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Blood transfusion Blood ID 14

One of the most commonly used forms of performance enhancement in endurance sports is the infusion of blood to increase the amount of oxygen-carrying red blood cells. An athlete may use for this purpose either his/her own blood - in which case the procedure is referred to as autologous blood transfusion - or the blood of someone else, known as homologous blood transfusion. Both procedures have advantages and disadvantages.

The advantages of autologous transfusion are that:

  • One need not worry about donor compatibility
  • Since one is using one’s own red blood cells detection is very difficult

The disadvantage is that one has to withdraw blood and store it for a period of time so that it will be available as required. The act of withdrawal significantly weakens an athlete, so the process cannot be performed any time near an important competition. It also alters certain physiological parameters in a way that may be detectable by the blood passport (see Bio-passport irregularities).

Homologous transfusion avoids these problems, but it is significantly easier to detect.

Homologous testing

Homologous blood transfusion is detected by a test that determines the presence of red blood cells of foreign origin. In addition to the well-known major blood types A, B, C, and O, and the Rh factors, which are determined by the presence or absence of certain protein molecules or antigens, red blood cells also may contain a number of other minor antigens.

The homologous blood test detects these antigens and, by using them as markers, it can be determined whether there is a homogeneous population of red blood cells present — as will be the case in anyone who has not had a blood transfusion from a foreign donor — or a heterogenous population, which is indicative of such a transfusion.

Autologous testing

There is no approved test for autologous transfusion currently in use.

One possible test is based on counting or quantitating the amount of red cells in the bloodstream, since any transfusion will increase this number. This test requires that the athlete breathe a small amount of carbon monoxide, which binds to red cells and thus acts as a tracer enabling them to be quantitated. However, carbon monoxide even in small doses may have deficits on performance, and thus this test has been opposed by athletes.

An alternative test for autologous transfusion is based on the presence of certain molecules commonly present in the bags in which blood is stored. A particular focus is the substance known as di-(2-ethylhexyl)phthalate or DEHP, used as a plasticiser to make the bags more pliant or flexible.

Several studies have shown that when an individual has a blood transfusion, significant amounts of DEHP are leached from the bag and enter the recipient’s blood stream. DEHP is subsequently metabolized, and several of its metabolites can be detected in the urine.

While DEHP is present in many other substances - and studies have shown that even individuals who have not received a blood transfusion generally test positive for these same metabolites - the levels are generally far higher following a recent transfusion. Thus it has been proposed that a urine test for these metabolites may be used to detect autologous blood doping.

This plasticiser test has not yet been officially approved for use however. In addition, DEHP-free bags are available and it seems likely that, now the test has been publicised, athletes using autologous transfusion will seek these DEHP-free alternatives.

Another alternative for detecting autologous blood transfusion is based on changes that occur in red blood cell membranes during storage. These changes might be detected either directly, through analysis of the red cells in an athlete, or indirectly, through changes in the metabolism that occur when the body recognizes and reacts to these altered cells.

