Haematologica 2002; 87:(07)ELT32
[Medline] [prev] [index] [next]

Response to "Addendum to strategies to deter blood doping in sports"
Michael Ashenden, PhD, Project Coordinator, SIAB.
International cell phone: +61 409 797 226. International fax: +61 409 797 557. Email: siab@compuserve.com

In addition to the intellectual merit of their article, the contribution by Profs d'Onofrio and Zini highlight two important tenets shared by SIAB. First, their willingness to share their view demonstrates clearly the desire of the medical profession to participate actively in the fight against doping. Second, their insightful remarks unequivocally ratify our (shared) belief that an exchange of ideas in an appropriate forum can harness the desire, intellectual capacity and varied perspectives of individuals with a wide range of expertise, and thereby offers a truly powerful tool to rid sport of doping.
Their comment that a surrogate of rHuEpo-enhanced autologous transfusion (EEAT) would be attractive to athletes resonates, and may even go some way to explaining the reports of blood transfusion bags being discovered at the Salt Lake City Winter Olympics. It is acknowledged that EEAT would ameliorate a reduction in performance during the period in which red cells were being harvested, and provided that athletes had access to illicit medical support (which would be mandatory to store and tranfuse autologous blood) this alternative strategy for blood doping is plausible and therefore demands attention.
The simultaneous use of r-HuEPO would indeed increase the efficacy of red cell harvest, and would also reduce the physiological impact on training intensity. Regular phlebotomy may also reduce the sensitivity of blood tests which incorporate Hb levels. However as the authors point out, aggressive acceleration of red cell production would replicate, or perhaps even magnify, the disturbance in reticulocyte indices noted during r-HuEPO administration, and the opposite goals of maintaining near-normal Hb (to facilitate normal training), and aggressively boosting erythropoiesis (to harvest a sufficient quantity of red cells to provide a performance advantage when the cells are re-infused), suggests that there would be transient periods where the athlete would risk triggering a blood test that incorporated both Hb and reticulocyte indices. As well, the likelihood of r-HuEPO being detectable in the athlete's urine during this phase is high. Therefore random out-of-competition testing that combines blood and urine evaluation would seem similarly capable of detecting EEAT as it is of detecting r-HuEPO use by itself &endash; provided the athlete is tested whilst using EEAT!
But the cost and logistical implications of out-of-competition blood and urine testing for r-HuEPO use, notwithstanding the potential lack of sensitivity of blood tests, suggest that it cannot be relied upon as the sole means of deterring EEAT. Profs D'Onofrio and Zini make a persuasive argument that EEAT may enhance the attractiveness of autologous blood doping. However it is important to recognise that in common with all recognised blood doping practices, the ultimate goal of EEAT would be to elevate the athlete's Hb beyond typical values at the time of competition, and the re-infusion of 2-3 units prior to competition would be difficult to disguise provided that there was a historical record of the athletes blood profile to refer to. Therefore the plausibility of athletes using EEAT further underlines the necessity to have some form of 'Haematologic Passport' in place to deter EEAT and any surrogate of this strategy. Obviously a test capable of detecting the re-infusion of autologous blood would be highly desirable, and represents the single greatest deterrent to EEAT and/or autologous transfusion.
The authors also made the valid observation that the original article did not contain details of the participants and supporting industries associated with SIAB. This was a deliberate decision based upon multiple considerations. First, it was essential to maintain a degree of objectivity and to focus on scientific issues with academic relevance rather than the individuals performing the research (this coincided with the desire to respect the peer-reviewed forum). Second, the publication of academic and pharmaceutical company involvement must respect the bureaucratic considerations incumbent upon these institutions. As Profs d'Onofrio and Zini alluded to, the participation of industries is indeed 'delicate', and access to products prior to their commercial release demands that rigorous confidentiality procedures are implemented. At the time of publication affiliates were at different stages of this process. Particularly in light of this latter consideration, it was decided that to include or exclude specific groups would have been preemptory or unfair (respectively).
The list of medical and scientific experts collaborating with SIAB continues to expand as groups with relevant interest and motivations are recognised. An overview of SIAB's research and current list of participants was presented at the 7th European Haematology Association symposium in Florence, and interested readers are invited to review these proceedings, and are also directed to a website (still in preparation) dedicated to the research undertaken by SIAB (www.siab.ws). Far from being esoteric, SIAB is committed to embracing and facilitating discussion and cooperation in the fight against blood doping in sport. Readers are earnestly encouraged to contact the Project Coordinator directly to initiate discussion or seek further information.