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The Physiological Advantages and Disadvantages to Athletic Sports Performance of Blood Removal, Storage, and Later Transfusion

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The Physiological Advantages and Disadvantages to Athletic Sports Performance of Blood Removal, Storage, and Later Transfusion into the Same Individual (i.e. Blood Doping) Introduction Blood doping, or induced erythrocythemia, is a term used to describe any means by which a person's total volume of red blood cells is increased (Wilmore, 1994). The strategy has been adopted by a number of athletes, with positive results in endurance sports such as cycling, cross-country skiing and long-distance running. Whilst a fairly small increase in erythrocyte mass is seen in athletes after months of endurance training, dishonest athletes may strive to increase their erythrocyte mass further through the illegal and unethical processes blood doping or administration of human recombinant erythropoietin (rHuEPO). The potential benefits of using such procedures are alluring to the athlete; the increase in erythrocyte mass (and so too in haemoglobin) causes a subsequent increase in the oxygen-carrying capacity of the blood, providing an increased supply of oxygen to the active muscles and making them more fatigue-resistant. Furthermore, the increased erythrocyte mass causes improved thermoregulation and lactate buffering, which are also of great advantage to the athlete competing in an endurance event. If used in a controlled environment, blood doping may alter erythrocyte concentration with nominal side effects. The inherent problem of blood doping is concerned with abuse rather than use, with athletes re-infusing excessive amounts of erythrocytes to constantly improve endurance performance to its maximum, to maintain their reign at number one in their sport. This puts considerable strain on the cardiovascular system and can lead to, sometimes fatal, physiological problems. The quandary with blood doping, and indeed what makes it particularly appealing to the athlete, is that accurate detection is near impossible since it is very hard to make a distinction between autologously transfused erythrocytes and untreated erythrocytes. Also, that the athlete who trains at a high altitude naturally induces an increase in erythrocyte production, one cannot be unfailingly certain that the abnormally high haematocrit is due to blood doping. ...read more.


The effect of erythropoietin on oxygen capacity is illustrated through experiments on the effect of injecting low doses of rHuEPO on performance endurance and VO2max. Six weeks after erythropoietin administration (Wilmore, 1994) haemoglobin concentration and haematocrit increased by 10%, VO2max increased 6% to 8%, and time to exhaustion increased 13% to 17% (Wilmore, 1994). These results were accredited to the enhanced erythrocyte, and hence haemoglobin, mass. Figure 1: The positive and negative effects of rHuEPO administration to the athlete. Figure 2: The regulation of erythropoietin stimulation in the body. EPO is produced in response to the amount of oxygen available to the tissue. If the tissue is not receiving enough oxygen, the ensuing hypoxic state stimulates the production of EPO, and thus erythrocytes. Conversely, if the tissue is in a hyperoxic state, the production of EPO is attenuated. A number of advantages can be seen in the use of rHuEPO when compared with traditional blood doping techniques. The administration of rHuEPO is much easier and more effective; indeed, the athlete may perceive an instantaneous increase in energy after rHuEPO administration. Furthermore, traditional blood doping causes an increase in erythrocyte concentration that is only sustained for a few weeks. Conversely, rHuEPO administration causes a rise in erythrocyte mass that takes several weeks to accomplish, but that is sustained for the duration of rHuEPO treatment. The Physiological Advantages of Blood Doping Unarguably, blood doping conveys beneficial effects to the endurance athlete (figure 3). Each gram of haemoglobin has the capacity to carry 1.34ml of oxygen. So, an increase of 2g/100ml in haemoglobin concentration may cause a subsequent rise in the capacity of the blood to carry oxygen by approximately 25ml for every 1000ml of blood. In effect, assuming the increase in blood viscosity would not have an adverse effect on the heart, this would mean that at a cardiac output of 24 litres per minute, 300ml of extra oxygen (Jones, 1989) ...read more.


These higher doses administered over long periods increase the likelihood of toxic reaction. Although erythropoietin is removed from the liver within a day of administration, its effects may still be apparent for 2 to 3 weeks, and the consequence of excessive dosage may not be noticeable in time to be treated. Conclusion The International Olympic Committee has ruled "any blood doping procedure used in an attempt to improve athletic performance is unethical, unfair, and exposes the athlete to unwarranted and potentially serious health risks"(Verbruggen, 2001). The problem is that, at present, it is impossible to determine with absolute certainty that an athlete is using blood doping. Its undetectability renders blood doping a very attractive option to the dishonest athlete. Who is to define what signifies an unnaturally high erythrocyte concentration? It is also impossible to prove that the abnormally high erythrocyte concentration is due to blood doping, and not training at high altitude. However, given the inherent dangers associated with the use of rHuEPO by competitive athletes, it is imperative that effective tests to determine whether it has been used are developed. The development of such tests should focus attention to features of the erythrocytes, including their distribution and haemoglobin and haematocrit levels, and characteristics of the reticulocytes and macrocytes. The athlete will forever be looking for ways to improve performance. This is not a characteristic that is peculiar to the world of sport, rather it reflects the trend in our society (Verbruggen, 2001). Every means is justified to achieve the desired ends. The development of the "sleep chamber" allows athletes a way to improve their erythrocyte concentration through permissible and harmless means. The chamber apes the decreased air pressure of high altitudes, so causing an increase in erythrocyte production. Controlled use of this procedure may potentially increase the haemoglobin concentration by in excess of 23%. This process, and that of high altitude training, offers the endurance athlete a way of improving performance without resorting to unethical, illegal, and potentially very dangerous, measures. ...read more.

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