Autologous blood transfusion (or How to win a grand tour in 2009)

[mitochondrion]

It is my intention to explode some of the myths circulating at present.

The largest performance enhancements are seen when oxygen delivery to the tissues is increased, raising the anaerobic threshold and reducing resultant oxygen debt. This lowers tissue lactate, decreases perceived effort and enables faster recovery.

In the past microdosing EPO regimens resulted in higher red cell mass all year around. More recently CERA and Hematide have been used to good effect. However the most reliable method of increasing oxygen delivery is autologous blood transfusion.

During a three week tour the body is pushed to extreme, as a result the endocrine and haematological systems are severely stressed. Serum titres of both steroid and peptide hormones drop, particularly in the third week. Haemocrit would normally drop fractionally.

Athletes currently undergo transfusion perhaps twice in the three weeks, 24-48 hours before the queen stage or key time trials.

Stored autologous blood has a reduced p50 and is initially poor at releasing blood to the tissues. The level of 2-3 DPG decreases as storage time increases. Exercise, altitude, small doses of growth factors, free T3 and androgens accelerate the transition to a higher 2-3- DPG level and greater oxygen delivery.

Improper donation and storage leads to bacterial contamination and/or clumping turning the blood darker in colour.

Haemodilution occurs prior to testing, 1 litre of Hartmanns takes as little as 4 minutes to infuse through a 14G cannula. No reliable test is in place to detect autologous transfusion.

New pharmaceutical performance enhancers have additive effects to transfusion.

 

[lean mean &green]

there are a lot of contributors who are very well informed. the above won't likely explode myths on this forum.

i encourage you to keep reading and contributing tho.

 

[Cobblestones]

It is my intention to explode some of the myths circulating at present.

The largest performance enhancements are seen when oxygen delivery to the tissues is increased, raising the anaerobic threshold and reducing resultant oxygen debt. This lowers tissue lactate, decreases perceived effort and enables faster recovery.

In the past microdosing EPO regimens resulted in higher red cell mass all year around. More recently CERA and Hematide have been used to good effect. However the most reliable method of increasing oxygen delivery is autologous blood transfusion.

During a three week tour the body is pushed to extreme, as a result the endocrine and haematological systems are severely stressed. Serum titres of both steroid and peptide hormones drop, particularly in the third week. Haemocrit would normally drop fractionally.

Athletes currently undergo transfusion perhaps twice in the three weeks, 24-48 hours before the queen stage or key time trials.

Stored autologous blood has a reduced p50 and is initially poor at releasing blood to the tissues. The level of 2-3 DPG decreases as storage time increases. Exercise, altitude, small doses of growth factors, free T3 and androgens accelerate the transition to a higher 2-3- DPG level and greater oxygen delivery.

Improper donation and storage leads to bacterial contamination and/or clumping turning the blood darker in colour.

Haemodilution occurs prior to testing, 1 litre of Hartmanns takes as little as 4 minutes to infuse through a 14G cannula. No reliable test is in place to detect autologous transfusion.

New pharmaceutical performance enhancers have additive effects to transfusion.

This is all correct and very informative, but I don't see which myth you're going to explode. Kohl told us everything about autologous transfusions. They're hard to detect. And unless you pack cells, you wouldn't even need hemodilution prior to testing. Still, one method would be to look for a decreased number of reticulocytes, another would be CO total blood volume testing. The former is hard (and EPO-type microdosing might prevent discovery) the latter hasn't been used (yet).

 

[Advancedone]

I think Mitochondrion has set a few peoples perceptions straight.
Namely: that they will only use maybe 2 transfusions in a GT and that it takes 24-48 hours to reach the bloods full potential to release oxygen.

Some people seem to indicate that riders transfuse all the time and do it just before a stage.
I raised the issue of the 24-48 hours with Bigboat and he never answered, I know he seems to indicate that the transfusions are used on the morning of stages, but I've always been informed from a medical viewpoint transfusions are useless if you are trying to get the oxygen carrying ability of the blood up in a trauma situation (i.e. quickly) the same as you would be trying to do if transfusing on the morning of an important stage. In fact they can even have a slightly negative effect short term.

