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

[Ozzie2]

Great posts Krebs, one small correction though. Rasmussen failed to show for four tests. You said "4yrs in a row". Just don't want others to get confused.



Some things to consider. First, it isn't natural in any way to re-infuse your own blood, other than to combat illness (such as cancer recovery). It does however give you a solid advantage for aerobic endurance. Thus, it is cheating.

Next, no one ever has gained a huge advantage by using sticky bottles to help climb hills. There are a few cases where people squawked about it. In the 1986 Tour, Sean Kelly almost got into a fist fight with Erik Vanderarden because while Sean had climbed all the mountains that year (a tough year too), Erik had rode up the hills on long stretches with both the help of car handles, and pushes from fans. But they were competing for the Maillot Vert. Not the overall victory. If Erik had done that in an attempt to win the Maillot Jaune, I'm sure quite a few riders would have joined in on the fist fight.

In the 2006 Tour, during Floyd Landis breakaway he used something like 85 water bottles, pouring most over his head. Several of those were sticky bottles. But most were not. The issue only came up through some speculation in the press. None of his rivals, and no serious fans thought Floyd had used that to an advantage. Did Floyd cheat? Not by using sticky bottles. He did cheat by doping. But he was also in the majority there, as it's highly likely many others were doping too. But there's also a rub. Just who was doping how much? One might say that Floyd was getting superior doping to that of his rivals, and thus cheated more. Just as Bjarne Riis probably doped more than Indurain, Rominger, Zulle, etc. during the 1996 Tour.

Again, great thread. I'm learning a lot here.

YOURE learning? you gotta be kidding. your like a legend her aren't you?

your comments re superior doping are starting to get my brain juices flowing along the lines of what i was thinking when i posted- in regards to cheating_more.

very interesting when you think it through.

perhaps you have to know (even remotely) some cyclists to understand the nature of doping and "drugs" and their attitudes to them to really know?

i mean the grey lines are gray no?

is (a rehydration) drip doping? it isn't your saline

what about a painkilling needle in the knee?

or the poms and their new bikes each 3 years

better rehab, physio?

 

[sherer]

Sticky bottles are when you're getting a new water bottle from the team car and hold onto just that bit longer in order to get a bit of a tow, then a push off against a firm arm just as the car has mysteriously accelerated.

thanks for the info, should prob have worked that one out myself.

 

[blackcat]

Ozzie2, I have been involved with elite sport for many yrs now and the debate about whether or not to let sport be a free for all versus maintaining bans on drugs and doping methods has always existed.

It is a philosophical and ethical debate. The way that I view it is that human performance is a combination of two main factors, genetics and environment. The interaction between those two factors underlies important charateristics such as the psychology of elite performance, ie: determination, motivation etc. It also underlies the physiology of elite performance, the right genetics are required to produce a world champion, but genetics on their own will not suffice. This is where training and nutrition become important. Now lets add a very important co-variable into this equation.... MONEY. Countries with more money are more successful at sport in general. On this topic I don't think you can use the argument that simply having more money is unethical (you can) but it opens a whole new can of worms. Regardless of how much money you have though (to spend on cutting edge sports science and technology for example) this on its own does not produce a world class athlete. You must have the first 2 factors which are far more important than money.

BUT, PEDs and doping methods bring a different kind of variable into the equation. Now you are able to bypass the first 2 factors and create something that is unphysiological. IMO it brings a fundamental change to the world of sports performance. Our ethical and moral code dictates that we humans want to compete against each other using human evolution as our benchmark. Once we start playing around and artifically manipulating our evolutionary history we are changing that benchmark. we create performances that may not be possible to achieve with genetics and environment alone.

Humans in general are honest creatures IMO. We want to see the gladiators fight it out based on their skills and strength. If a doctor behind the scenes becomes just as resposnsible as the athlete we are always left wondering who the real winner was, the athlete, the doctor or some combination of both? Think about that weird empty feeling you get when you see a movie that finishes without an ending, or how people feel whose loved ones go missing never to be found. I think humans need closure. If drugs were legal, I believe we loose that closure.

there is also an inverse relationship to money.

Morocco, and sub Saharan Africa, Kenya and Ethiopia in endurance running. Then the Caribbean nations in the sprint disciplines.

Also some Caribbean/Central American courties like Cuba, Domincan Republic and Puerto Rico in baseball.

And there was a history of jewish basketballers in the early era of the NBA when there was anti-semitism and less opportunities in other vocation spheres.

So, the money variable is fluid and forever changing and altering the dynamics, not necessarily working in one direction only.

