Blood Doping: Is It Really Worth It?
Biology 1407 Concepts of Biology II, Texarkana College, Texarkana, Texas 75599
Key words: Blood doping, erythrocytes, erythrocythemia, hemoglobin, High Altitude Bed ®, Holistic Blood Doping, red blood cells
Abstract: Blood doping has become an integral part of sports and fair play. It enhances your performance by increasing red blood cell mass and thereby delivering more oxygen to muscle (#2). This manipulation has gained notoriety in the sports world for what it can do for an athlete during endurance events. Special concern has been expressed that the cardiovascular system of an athlete undergoing this procedure could be in jeopardy. Still, there are athletes out there that will put themselves at risk just to experience the thrill of being number one, regardless of the circumstances. Fortunately, the last few years have been generous to mankind and several ways have been discovered to increase our blood’s oxygen carrying capacity that are not detrimental to us in anyway. They are altitude training and the High Altitude Bed ®. Both are safe and practical ways to achieve what some people accomplish through a highly dangerous and somewhat controversial method.
Each year an athlete’s ability to perform seems to increase by leaps and bounds. Some reasons for this increase can be attributed to better training methods, better conditioning techniques, and better overall health of the athlete. While most of the situations involve one or more of the previously mentioned scenarios, some athletes always seem to take it a step further. They engage in a process called blood doping. This procedure does increase their athletic ability, but potentially may do more harm than good.
Some background information is needed before one can understand exactly what blood doping can do for an individual. In order for our muscles to perform, they need a ready supply of oxygen. During high intensity exercise, oxygen becomes depleted and the body cannot get enough oxygen to the muscles in order for them to perform at their optimal potential. This lack of ability to get oxygen to the muscles is called oxygen debt and results in lactic acid being formed. Lactic acid is a waste product of anaerobic cellular respiration within the muscle tissue, which can cause muscle soreness that is usually felt after a hard or long workout. Fatigue usually sets in with the onset of lactic acid production. Oxygen is carried to the muscles by two delivery systems. Three percent of oxygen is carried in solution (plasma) and 97 percent is bound to hemoglobin, the principle protein in erythrocytes (red blood cells). If hemoglobin amounts are increased, this will lead to increased oxygen levels that can be transported to the muscles. This will allow the muscles to become more fatigue resistant.
What is Blood Doping?
Blood doping, often called induced erythrocythemia, is the intravenous infusion of blood to produce an increase in the blood’s oxygen carrying capacity (#10). It is a procedure that begins with between 1 to 4 units of a person’s blood (1 unit = 450 ml of blood) being withdrawn, usually several weeks before a key competition. The blood is then centrifuged and the plasma components are immediately reinfused while the remaining red blood cells are placed in cold storage (#7). The RBC’s are then reinfused back into the body, usually 1 to 7 days before a high endurance event. If done correctly, this process can increase the hemoglobin level and RBC count by up to 20%.
When a blood doping procedure is initiated, the packed RBC’s that have been centrifuged can be stored using two different methods. They can either be refrigerated at 4° C or frozen at - 80° C. Most of the earlier procedures were done so by using the refrigeration method. The results were semi-successful because of the life cycle of a RBC. The average life span of a RBC is 120 days. Therefore, each day, approximately 1% of any RBC population is lost (#5). Our bodies continuously replace the lost RBC’s , but in blood removed from the body, the number of RBC’s steadily decline, never to be replaced. It usually takes 3 to 8 weeks for a person to re-establish normal RBC levels, so at the time their bodies are ready for reinfusion, only 60% of the removed RBC’s would actually be viable (#5). This is an important point because most of the early testing was done without adequate time being given to re-establish proper RBC levels. Therefore, earlier test subjects were starting out with a deficit of RBC’s. When the removed blood was reinfused, the results were usually very minor or not noticeable at all.
