Study of a new indirect method based on absolute norms of variation to detect autologous blood transfusion

Abstract

The aim of this study was to investigate an indirect method based on a determination of absolute norms of variation in biological markers that could be used to identify autologous blood transfusion within the framework of the fight against doping. The selection of markers was made from experimental variations obtained during different phases including an increase in training volume at sea level, high altitude training, blood withdrawal and autologous blood reinfusion. The global statistical method was then developed in order to fix absolute norms of variation for each selected marker. The markers selected were haematocrit (Hct), haemoglobin concentration ([Hb]), stimulation index (Off-hr) and the absolute norms of variation (normDelta) established for a maximal 15 days period were normDeltaHct(0-15) >6%, normDelta[Hb](0-15) >4% and normDeltaOff-hr(0-15) >20%. From analyses between two blood samples spaced at an interval of maximum 15 days, this method allows to show "abnormal" variation when a variation for one of the selected markers is strictly superior to the absolute norms of variation established. The legal framework for an immediate application of this method could be that of the internal regulations implemented by each international federation in accordance with the health policy in vigour.

Hepcidin as a new biomarker for detecting autologous blood transfusion

“…The variation in these standard blood variables after RBC transfusion that was observed in the present study was consistent with that reported in the literature [9,[23][24][25][26]. After saline infusion, several variables showed significant variation from baseline at a number of time points.…”

Hemoglobin and hematocrit are not such good candidates to detect autologous blood doping

“…In conclusion, in regard to the important implications of a positive anti-doping test for the athlete's life, we think that the norms of variation proposed by Sallet et al [1] for detecting autologous blood transfusion require extra consideration/experimentation and should not be implemented as internal regulations by the international federations yet. Moreover, we caution against the general application of the use of [Ht] and [Hb] for indirect doping makers without broad consideration for its limitations.…”

“…In a recent manuscript published in the International Journal of Hematology, Sallet et al [1] reported absolute norms of variation established for a maximal 15 days period to distinguish autologous blood transfusion from normal modifications, using hematocrit (Ht), hemoglobin ([Hb]) and stimulation index (Off-hr) (calculated using the following equation [Hb] -60H reticulocytes in %) as markers. The thresholds the authors proposed are 6% for Ht, 4% for [Hb] and 20% for Off-hr.…”

“…For the authors of the present paper [1], the purpose of using altitude exposure is to obtain a natural stimulation of the erythropoiesis allowing them to compare with the effects of the autologous transfusion. Unfortunately, as attested by their results, the hypoxic stimulus they used was rather mild and did not elicit any alteration in the measured parameters.…”

Detection methods for autologous blood doping

“…[25] However, as some of these parameters are easily affected by dehydration or altitude training, the use of this protocol seems limited. As already mentioned, if two blood samples before and after the blood transfusion process separated by more than 15 days are obtained from the same subject, changes in haematocrit (Hct), Hb and OFFhr (Hb-60(%retic) 1/2 ) are observed, which were again proposed as the basis for this type of doping detection.…”