Detecting autologous blood transfusions: a comparison of three passport approaches and four blood markers

Abstract

Blood passport has been suggested as an indirect tool to detect various kinds of blood manipulations. Autologous blood transfusions are currently undetectable, and the objective of this study was to examine the sensitivities of different blood markers and blood passport approaches in order to determine the best approach to detect autologous blood transfusions. Twenty-nine subjects were transfused with either one (n=8) or three (n=21) bags of autologous blood. Hemoglobin concentration ([Hb]), percentage of reticulocytes (%ret) and hemoglobin mass (Hbmass) were measured 1 day before reinfusion and six times after reinfusion. The sensitivity and specificity of a novel marker, Hbmr (based on Hbmass and %ret), was evaluated together with [Hb], Hbmass and OFF-hr by different passport methods. Our novel Hbmr marker showed superior sensitivity in detecting the highest dosage of transfused blood, with OFF-hr showing equal or superior sensitivities at lower dosages. Hbmr and OFF-hr showed superior but equal sensitivities from 1 to 4 weeks after transfusion compared with [Hb] and Hbmass, with Hbmass being the only tenable prospect to detect acute transfusions. Because autologous blood transfusions can be an acute practice with blood withdrawal and reinfusion within a few days, Hbmass seems to be the only option for revealing this practice.

Current markers of the Athlete Blood Passport do not flag microdose EPO doping

“…One subject was not tested in Phase V, which present mean ± SD for n = 9 only Eur J Appl Physiol (2011) 111:2307-2314 2311 Parisotto et al 2001) or phlebotomy (Damsgaard et al 2006;Morkeberg et al 2009a), and decrease after rhEPO treatment ceases (Gore et al 2003) or blood is reinfused (Morkeberg et al 2009c). Thus anti-doping authorities carefully scrutinise reticulocyte levels for signs of doping.…”

“…Although the ABP software and z score approach can be tweaked to yield similar outcomes (Morkeberg et al 2009c), this requires that the same between-and within-subject variances be adopted with each of the calculations. This was not done in Borno's study, subsequently, although a theoretical insight, Borno's findings cannot be extrapolated to evaluate the true efficacy of WADA's ABP protocol.…”

Blood doping and its detection

“…Hbmr (derived from the formula [4.51 ϫ ln (Hb mass ) Ϫ ͌ reticulocyte percentage]; currently not part of antidoping testing) demonstrated superior sensitivity in detecting blood transfusion. 102 The same authors have reported that the determination of the ratio between the mass of Hb in the mature erythrocyte population and in the reticulocyte fraction (RBC Hb /Ret Hb ratio) is the best indicator of autologous blood doping. 103 …”

Blood manipulation: current challenges from an anti-doping perspective

“…Changes in Hb and %ret after transfusion may be difficult to distinguish from normal physiologic variations. 15 At baseline, a well-trained endurance athlete may have an expanded total blood volume of 8 L and a hematocrit of 45%, such that transfusion of a single unit may only make up ϳ 5% of the total RBC pool in circulation. In addition, the almost immediate posttransfusion removal of as much as 25% of the transfused RBCs from circulation limits the potential window of detection of RBCs with storage lesions.…”