Assessment of total haemoglobin mass: can it detect erythropoietin-induced blood manipulations?

Abstract

The purpose of the study was to reveal erythropoietin (epo) doping. It was recently suggested that the assessment of total haemoglobin mass (tHb) by means of the carbon monoxide re-breathing technique should be implemented in anti-doping work. Since epo may increase the haemoglobin concentration [Hb] simply by reducing plasma volume we injected eight human subjects with epo for 15 weeks and directly tested the feasibility hereof. Epo treatment increased [Hb] in all subjects at all time points (range 3.8-18.8%). In approximately half the subjects this was mainly the consequence of an increased tHb, but in the remaining subjects the change was the result of a decrease in the plasma volume. After the initial epo "boosting" period the assessment of tHb could not detect epo injections in 50% of the subjects in the remaining "maintenance" period. In our opinion the variability observed over time when assessing tHb is not justifiable in an anti-doping setting.

Screening for recombinant human erythropoietin using [Hb], reticulocytes, the OFFhr score, OFF z score and Hb z score: status of the Blood Passport

“…We should mention, however, that a recent study demonstrated the failure of total Hb mass to be a reliable marker for rHuEpo use (Lundby and Robach 2009). A limitation to the present study is that moderately trained university students do not represent the target population.…”

Reliability and validity of non‐invasive determined haemoglobin mass and blood volumes

“…In this study, we performed two CO rebreathing tests on the same day in order to limit day-to-day variations. Indeed, interventions leading to only small changes in Hb mass and BVs are often applied in scientific studies (Prommer et al, 2008;Schumacher et al, 2008;Lundby & Robach, 2010;Mørkeberg et al, 2011;Hughson et al, 2012;Robach et al, 2012Robach et al, , 2014Siebenmann et al, 2012;Austin et al, 2014;Linnarsson et al, 2015;Wehrlin et al, 2016). The % TE when using the Rad-57 was, however, around 6%.…”

Blood doping and its detection

“…The CO rebreathing technique for detecting nonphysiologic increases in Hb mass is still investigational, 24,25 and besides practical difficulties related to this method, its potential inclusion in the blood passport may be problematic, 26 because the margin of variation when assessing Hb mass (biologic and measurement errors) would still allow athletes to manipulate with blood volumes that would increase exercise performance considerably. 27 Finally, it should also be considered that, from an athlete's viewpoint, it may not be desirable to breathe CO shortly before a competition as this may limit exercise performance.…”