I think Mitochondrion knows his (or her) stuff and isn't just repeating what he has read elsewhere. Have a look at his other post, they are all very considered and very accurate. Thanks.

 

[blackcat]

I think Mitochondrion has set a few peoples perceptions straight.
Namely: that they will only use maybe 2 transfusions in a GT and that it takes 24-48 hours to reach the bloods full potential to release oxygen.

Some people seem to indicate that riders transfuse all the time and do it just before a stage.
I raised the issue of the 24-48 hours with Bigboat and he never answered, I know he seems to indicate that the transfusions are used on the morning of stages, but I've always been informed from a medical viewpoint transfusions are useless if you are trying to get the oxygen carrying ability of the blood up in a trauma situation (i.e. quickly) the same as you would be trying to do if transfusing on the morning of an important stage. In fact they can even have a slightly negative effect short term.

I think Mitochondrion knows his (or her) stuff and isn't just repeating what he has read elsewhere. Have a look at his other post, they are all very considered and very accurate. Thanks.

I was the first to harangue BB because of his delusions, this one in particular.

I do not rule out, that riders have not experimented depositing and dumping blood for stages. That may well have occurred. Yet if BB was as well informed as he asserts he is, he would have known this medical procedure does not boost the O2 capacity immediately. He has some knowledge, but some glaring holes, and perpetuates his misconceptions.

 

[Escarabajo]

... Athletes currently undergo transfusion perhaps twice in the three weeks, 24-48 hours before the queen stage or key time trials.
...

OK. Here is where I am skeptical. I am not an expert but I need explanation on the following: there are about 6 to 7 key stages spreaded out throughout the tour. The majority of the times you have a couple on the first week (TTT, ITT), a couple on the second week (Pyrenees, or Alps whichever they put first) and 3 to 4 key stages on the last week. The problem is that usually the last week extends until the penultimate stage which is Mt. Ventoux or an ITT. Here is where I have the confusion. You would need at least three transfusions in every tour and the last one you have to hope that the effect will take you to Paris without having to bonk on the final days. Am I missing something or the Kohl theory is the only rule?
Was that what happened with Armstrong in Verbier? The effect was already gone until he got recharged on the rest day or even that same night when Contador won the stage? How long does the effect of each transfusion last?

 

[blackcat]

OK. Here is where I am skeptical. I am not an expert but I need explanation on the following: there are about 6 to 7 key stages spreaded out throughout the tour. The majority of the times you have a couple on the first week (TTT, ITT), a couple on the second week (Pyrenees, or Alps whichever they put first) and 3 to 4 key stages on the last week. The problem is that usually the last week extends until the penultimate stage which is Mt. Ventoux or an ITT. Here is where I have the confusion. You would need at least three transfusions in every tour and the last one you have to hope that the effect will take you to Paris without having to bonk on the final days. Am I missing something or the Kohl theory is the only rule?
Was that what happened with Armstrong in Verbier? The effect was already gone until he got recharged on the rest day or even that same night when Contador won the stage? How long does the effect of each transfusion last?

the effects last. They blood will take a while to dissipate thru natural cell death one assumes, and the crit will rise, as excess plasma has been lost.

So, for every 600ml of packed cells added to the 6 litres or however much the natural blood capacity of the rider is, they gain those 600ml and only lose through natural attrition.

They do not need transfusion after transfusion. Where do you think that blood goes? I am assuming you are not thinking it is dumped.

what is the cell life roughly of red blood? 100 days abouts, 3 months?

 

[Hmmmmm]

what is the cell life roughly of red blood? 100 days abouts, 3 months?

Red blood cells have a limited life span of around 100 to 120 days.

Also, I have received multiple transfusions in the past for medical reasons and the results were noticed rather quickly - less tired, easier breathing

 

[blackcat]

Red blood cells have a limited life span of around 100 to 120 days.

