Haematological Testing and Antidoping Policies

Dear Editors,

Enhancement and optimization of oxygen delivery to the muscles is an effective mean to produce substantial improvements on athletic performances, especially in endurance sport disciplines. Considerable advances in biomedical research have propitiated the commercialization of innovative therapeutic strategies for the treatment of disorders characterized by insufficient peripheral oxygenation. Unfortunately, some of these methods turned out as unethical and dangerous alternatives to boost erythropoyesis in athletes. Such strategies currently include blood transfusions, administration of erythropoiesis-enhancing substances, altitude simulators [[1]]. Owing to considerable benefits on athletic performances and challenging detection, the use of these techniques has become commonplace among elite and professional athletes, forcing sport organizations and medical commissions to develop reliable testing tools to unmask the cheating. Although the reference technique to identify the misuse of erythropoiesis-stimulating substances is as yet the urinary test, indirect hematological testing is pivotal to this process, as a primary screening tool to identify potential cheaters and to recognize erythropoietic responses to doping techniques other than recombinant human erythropoietin or analogous substances [[2]].

However, the standardization of the whole analytical process is crucial to ensure reliability of results, for either identifying illicit practices or preventing clean athletes to be unfairly sanctioned. The article of Robinson et al., recently published on this journal, carries a substantial contribution to this topic, confirming the importance of the accurate standardization of analytical procedures to avoid critical variations on both hematocrit level and reticulocytes count [[3]]. However, this is not sufficient to ensure reliability of hematologic testing in athletes subjected to antidoping controls. In this peculiar contest, the standardization of the preanalytical phase is equally crucial. So far, no definitive guidelines have been issued to guide operators during the delicate process of sample collection and handling. This is an unacceptable omission. We have earlier demonstrated that significant variations of hematologic testing might arise from uncontrolled preanalytical variables, including the physical workload [[4]], the time of tourniquet placing [[5]], and the blood drawing technique [[6]]. Occasionally, these variations might achieve clinically meaningful differences, influencing the final judgement and leading to inappropriate acquittal or sanctioning of athletes. On these bases, we advocate a major commitment of the World Anti-Doping Agency (WADA), sport organizations, and medical commissions, for the formulation and the rigorous application of international, validated preanalytical and analytical protocols. This is a key process to achieve reliable results, preventing too many wasted efforts in antidoping testing.

References

• 1 Lippi G, Franchini M. The new frontiers of blood doping.  Recenti Prog Med. 2002;  93 1-8
• 2 Lippi G, Franchini M, Guidi G. Second generation blood tests to detect erythropoietin abuse by athletes: effective but not preventive?.  Haematologica. 2004;  89 ELT05
• 3 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
• 4 Lippi G, Franchini M, Guidi G. Haematocrit measurement and antidoping policies.  Clin Lab Haematol. 2002;  24 65-66
• 5 Lippi G, Salvagno G L, Solero G P, Franchini M, Guidi G C. The influence of the tourniquet time on hematological testing for antidoping purposes.  Int J Sports Med. 2005;  DOI: 10.1055/s-2005-865749
• 6 Lippi G, Salvagno G L, Brocco G, Guidi G C. Preanalytical variability in laboratory testing: influence of the blood drawing technique.  Clin Chem Lab Med. 2005;  43 319-325