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Blood doping has become an integral part of sports and fair play. It enhances your performance by increasing red blood cell mass and thereby delivering more oxygen to muscle. This manipulation has gained notoriety in the sports world for what it can do for an athlete during endurance events. Blood doping can be broken down into two different procedure's blood transfusions and induced erythropotein, which is the newer modernistic version of blood transfusions .
Blood Transfusions:
Transfusing red blood cells is the oldest form of blood doping. Rumours about the use of transfusion in sport have been circulating since the 1960s, and blood doping was associated with US cyclists at the 1984 Los Angeles Olympic Games. The process of blood cell reinfusion can be further classified into to two different procedures autologous blood transfusion and homologous blood transfusions. Homologous transfusions are where a donor is found with the same blood type and their blood is withdrawn and infused into the recipient. In early tests scientists and doctors used this method literally transfusing the donors blood straight into the recipients, but problems with this method soon arised. One major problem was that the rate of success was not particular high due to the high chance of the recipient’s body rejecting the donor’s blood. As the body struggles to determine what the extra blood is, it will think it is a foreign matter and try to get rid of it. On the other hand autologous blood transfusions requires more sophisticated apparatus and the process is to withdraw the individual’s own blood and store these red cells for several weeks prior to reinfusion. The process starts with between 1 to 4 units of a person’s blood (1 unit = 450 ml of blood) being withdrawn, usually several weeks before a key competition. ”To prevent dramatic reductions in blood cell concentration, removal of each unit of blood occurs over 3-8 weeks because it takes this long to re-establish normal red blood cell levels” (W D. Mcardle etl al , 2000). The red blood cells are then separated from the plasma (centrifuged) and the plasma components are immediately reinfused while the remaining red blood cells are placed in cold storage. The packed red blood cells that have been centrifuged can be stored in two different ways they can either be refrigerated at 4°C or frozen at - 8°C. “Frozen blood cells store in excess of six weeks without significant loss of cells compared to conventional storage at 4°C (used in earlier studies); substantial hemolysis (destruction) occurs at 4°C after only three weeks”(W D. Mcardle etl al , 2000). When administrating a transfusion this would need to be taken into consideration as Mcardle etl suggest that “it usually takes a person about six weeks to replenish blood cells after withdrawal of two units of whole blood”
The red blood cells are then washed with saline infused back into the body, usually 3 to 5 days before an even.
When the red blood cells are stored appropriately, the process of blood reinfusion will largely boost hematological attributes. “ This in turn, translates to a 5 to 13% increase in aerobic capacity reduced submaximal heart rate and blood lactate for a standard exercise task, and augmented endurance both at altitude and sea level. In addition, significant thermoregulatory benefits (reduced body –heat storage and improved sweating response) ” (W D. Mcardle etl al , 1996). It is thought that the boosted blood volume will endow the athlete with greater maximal cardiac output. With the red blood cell packing increasing the blood’s oxygen carrying capacity, the amount of oxygen now available is specially profitable when partaking in long distance activities as oxygen transport and delivery are often restraining factors in exercise.
Though blood transfusions could be seen to be a beneficial risk to improve performance, it does have various short and long term heath risks to. “A large infusion in red blood cells (and resulting increase in red blood cell concentration ) could increase blood viscosity, or thickness, causing a decrease in cardio output, a decrease in blood flow velocity, and a reduction in peripheral oxygen content – all of which would reduce aerobic capacity” (W D. Mcardle etl al , 1996) . Also “the human heart was not designed to pump this thickened blood throughout the body and, therefore, could lead to a multitude of problems. Some of the problems that can arise from an autologous blood transfusion are phlebitis, septicaemia, hyperviscosity syndrome (including intravascular clotting, heart failure and potential death), bacterial infections, and air/clot embolisms. Even more frightening is the list of diseases that can be contracted through homologous transfusions. They include hepatitis, AIDS, malaria, CMV, and transfusion reactions (characterised by fever, urticaria, and possibly anaphylactic shock)” (D. Beckham , 2005). This is due to blood not being properly screened and tested.