Also, I have received multiple transfusions in the past for medical reasons and the results were noticed rather quickly - less tired, easier breathing

yes, but different end of the spectrum. Talking aerobic limit, and working at 100% of the O2 capacity. Surely it will help immediately, unless complications, but if it is not at effectiveness of 100%, can see why transfusions would be done 48-72 hours prior, and not necessarily a rest day.

 

[runninboy]

Red blood cells have a limited life span of around 100 to 120 days.

Also, I have received multiple transfusions in the past for medical reasons and the results were noticed rather quickly - less tired, easier breathing

So lets say a rider got a transfusion two days before the prologue, he should be able to carry the gains into the third week, or rather prevent his performance from dropping off in the third week?

Or would it be better to maybe have another transfusion the day before the rest day before the third week?

 

[Ozzie2]

So lets say a rider got a transfusion two days before the prologue, he should be able to carry the gains into the third week, or rather prevent his performance from dropping off in the third week?

Or would it be better to maybe have another transfusion the day before the rest day before the third week?

very enjoyable thread

thanks to those taking the time to post

one thought- for mine it is doping, but not drugs

i could comfortably "rehydrate' this way without moral conflict

im not supposing riders are less or more moral than me, but as i said i dont drink or smoke and live a mennonite lifestyle- and yeah i could do this no problem

as such, could it be assumed blood doping is not regarded as a "perfromance enhancing drug" by athletes but just an effective way to restore the body back to more balanced levels?

i mean we put (they choose to) these cyclists through 3 weeks of hell for the sake of a TV audience. i can't blame them for trying to survive and keep up.

i ask the question- is ABT regarded as "cheating" or is it just an accepted level playing field amongst tour cyclists?

 

[Krebs cycle]

It is my intention to explode some of the myths circulating at present.

The largest performance enhancements are seen when oxygen delivery to the tissues is increased, raising the anaerobic threshold and reducing resultant oxygen debt. This lowers tissue lactate, decreases perceived effort and enables faster recovery.

In the past microdosing EPO regimens resulted in higher red cell mass all year around. More recently CERA and Hematide have been used to good effect. However the most reliable method of increasing oxygen delivery is autologous blood transfusion.

During a three week tour the body is pushed to extreme, as a result the endocrine and haematological systems are severely stressed. Serum titres of both steroid and peptide hormones drop, particularly in the third week. Haemocrit would normally drop fractionally.

Athletes currently undergo transfusion perhaps twice in the three weeks, 24-48 hours before the queen stage or key time trials.

Stored autologous blood has a reduced p50 and is initially poor at releasing blood to the tissues. The level of 2-3 DPG decreases as storage time increases. Exercise, altitude, small doses of growth factors, free T3 and androgens accelerate the transition to a higher 2-3- DPG level and greater oxygen delivery.

Improper donation and storage leads to bacterial contamination and/or clumping turning the blood darker in colour.

Haemodilution occurs prior to testing, 1 litre of Hartmanns takes as little as 4 minutes to infuse through a 14G cannula. No reliable test is in place to detect autologous transfusion.

New pharmaceutical performance enhancers have additive effects to transfusion.

Good informative post but the bit about p50 needs further clarification. VO2max is insensitive to changes in p50 over a range that normally includes the usual left shift with respiratory alkalosis at altitude (see Wagner, Respir Physiol. 1997). Within this range, whilst increasing 2,3 DPG will enhance unloading at the tissues it decreases saturation in the pulmonary vasculature and therefore, SaO2 is decreased and VO2max remains the same. I am unaware that growth factors, t3, and androgens increase production of 2,3 DPG. Perhaps you can cite a reference for that please?

My question to you is thus, how far does p50 drop in stored blood? Also why does it drop if the blood is frozen to -80degC? My understanding is that at these temperatures glycolosis should be completely halted and therefore, little change in 2,3 DPG, pCO2 and [H+] would occur over time (but I could be wrong here??)

