003;  88 333-344
• 5 Robinson N, Saugy M, Mangin P. Effects of exercise on the secondary blood markers commonly used to suspect erythropoietin doping.  Clin Lab. 2003;  49 57-62
• 6 Leppänen E A, Gräsbeck R. Experimental basis of standardized specimen collection: effect of posture on blood picture.  Eur J Haematol. 1988;  40 222-226
• 7 Junge B, Hoffmeister H, Feddersen H M, Rocker L. Standardisation of obtaining blood samples: influence of tourniquet application on 33 constituents of blood and serum.  Dtsch Med Wochenschr. 1978;  103 260-265
• 8 Robinson N, Mangin P, Saugy M. Time and temperature dependant changes in red blood cell analytes used for testing recombinant erythropoietin abuse in sports.  Clin Lab. 2004;  50 317-323
• 9 Robinson N, Schattenberg L, Zorzoli M, Mangin P, Saugy M. Haematological analysis conducted at the departure of the Tour de France 2001.  Int J Sports Med. 2005;  26 200-207
• 10 Wilkinson J G, Martin D T, Adams A A, Liebman M. Iron status in cyclists during high-intensity interval training and recovery.  Int J Sports Med. 2002;  23 544-548
• 11 Lippi G, Franchini M, Guidi G. Haematocrit measurement and antidoping policies.  Clin Lab Haematol. 2002;  24 65-66