Induced Erythropotein (epo)
Erythropotein is a relatively recent entry into the deceitful pursuit of glory. EPO is a protein hormone produced by the kidney. After being released into the blood stream it binds with receptors in the bone marrow, where it stimulates the production of red blood cells (erythrocytes). Medically, EPO is used to treat certain forms of anaemia (e.g., due to chronic kidney failure). Logically, since EPO accelerates erythrocyte production it also increases oxygen carrying capacity, and because of the higher amounts of red blood cells an increase in is reached. This fact did not long escape notice of the athletic and cycling community, as seen in the 1998 Tour de France. Several team doctors and personnel from several teams were caught red-handed with thousands of doses of EPO and other banned substances. Ultimately about 50% of the teams withdrew from the race – either for cheating or in protest. Until recently accurate testing has been difficult because the recombinant human EPO made in the lab is virtually identical to the naturally occurring form and there are no firmly established normal ranges for EPO in the body. The only previously available route to detect cheating for sports governing bodies was to ban an athlete if the hematocrit level was too high (e.g., above 50%). Thus, over the past 10 – 15 years some athletes chose to cheat because, as long as they kept their hematocrit levels below 50%, there seemed little risk of getting caught. Fortunately, testing technology has now advanced and guarantees to cut down the tide of abuse. There is now an accurate urine test that can detect the differences between normal and synthetic EPO. This test is now the standard and was the sole means to detect for EPO use in the 2004 Athens Olympic Games. EPO has put a whole new spin on blood doping no need for messy transfusions the synthetic EPO is easily injected under the skin.
EPO can increase hematocrit for six weeks or longer, with levels reaching between 50-60%, it also can increase thrombostic activity. Though A high hematocrit level will improve performance it will inevitably lead to problems, a high hematocrit level means blood is more concentrated. This can lead to whole blood becoming sludge like and will clog capillaries. If this happens in the brain it results in a stroke. In the heart, a heart attack. Unfortunately, this has happened to several elite athletes who have used EPO. Additional dangers of EPO include sudden death during sleep, which has killed approximately 18 pro cyclists in the past fifteen years, and the insufficiency of white blood cells resulting in a weakend , which renders an athlete more susceptible to illness. In this later circumstance the individual develops anaemia as a result of the body’s reaction against repeated EPO injections.
Case studies Of Athletes Using Blood Doping
Many athletes have been suspected to, or have been caught using blood -doping techniques to improve performance, Though none more notable then Nina Kraft. November 12, 2004 - Nina Kraft, female winner of the previous month’s ironman Triathlon World Championship, admitted yesterday to use of “an illegal substance in the weeks leading up to her victory on October 16. She tested positive for EPO or Erythropoietin in the results released earlier that week. Kraft and her coach/manager, Martin Malleier both confirmed her use of the performance-enhancing drug on a phone call with WTC President. "During our lengthy conversation, they were both very forthright about their mistake," said Fertic. We're very disappointed that this happened at our event." ( B.Gifford, 2004)
Kraft had placed within the top three at the Iranian Triathlon World Championship in 2001, 2002 and 2003. Kraft dominated the women's race this year, winning by more than 16 minutes over Natascha Badmann. Second-place finisher and four-time world champion, Badmann will now reign as the 2004 world champion. "I did something stupid. The mistake cannot be rectified - I am going to bear all the consequences. I never really rejoiced over the victory in Hawaii. I was ashamed the entire time, especially in front of my family. I cheated," she told the Hesse state radio yesterday”. (Runners wb.com, 2004)
Having been caught and admitting cheating will obviously have serious implications on her career, the positive drug test costs Kraft the $100,000 winner's purse, sponsorship income and potentially, her career. Another athlete caught was Roberto Heras faces a two-year ban from cycling after a Spanish laboratory confirmed he used the banned blood-boosting drug EPO.
Heras, 31, had insisted he was innocent after an initial sample taken at this year's Vuelta tested positive. But EPO has also been found in the Spaniard's second 'B' sample. Heras's Liberty Seguros team issued a statement saying he would be sacked as soon as they received notice of the positive test from world cycling's governing body the UCI.
Conclusion:
Pharmacological cheating in sports is not a new phenomenon. Unfortunately, the modern era has witnessed explosive growth in new and different ways to achieve false victory. Blood transfusions were the cheaters choice of the 70s and early 80s, and new advances in science and sports medicine have seen the introduction of EPO during the 90s and into the millennium. But what has not changed in blood doping over the years is the serious health risks associated with the process. From researching the subject it seems that many athletes seem to have the mentality that they must win at any cost and that the potential risks of blood doping are a small price to pay for success. Alternative means of improving performance would be better recommended to use such as altitude training and the altitude sleep chamber. Both methods are currently safe and legal means of improving results and have been proven to improve performance. And, if all else fails, hard work and determination can go a long way.
Reference list
(1) William D. Mcardle, Frank I. Katch And Victor L. Katch. (1996)
Exercise Physiology, Energy, Nutrition, and Human Performance
(2) William D. Mcardle, Frank I. Katch And Victor L. Katch. (2000)
Essentials Of Exercise Physiology.
(3) Darren Beckham (2002) Blood Doping: Is It Really Worth It?
[Online] Available From
(4) Runners web, Runner's and Triathlete's (2002) Drugs in Sport:
Ironman Winner Nina Kraft admits to use of illegal substance.
[Online] Available From web.html
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Bill Gifford (2004) Cheating Athletes Who dopes, why they dope,
and who it hurts. [Online] Available from