If indeed transfusions are occurring during the tour, then the question must be asked, why aren't they getting caught red handed? At some point there needs to be bags of blood, cannulas, doctors and athletes all together at the scene of the crime. How come police cannot catch them? The doctor has to receive the blood from a mystery helper at some point. Follow the doctors everywhere. Follow the athletes everywhere. Surely it can't be that hard?

 

[lean mean &green]

I think Mitochondrion knows his (or her) stuff and isn't just repeating what he has read elsewhere. Have a look at his other post, they are all very considered and very accurate. Thanks.

i looked at his other posts before you suggested it. i noticed there all almost identical in wording to this one.

 

[lean mean &green]

If indeed transfusions are occurring during the tour, then the question must be asked, why aren't they getting caught red handed? At some point there needs to bags of blood, cannulas doctors and athletes all together at the scene of the crime. How come police cannot catch them? The doctor has to recieve the blood from a mystery helper at some point. Follow the doctors everywhere. Follow the athletes everywhere. Surely it can't be that hard?

agree.

common sense suggests that transfusions would be more frequent and less sizeable. More frequency, less volume.

 

[blackcat]

very enjoyable thread

thanks to those taking the time to post

one thought- for mine it is doping, but not drugs

i could comfortably "rehydrate' this way without moral conflict

im not supposing riders are less or more moral than me, but as i said i dont drink or smoke and live a mennonite lifestyle- and yeah i could do this no problem

as such, could it be assumed blood doping is not regarded as a "perfromance enhancing drug" by athletes but just an effective way to restore the body back to more balanced levels?

i mean we put (they choose to) these cyclists through 3 weeks of hell for the sake of a TV audience. i can't blame them for trying to survive and keep up.

i ask the question- is ABT regarded as "cheating" or is it just an accepted level playing field amongst tour cyclists?

its cheating, its doping, and it can be dangerous. You should do some homework before a silly post like that.

Did PDM get dodgy blood way back? Not sure. But in 2004 Vuelta, Vino and the T-Mobile riders all pulled out of the Vuelta with "sickness", a food poisoning. Yeah, sure. The story is it was bad blood transfusions. Evans, Konecny and Zabel whom did not suffer the "food poisoning" stayed in the race. No dodgy transfusions, as they did not get blood.

Could be apocryphal. Me: leaning to 50/50. As there is a lotta BS, but lots of truth and substance in the doping tales. Put about twice as much stock in this tho, than the function you assess Bigboat with.

 

[red_explosions]

It is my intention to explode some of the myths circulating at present.

The largest performance enhancements are seen when oxygen delivery to the tissues is increased, raising the anaerobic threshold and reducing resultant oxygen debt. This lowers tissue lactate, decreases perceived effort and enables faster recovery.

In the past microdosing EPO regimens resulted in higher red cell mass all year around. More recently CERA and Hematide have been used to good effect. However the most reliable method of increasing oxygen delivery is autologous blood transfusion.

During a three week tour the body is pushed to extreme, as a result the endocrine and haematological systems are severely stressed. Serum titres of both steroid and peptide hormones drop, particularly in the third week. Haemocrit would normally drop fractionally.

Athletes currently undergo transfusion perhaps twice in the three weeks, 24-48 hours before the queen stage or key time trials.

Stored autologous blood has a reduced p50 and is initially poor at releasing blood to the tissues. The level of 2-3 DPG decreases as storage time increases. Exercise, altitude, small doses of growth factors, free T3 and androgens accelerate the transition to a higher 2-3- DPG level and greater oxygen delivery.

Improper donation and storage leads to bacterial contamination and/or clumping turning the blood darker in colour.

Haemodilution occurs prior to testing, 1 litre of Hartmanns takes as little as 4 minutes to infuse through a 14G cannula. No reliable test is in place to detect autologous transfusion.

New pharmaceutical performance enhancers have additive effects to transfusion.

Excellent post. However you forgot to mention that half the peleton are now juicing on cow blood for that little extra something. Just ask BigBoat lol.