What was needed next was for scientists to find a way to get the maximum amount of RBC’s infused into a subject’s body at the most appropriate time. First, it was determined that by freezing the RBC’s after they were centrifuged you could completely halt the aging process of the cells. This process will allow you to store blood for up to 10 years with only 10% to 15% of the RBC’s being lost (#4). Second, it appeared that in high endurance athletes that it took at least five to six weeks, possibly as long as ten weeks, to re-establish proper amounts of RBC’s. This was based on the time it took for them to return hematocrit and hemoglobin concentrations back to pre-withdrawal levels (#12). These were huge developments in blood doping procedures and most of the later tests have proven to be successful.
Problems and Side Effects
It is also possible that blood doping could have effects opposite to those intended. A large infusion of red blood cells (and resulting increase in cellular concentration) could increase blood viscosity and bring about a decrease in cardiac output, a decrease in blood flow velocity, and a reduction in peripheral oxygen content – all of which would reduce aerobic capacity (#7). The human heart was not designed to pump this thickened blood throughout the body and, therefore, could lead to a multitude of problems. Some of the problems that can arise from an autologous blood transfusion are phlebitis, septicemia, hyperviscosity syndrome (including intravascular clotting, heart failure and potential death), bacterial infections, and air/clot embolisms (#4). Even more frightening is the list of diseases that can be contracted through homologous transfusions. They include hepatitis, AIDS, malaria, CMV, and transfusion reactions (characterized by fever, urticaria, and possibly anaphylactic shock). Because of these reactions, among others, homologous blood transfusions are highly discouraged (#10). A great example of a successful blood doping procedure with adverse side effects is of the 1984 United States Olympic cycling team. Previous American cycling teams had not fared well in past Olympic Games. But in the 1984 Los Angeles games, they decided to try blood doping as a way to get an advantage on the competition. The results were a huge success. The team brought home a U.S. cycling team record of nine medals. The problem was not the fact that the athletes had undergone blood doping procedures, but, rather, how the procedure was performed. Between the Olympic trials and the actual games, the Americans did not have adequate time to use their own blood as a transfusion. Instead, they had to rely on the blood of relatives and others with similar blood types. Consequently, some of the cyclists received tainted blood and a short time after the Games contracted hepatitis, a serious liver disease (#8).
Latest News and Discoveries
After the 1984 Olympic Games, the International Olympic Committee decided to discourage blood doping and, along with the NCAA and American College of Sports Medicine, ruled that "any blood doping procedure used in an attempt to improve athletic performance is unethical, unfair, and exposes the athlete to unwarranted and potentially serious health risks" (#3). However, the problem lies with being able to unequivocally detect that an athlete is in fact undergoing blood doping procedures. After all, what constitutes an abnormally high RBC level? Also, how do you distinguish between blood doping athletes and those athletes who boost their hemoglobin levels by training at high altitudes? The answers to both of these questions are very perplexing. As of now, there are no foolproof tests for an athlete who blood dopes. The agencies that have banned this practice will have to rely on the integrity of the athletes, coaches, and their medical support personnel to comply with their ruling.
A new invention by a University of Colorado at Boulder professor only adds to the controversy of blood doping. Igor Gamow, an Associate Professor of Chemical Engineering, has invented a sleep chamber that may enable endurance athletes to, in effect, train while they sleep (#9). The chamber mimics the reduced air pressure of high altitudes and stimulates the production of red blood cells. This enables an athlete training at sea level to gain the same fitness advantage as an athlete living at high altitude. If this chamber is used correctly (six to eight hours a day for two to three weeks) the hemoglobin concentration can be boosted by more than 23%. Because the High Altitude Bed ® is legal, safe and natural; this procedure of red blood cell enhancement is called Holistic Blood Doping (#3).
At the present time blood doping is a controversial issue. With the new advances in science and sports medicine, this will probably be a dilemma for years to come. Many present and future athletes will have to use their best judgment when this procedure becomes an issue in their lives. Blood doping is illegal but is also undetectable. The potential risks of such a procedure seem to outweigh any potential benefits, above and beyond the ethical issues involved (#12). If a distinct advantage is needed in endurance events, altitude training and the altitude sleep chamber pose far fewer risks and are currently safe and legal. And, if all else fails, hard work and determination still count for something.