Preanalytical variability: the dark side of the moon in blood doping screening

Excerpt

Ergogenic aids, either licit or prohibited, are commonly used, misused and abused, to produce a broad scale of effects, ultimately improving performance, body weight, aggressiveness, mental concentration and physical strength, delaying fatigue and pain desensitization. Among the various techniques, blood doping is common in elite and professional endurance athletes to upregulate or to make more efficient the mechanisms of oxygen transport and delivery to peripheral tissues and muscles. Blood doping includes a wide variety of methods or substances, such as blood transfusions, administration of recombinant human erythropoietin and novel erythropoiesis-stimulating substances [e.g., the continuous erythropoiesis receptor activator (CERA), artificial oxygen carriers, allosteric hemoglobin modulators, as well as various altitude training simulator systems] (Lippi and Guidi 2004), and emerging techniques such as gene doping (Lippi and Guidi 2004) and red blood cell (RBC)-mimicking synthetic biomaterial particles (Lippi et al. 2010a). Given the widespread diffusion of these practices, which corrupt the fairness of the “Olympic spirit” and carry several risks for the athlete’s health, antidoping testing is designed to identify unfair athletes. However, antidoping testing completely relies on laboratory investigations [e.g., hemoglobin (Hb) and hematocrit (Hct) are measured as indirect markers of blood doping in athletes] (Lippi 2007), and must hence be subjected to same strict governance that characterize routine laboratory diagnostics. In a recent article published in this journal Bornø et al. provided a dramatic evidence that indirect screening methods are able to indicate recombinant human erythropoietin (rHuEpo) injections in 58% of subjects, so that nearly half of rHuEpo-injected subjects cannot be reliably detected (Bornø et al. 2010). This is a very important finding, which paves the way for additional consideration on the screening for rHuEpo using Hb concentration Hb, and reticulocyte percentage (retic%). …