What are the legal and illegal means of increasing your red blood cell count and how do the various methods work?

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Edward Jessop                                                            10th February 2004

What are the legal and illegal means of increasing your red blood cell count and how do the various methods work?

Blood is an obviously essential for the body. However, making the blood work more efficiently and to make it carry both more red blood (oxygen-carrying) cells and have more volume (plasma) can increase an athlete's ability to work harder. When the body increases its stores of blood cells naturally, the blood marrow in the bones is stimulated by a hormone called erythropoietin (EPO) that is released by the kidneys. The stimulus for the body to do this is when the brain detects that the tissues are receiving too little oxygen. Conversely, if cells are getting too much oxygen, EPO levels are reduced and the bones slow production of erythrocytes (red blood cells). The easiest and legal way for athletes to increase the volume of red blood cells in their body is to train at altitude.

When the body is exposed to the lower oxygen of the high altitude the kidneys produce EPO and the cell counts increase. Because the athlete is continuously subjected to this lower oxygen concentration in the air, the cells develop as quickly as they can, over several weeks. The gains in cells per litre of blood can be great over several weeks, depending on how high above sea level one is. This effect can be seen easily when comparing blood samples from people who live in two different areas. For example, if one were to take a blood sample from people who happened to live in a coastal area, they would have a much lower red blood cell count than someone who lived high in a mountainous region. As would seem logical, mountains are slightly more dangerous areas than flat, temperate valleys or normal training areas like gyms. Because of environmental concerns like fallen rocks or difficult terrain, steep slopes or even the thin air that is helping to train the athlete, training in a high-altitude setting can be dangerous. Because of the low oxygen content of the air, all the tissues of the body will be oxygen-starved until the body can produce enough blood cells to make up the deficit and then to improve until the body reaches normal levels. When the athlete begins to train, the max VO2 that they can reach is a huge drop from what it was at sea level. It requires that they breathe harder and their heart beat much faster in order to get the same level of oxygen from the air, due to their low relative efficiency of their blood and body at this altitude. Should the athlete force himself or herself to try and train at the same intensity immediately, all kinds of injuries and conditions can result, from hypoxia (low oxygen levels), altitude sickness (similar to hypoxia but more chronic, causing weakness, nausea, blue fingers, toes and lips, and other symptoms), edema and pulmonary edema (edema- fluid build-up in tissues, pulmonary edema- fluid begins to build up in lungs, drowning can occur miles from water in this situation) and other adverse side effects. All in all, this method of training is difficult to maintain and to begin, and the blood cells are slowly lost once the athlete returns to lower altitudes where the competition will likely be held. Another method that some athletes have taken up in order to improve oxygen circulation is commonly referred to as blood doping.

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The process of blood doping involves withdrawing a sample of blood from an athlete several months before an event, and processing it to remove some of the plasma and leave behind the blood cells. New blood cells grown in the bones quickly replace those cells that are taken out. One or two days before the event, these blood cells are reintroduced to the athlete via an intravenous line. This infusion of millions of cells into the athlete can greatly influence the oxygen-carrying capacity of the athlete, providing a similar effect as having trained at higher altitudes for months, but ...

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