Erythropoietin doping. A
comment.
Angel F. Remacha
Hematology Department. Hospital de Sant Pau. Barcelona. Spain.
Correspondence: Dr Angel F. Remacha, Hematology department,
Hospital de Sant Pau, Avda Padre Claret 167. Barcelona 08013
Spain. E-mail: 2107@hsp.santpau.es
Detection of erythropoietin abuse is an old chesnut in an Olympic
year.1 In this regard, I have read with interest the
two excellent works2,3 on blood doping with
erythropoietin published in Haematologica. Nevertheless, I should
like to make the following aspects, I agree that the use of Hct or
Hb as the only criterion for detecting rHuEpo doping is not the
best methodology. Accordingly, the work in Haematologica (3)
demostrates that more than 50% of cases during the treatment would
not be detected using the Hct or Hb, which is the procedure
accepted by International Sports Authorities.1 The
proposed model to detect erythropoietin abuse is very complicated
and simplification is advisable.3 Looking at the
variables and their coefficients, it is very probable that, using
a multivariate approach, some of the variables will be
redundant.
Apart from the strict statistical approach, it is important to
include biological and practical criteria. In this regard, it is
advisable to employ variables that could be determined using
several methodologies and not to depend on a specific analyzer.
Markers related to iron metabolism and erythropoeisis (ferritin,
transferrin receptor, serum erythropoietin, reticulocytes and
their maturity fractions) are widely used and their clinical
diagnostic value is well known. Moreover, results could be
obtained in minutes and with an excellent reproductibility. By
constrast, other factors such as new reticulocyte related
variables are very interesting, but less utilised and more
difficult to evaluate. Variations in these parameters during the
different phases of exercise (training, competition, etc.) have
been demonstrated,4 and these could affect the
diagnostic value of these models. For instance, it is well known
that urine and serum erythropoietin,5 reticulocytes,
ferritin and other parameters undergo changes depending on the
phase of competition.4
Bearing in mind the controversial reactions produced by the use of
Hct or Hb, before one of these models is definitively adopted,
prudence is the best advice, even when we know that these models
are far better than the ones adopted by Sports
Authorities.
