The Influence of the Tourniquet Time on Hematological Testing for Antidoping Purposes

Abstract

Hematological manipulation to optimize aerobic performances is a serious problem in elite and professional sports and the approach to identify blood doping is as yet challenging. In most cases, the current strategy contemplates a first stage of analysis, based on the application of arbitrary threshold for hemoglobin or hematocrit, followed by second-generation blood tests, or the adoption of an individual hematological passport. To establish the influence of preanalytical variables on the athletes' hematological profile, we compared hemoglobin, hematocrit, and reticulocytes count in 27 male professional cyclists after a mean time of 2.30 ± 0.12 tourniquet holding. Statistically significant differences were observed for hematocrit (+ 2.4 %; p < 0.001) and hemoglobin measurements (+ 1.4 %; p < 0.001), but not for the reticulocytes count (- 1.9 %; p = 0.170). In 4 out of 27 cases (15 %), the variability of the hematocrit measurement exceeded the 4.1 % desirable analytical quality specification for total error. Results of the present investigation further highlight the risk that unfulfillment of rigorous and standardized procedures for collection of blood specimens might increase the number of false positive testing and might lead to inappropriate sanctioning of a minority of clean athletes with hematocrit or hemoglobin values naturally elevated. Owing to the minor biological variability and the lesser susceptibility to variation of the preanalytical phase, the hemoglobin concentration might be a more suitable parameter than hematocrit for inclusion within laboratory testing to identify blood doping.

Sports medicine - hematocrit - hemoglobin - laboratory testing - doping

References

• 1 Leigh-Smith S. Blood boosting.  Br J Sports Med. 2004;  38 99-101
• 2 Schumacher Y O, Jankovits R, Bultermann D, Schmid A, Berg A. Hematological indices in elite cyclists.  Scand J Med Sci Sports. 2002;  12 301-308
• 3 Manfredini F, Carrabre J E, Litmanen H, Zhukovskaja L, Malagoni A M, Dal Follo D, Haberstroh J. Blood tests and fair competition: the biathlon experience.  Int J Sports Med. 2003;  24 352-358
• 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 Malcovati L, Pascutto C, Cazzola M. Hematologic passport for athletes competing in endurance sports: a feasibility study.  Haematologica. 2003;  88 570-581
• 6 Ricos C, Alvarez V, Cava F, Garcia-Lario J V, Hernandez A, Jimenez C V. et al . Current databases on biologic variation: pros, cons and progress.  Scand J Clin Lab Invest. 1999;  59 491-500
• 7 Lippi G, Franchini M, Guidi G. Second generation blood tests to detect erythropoietin abuse by athletes: effective but not preventive?.  Haematologica. 2004;  89 ELT05
• 8 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
• 9 Ashenden M J, Gore C J, Parisotto R, Sharpe K, Hopkins W G, Hahn A G. Effect of altitude on second-generation blood tests to detect erythropoietin abuse by athletes.  Haematologica. 2003;  88 1053-1062
• 10 Sharpe K, Hopkins W, Emslie K R, Howe C, Trout G J, Kazlauskas R, Ashenden M J, Gore C J, Parisotto R, Hahn A G. Development of reference ranges in elite athletes for markers of altered erythropoiesis.  Haematologica. 2002;  87 1248-1257
• 11 Lippi G, Franchini M, Guidi G. Second generation blood tests to detect erythropoietin abuse by athletes: effective but not preventive?.  Haematologica. 2004;  89 ELT05
• 12 Villarrubia J. Decision rules for hematology review. An international perspective.  Lab Hematol. 2004;  10 158-159
• 13 UCI Cycling Regulations. Part XIV: anti-doping rules of the UCI. http://www.uci.ch/imgArchive/Road/Health/14 %20 anti-E.pdf . 
• 14 The WADA World Anti-Doping Program Guidelines for blood sample collection. www.wada-ama.org/rtecontent/document/Blood%20Testing%20Guideline.pdf . 
• 15 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 Wschr. 1978;  103 260-265
• 16 Banfi G, Dolci A, Zorzino L, Longhi E, Barberis M. Comparison of 3 automatic systems for reticulocytes counts during an ultraendurance mountain marathon.  J Sports Med Phys Fitness. 2003;  43 256-257
• 17 Riley R S, Ben-Ezra J M, Tidwell A, Romagnoli G. Reticulocyte analysis by flow cytometry and other techniques.  Hematol Oncol Clin North Am. 2002;  16 373-420
• 18 Riley R S, Ben-Ezra J M, Goel R, Tidwell A. Reticulocytes and reticulocyte enumeration.  J Clin Lab Anal. 2001;  15 267-294
• 19 Lippi G, Guidi G. Laboratory screening for erythropoietin abuse in sport: an emerging challenge.  Clin Chem Lab Med. 2000;  38 13-19
• 20 Schumacher Y O, Grathwohl D, Barturen J M, Wollenweber M, Heinrich L, Schmid A, Huber G, Keul J. Haemoglobin, haematocrit and red blood cell indices in elite cyclists. Are the control values for blood testing valid?.  Int J Sports Med. 2000;  21 380-385
• 21 Neumayr G, Pfister R, Mitterbauer G, Gaenzer H, Joannidis M, Eibl G, Hoertnagl H. Short-term effects of prolonged strenuous endurance exercise on the level of haematocrit in amateur cyclists.  Int J Sports Med. 2002;  23 158-161
• 22 Lippi G, Franchini M, Guidi G. Haematocrit measurement and antidoping policies.  Clin Lab Haematol. 2002;  24 65-66
• 23 Schmidt W, Biermann B, Winchenbach P, Lison S, Boning D. How valid is the determination of hematocrit values to detect blood manipulations?.  Int J Sports Med. 2000;  21 133-138