 

[lean mean &green]

the glossary of terms so normal people can read this thread:
(sorry i'm a teacher)

microdosing - frequent but smaller doses which are better at avoiding detection, especially a simple test like hematocrit

EPO, CERA, Hematide - drugs that increase the body's own RBC production in order of oldest to newest

autologous transfusion - a specimen (sample) collected from one's self that is transfused back into the athlete at a later date

endocrine and haematological systems - body systems that produce hormones and blood respectively

p50 - a measure of red blood affinity for oxygen, (how tightly they bind together, there's a happy medium, more or less is not always better)

t3 - a thyroid hormone

androgens - anabolic or tissue building drugs/hormones

2,3 DPG - the presence of this compound directly effects oxygen affinity, it improves oxygen delivery at the tissues that need it, ie RBC's give up oxygen "more easily" to working muscles

haemodilution - adding plasma so as not to throw hematocrit out of whack

Hartmann's - a solution that is added when doing transfusions, it's "standard operating procedure"

14G cannula - a certain size tube

glycolysis - breakdown of glucose for energy

SaO2 - oxygen saturation, ie how well red blood cells are picking up oxygen

alkalosis - blood is becoming basic, ie less acidic

pCO2 and [H+] - has to do with pH, don't worry about it for now

take home message:
transfusions are less effective right away, they have to be done a few days prior to important stages, most of the forum already knew this according to recent doping positives who have cooperated. 2 transfusions during a tour is conjecture, i'm not sure myself. i think they transfuse as often and as strategically as they can afford.

ABT is cheating

RBC's have a useful lifespan but some of the cells transfused are old, some thriving, and some immature, they're not all studs. you would have to transfuse much more often than once every three months to achieve significant benefits. How much the body's own RBC production slows in these circumstances is a bit of a mystery to me but could cause significant problems as well.

I don't think the UCI is willing to use round the clock surveillance or whether they have the right to do so, you only really have to surveil the top 10 on GC, wouldn't be that hard or expensive. I don't know where you draw the line from a legal perspective.

 

[sherer]

one thing from reading this is it says the level in the blood will drop after the blood it put back so does that mean a drop off in performance the first day the blood is used ?

 

[keen_but_slow]

I'm in England, and the Tour is shown on TV screens at work. A lot of people follow it, and most of them know cycling only from the Tour and the Olympics. There was thus excitement about the boy Wiggins doing well, and some questions over the ... ahem ... ethics of the race.

I sent a link to one of the Kohl stories where he said that the transfusions were taken on the second rest day, and took 2 days to work. My comment was that all bets were off as of rest day +2.

In some respects I was happy to see Wiggins unable to follow Schleck Sr that day. I'd like to hope it was his lack of experience of "racing" a GT rather than just scratching round for stage wins which is all he's done previously, but Kohl's comments plus that IM chat meant that for me, the Tour was nothing more than a spectacle from then on.

 

[red_explosions]

I'm in England, and the Tour is shown on TV screens at work. A lot of people follow it, and most of them know cycling only from the Tour and the Olympics. There was thus excitement about the boy Wiggins doing well, and some questions over the ... ahem ... ethics of the race.

I sent a link to one of the Kohl stories where he said that the transfusions were taken on the second rest day, and took 2 days to work. My comment was that all bets were off as of rest day +2.

In some respects I was happy to see Wiggins unable to follow Schleck Sr that day. I'd like to hope it was his lack of experience of "racing" a GT rather than just scratching round for stage wins which is all he's done previously, but Kohl's comments plus that IM chat meant that for me, the Tour was nothing more than a spectacle from then on.

^^ England +1

You know, prior to stage 17 I was convinced Wiggo was boosting. His slight tailing off in the last few stages have possibly persuaded me that he was clean all along. He certainly talks the talk on anti-doping. Good to see that he intends to post his blood results as well.

If Wiggo is clean, he's the winner of the tour for me. Astana and Saxo Bank just look way too shifty. Call me a cynic, but there ain't no way on earth a clean Armstrong beats a clean Wiggins. As for Contadope.......................