Contributor: Andy Smith

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Janssen admission Admission statement 09/09/2017
Puerto appeal Appeal against sanction 14/06/2016
Boogerd suspension Temporary suspension 06/01/2016
Ballan appeal Appeal against sanction 27/02/2015
Leinders suspension Permanent ban 22/01/2015
Celaya suspension Temporary suspension 22/04/2014
Marti suspension Temporary suspension 22/04/2014
Bruyneel suspension Temporary suspension 22/04/2014
Ballan suspension Temporary suspension 17/01/2014
Bonazzi suspension Temporary suspension 17/01/2014
Van Dijk ozone treatment Violation 30/11/2013
Klier admission Admission statement 15/08/2013
Zabel admission 2 Admission statement 28/07/2013
Ullrich admission 2 Admission statement 22/06/2013
Puerto convictions Criminal conviction 30/04/2013
Holczer v Schumacher Hearing evidence 18/04/2013
Boogerd admission Admission statement 06/03/2013
Riccò appeal Appeal against sanction 01/03/2013
Puerto - Vainsteins link Hearing evidence 16/02/2013
Puerto - Cipollini link Hearing evidence 09/02/2013
Rasmussen, M admission (Rabobank) Admission statement 31/01/2013
Rasmussen, M admission (CSC) Admission statement 31/01/2013
Sánchez investigation Investigation 26/01/2013
PDM teamwide doping Admission statement 23/01/2013
Puerto - Wielinga link Investigation 23/01/2013
Dekker, T admission Admission statement 19/01/2013
Armstrong admission Admission statement 14/01/2013
Bruyneel resignation Termination of contract 12/10/2012
Leipheimer suspension Temporary suspension 10/10/2012
Danielson suspension Temporary suspension 10/10/2012
Hincapie admission Admission statement 10/10/2012
Hamilton admission 2 Admission statement 30/08/2012
Armstrong permanent ban Permanent ban 24/08/2012
US Postal lifetime bans Permanent ban 10/07/2012
Di Grégorio arrest Arrest 10/07/2012
US Postal investigation 2 (2003-2004) Investigation 12/06/2012
US Postal investigation 2 (2005-2007) Investigation 12/06/2012
Riccò suspension 2 Temporary suspension 19/04/2012
Ullrich admission 1 Admission statement 10/02/2012
Ullrich appeal 2 Appeal against sanction 09/02/2012
Ullrich appeal 1 Appeal against sanction 30/11/2011
Riccò suspension 1 Temporary suspension 08/06/2011
Ricco fired Termination of contract 06/02/2011
Landis admission 2 Admission statement 30/01/2011
Kugler suspension Temporary suspension 23/12/2010
Matschiner admission Admission statement 12/10/2010
Matschiner conviction Criminal conviction 11/10/2010
Valverde appeal Appeal against sanction 01/06/2010
Maynar suspension Temporary suspension 21/10/2009
Kashechkin appeal Appeal against sanction 07/08/2009
Dekker, T counter-analysis positive Positive test 20/06/2009
Freiburg Report - T-Mobile Investigation 13/05/2009
Valverde Italian suspension Temporary suspension 11/05/2009
Mantova investigation Investigation 01/04/2009
Matschiner arrest Arrest 30/03/2009
Kohl admission Admission statement 22/10/2008
Freiburg criminal investigation: Telekom Investigation 13/10/2008
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Bebto suspension Permanent ban 10/07/2008
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Guidi suspension Temporary suspension 08/05/2008
Ullrich fraud investigation Investigation 13/04/2008
Scarponi appeal Appeal against sanction 27/03/2008
Balestri, Barotti RS and Barotti A suspensions Permanent ban 10/03/2008
Jaksche suspension Temporary suspension 19/09/2007
Kashechkin positive Positive test 01/08/2007
Sinkewitz admission Admission statement 31/07/2007
Vinokourov positive Positive test 21/07/2007
Scarponi suspension 1 Temporary suspension 13/07/2007
Jaksche admissions 1 Admission statement 30/06/2007
Jaksche admissions 2 Admission statement 30/06/2007
Puerto - Bartoli link Hearing evidence 25/05/2007
Scarponi admission 1 Admission statement 08/05/2007
Basso admission Admission statement 07/05/2007
Osa, U blood bag identified Hearing evidence 30/04/2007
Osa, A blood bag identified Hearing evidence 30/04/2007
Basso case reopened Investigation 23/04/2007
Ullrich blood match Investigation 03/04/2007
Pevenage admission Admission statement 16/03/2007
Puerto Court 31 judgement Hearing evidence 08/03/2007
Cofidis convictions Criminal conviction 19/01/2007
Botero cleared Appeal against sanction 11/11/2006
Basso cleared Investigation 27/10/2006
Ullrich and Pevenage raids Investigation 14/09/2006
Puerto list (active in 2006) Investigation 30/06/2006
T-Mobile sackings Termination of contract 30/06/2006
Mancebo fired Termination of contract 30/06/2006
Puerto list (inactive in 2006) Hearing evidence 30/06/2006
Phonak suspensions Temporary suspension 02/06/2006
Puerto arrests Arrest 23/05/2006
Hamilton appeal decision Appeal against sanction 12/02/2006
Rumsas, E conviction Criminal conviction 26/01/2006
Rumsas, R conviction Criminal conviction 26/01/2006
Rumsas, R arrest Arrest 29/06/2005
Phonak management resignations Termination of contract 03/01/2005
Pérez, S positive Positive test 05/10/2004
Hamilton positive 1 Positive test 11/09/2004
Hamilton Olympic blood doping Positive test 19/08/2004
CSC doping Hearing evidence 14/08/2004
Oil for Drugs raids Arrest 10/06/2004
Kelme legal investigation Investigation 21/05/2004
Kelme sports investigation Investigation 30/03/2004
Manzano revelations 2 [laundry list] Admission statement 25/03/2004
Manzano revelations 1 Admission statement 21/03/2004
Madejak arrest Arrest 14/01/2004
Madejak suspension Temporary suspension 12/01/2004
Rumsas, E arrest Arrest 28/07/2002
Soprani arrests Arrest 29/06/1999
Riis transfusion Hearing evidence 17/07/1997
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Almeida Luis
Armstrong Lance
Arratibel Iñaki
Azevedo Alfonso
Balestri Maurizio
Ballan Alessandro
Bartoli Michele
Basso Ivan
Batista Rogério
Belda Vicente
Blum Andreas
Bonazzi Fiorenzo Egeo
Boogerd Michael
Botero Santiago
Bruyneel Johan
Cardoso Pedro
Celaya Pedro
Cipollini Mario
Colom Antonio
Cordova Alfredo
Danielson Tom
De Saedeleer Johan
Dekker Thomas
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Klier Andreas
Klöden Andreas
Kohl Bernhard
Kugler Josef
Labarta José Ignacio
Landis Floyd
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Leinders Geert
Leipheimer Levi
Léon Alberto
Madejak Boguslaw
Mancebo Francisco
Marti José Pepi
Matschiner Stefan
Maynar Marcos
Merino Batres José Luis
Müller Jörg
Osa Aitor
Osa Unai
Pantani Marco
Pedersen Alex
Pérez Santiago
Pevenage Rudy
Pino Álvaro
Rasmussen Michael
Riccò Riccardo
Rodriguez Alexis
Rooks Steven
Rumšas Edita
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Santuccione Carlo
Scarponi Michele
Schmid Andreas
Schmidt Mark
Segui Christian
Sevilla Oscar
Silva Paulo
Silva Tiago
Sinkewitz Patrik
Terrados Nicolas
Theunisse Gert-Jan
Ullrich Jan
Vainsteins Romans
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Vinokourov Alexander
Virú Walter
Zabel Erik
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