 

[mitochondrion]

Performance after transfusion

2-3 DPG levels within stored blood reduce with the passage of time. This reduction occurs to a lesser extent in cooled or frozen blood. The shelf life is limited to a maximum of 180 days with citrated blood, less for SAG-M.

Research in the late 70s and 80s with renal patients showed that manipulation of the androgen axis could effect oxygen affinity. Further work demonstrated that blood from an EPO treated patient exhibited higher 2-3 DPG levels.

Blood for autologous transfusion would need to be taken at least 3 months prior to a grand tour to enable a non-EPO treated rider recover from donation. Resultant peaks in performance limit a rider to one successful tour in the middle of the year.

In elite athletes, initial performance following transfusion may be affected by disportional increases in myocardial oxygen demand vs delivery due to increased blood volume and increased viscosity.

Transfusion of old or spoiled blood would ruin a tour for a particular rider but a non-negative test ends your career for 2 years.

Allegedly Landis suffered immediately post transfusion plus a bonk and the testosterone was given to improve his oxygen delivery.

 

[barrlley]

Seems like you guys put far too much thought into this. All sports have cheats, and they will continue to have them. Catch one thing, they'll find another. Cycling is a business, riders are paid to perform, and as long as that holds true, riders will do whatever they can to improve their chances of winning. Millions of euros on the line here. Not that this is any sort of validation, but if you wanna come down hard on cheats, then you should probably broaden your horizons to include pretty much anything you can think of, as everything has its cheats, tends to be ingrained in humanity. Expecting cycling to rise above that is extremely unrealistic--it just was unfortunate enough to bear the brunt of the criticism.

 

[elapid]

2-3 DPG levels within stored blood reduce with the passage of time. This reduction occurs to a lesser extent in cooled or frozen blood. The shelf life is limited to a maximum of 180 days with citrated blood, less for SAG-M.

Research in the late 70s and 80s with renal patients showed that manipulation of the androgen axis could effect oxygen affinity. Further work demonstrated that blood from an EPO treated patient exhibited higher 2-3 DPG levels.

Blood for autologous transfusion would need to be taken at least 3 months prior to a grand tour to enable a non-EPO treated rider recover from donation. Resultant peaks in performance limit a rider to one successful tour in the middle of the year.

In elite athletes, initial performance following transfusion may be affected by disportional increases in myocardial oxygen demand vs delivery due to increased blood volume and increased viscosity.

Transfusion of old or spoiled blood would ruin a tour for a particular rider but a non-negative test ends your career for 2 years.

Allegedly Landis suffered immediately post transfusion plus a bonk and the testosterone was given to improve his oxygen delivery.

I asked this a few months ago but only received an obscure BB answer - why can't they use 2-3 DPG levels to detect autologous blood doping? Is it diluted out to near or normal levels when only 10% of blood volume is transfused?

 

[rolfrae]

Seems like you guys put far too much thought into this. All sports have cheats, and they will continue to have them. Catch one thing, they'll find another. Cycling is a business, riders are paid to perform, and as long as that holds true, riders will do whatever they can to improve their chances of winning. Millions of euros on the line here. Not that this is any sort of validation, but if you wanna come down hard on cheats, then you should probably broaden your horizons to include pretty much anything you can think of, as everything has its cheats, tends to be ingrained in humanity. Expecting cycling to rise above that is extremely unrealistic--it just was unfortunate enough to bear the brunt of the criticism.

But this is a cycling forum, not an other sports or life in general forum. People here care because they love the sport and despise the dishonesty or riders claiming to be the best at the sport we all (on here) love, but denying the truth behind their successes. I don't think that's unrealistic or naive--idealistic, maybe.

 

[slcbiker]

Allegedly Landis suffered immediately post transfusion plus a bonk and the testosterone was given to improve his oxygen delivery.

I've heard a lot of things credited to steroids, but that's not one of them. Do you have a source for that?

Also why wouldn't this make levels in the "blood passport" bounce? Unless you're doing some sort of dilution?