 

[DarkWing]

From: Excercise physiology By William D. McArdle, Frank I. Katch, Victor L. Katch

Early research in this area noted a rapid increase in VO2Max following infusion of whole blood. One study reported a 23% overnight increase in exercise perfromance and a 9% increase in VO2Max with blood doping. Subsesquent investigations (including a study by a past critic of the technique) support previous findings and show physiologic and performance improvements with red blood cell reinfuseion.

Something I don't quite seem to understand:
Kohl said that he didn't need to dilute his blood if he injected whole blood - but wont you body excrete the excess plasma thus giving you a high HCT? (leaving you only with extra RBC's - not extra blood volume)

How do they deal with the high (above 50) hct's during the race? Surely they can't show up to tests after the race with a hct of 56%.

 

[blackcat]

From: Excercise physiology By William D. McArdle, Frank I. Katch, Victor L. Katch




Something I don't quite seem to understand:
Kohl said that he didn't need to dilute his blood if he injected whole blood - but wont you body excrete the excess plasma thus giving you a high HCT? (leaving you only with extra RBC's - not extra blood volume)

How do they deal with the high (above 50) hct's during the race? Surely they can't show up to tests after the race with a hct of 56%.

plasma will dissipate over time, but not overnight. Someone will answer this better. Landis and Kohl's 'crit rose a few points. I would like to see the results of other riders' crits in the public forum. Ofcourse, there are techniques to manipulate this and warp the results.

 

[Bala Verde]

This forum has certianly sparked my interest in this area. I work with elite athletes so this could be considered "research" for me! Anyway, I was just looking through some literature on autologous blood transfusions and it shows that if you remove 500m of blood it takes about 35 days to normalise blood volume, but it is possible to take out around 450ml once per week for at least 3 weeks and see a normalisation after about 70 days (instead of requiring around 100 days if you took them out once per month).

What this tells us is that during the off-season blood is coming out, most likely at the rate of 500m per week for a month or so, and then a range of methods eg: CERA, EPO, hematide, steroids could be employed to bring the levels back to normal far more rapidly than the above. Cease using these products for about 3 weeks and then repeat the process. In the space of 4 months you could have 2-3 L of your own blood ready at hand. Accelerated erythropoesis will show up in the blood tests alone due to the natural homeostatic regulation that occurs in response to the blood loss.

Its no secret that every year Lance would disappear for months at a time in the off-season on "training" camps conducted in remote locations, where he was unavailable for out of competition testing.

If you conduct CO rebreathing + blood testing during that period, and again at the onset of a GT and 2 or 3 times during a GT, you WILL catch them out.

I was wondering, since you mentioned Mr. Armstrong, if a rider and his medical doctor can harvest 2-3L, while they would use 2-3 times 500ml during a GT, aproximating 1-1.5L, why would, in this case Mr. Armstrong, only focus on the TdF.

With that amount of extra blood you'd be able to do well in 2 (maybe non consecutive) GTs. Well, maybe since Mr. Armstrong only focused on the TdF, and it falls right in the middle between the other GTs it's understandable.

Would they use the extra blood as a back-up, or safety precaution if something goes wrong.

I also wonder where non-European riders would have there blood drawn. It should be in Europe right, because, if you don't own a private jet. how would you transport bags of blood on an airplane....

Oh and another thing I mentioned before, but we started discussing something else, if Mintochondrion is right that di Luca's CERA positive is likely to have originated from stored blood used as blood transfusion, did his doctor make a mistake?

 

[mitochondrion]

The off season

Donation would normally occur in the off season for those targeting the early classics or Giro. During this time at say an altitude camp, one could microdose EPO, (CERA or Hematide would be easier to detect given their longer half lives) to recover from the donation more quickly than native physiology would allow.

Di Luca's 2nd and 3rd blood bags therefore contained small titres of CERA leading to the non-negative results.

Riders who plan to contend the GC in a major grand tour, know that the majority of their tests will take place in the weeks immediately before and during the aforementioned tour. The method of autologous blood transfusion described would result in very little opportunity for WADA unless one was caught with the venesection / transfusion equipment.

Their best hope lies in shutting down the doctors and / or DNA matching bags to riders. The past few years have shown us that governments want to protect their athletes.

Finally, autologous transfusion is not limited just to cycling, what about 5 hour tennis matches at the end of a two week tournament?

 

[BigBoat]

Something I don't quite seem to understand:
Kohl said that he didn't need to dilute his blood if he injected whole blood - but wont you body excrete the excess plasma thus giving you a high HCT? (leaving you only with extra RBC's - not extra blood volume)

How do they deal with the high (above 50) hct's during the race? Surely they can't show up to tests after the race with a hct of 56%.

Kohl SAID he hemodiluted with human albumin & saline. Read his views. Crit shoots through the bloody roof with whole blood transfusions. Post stage blood values are actually not taken. 2 hours after a race is the minimum blood collection timeframe. I doubt anybody gave post stage samples in this year's TDF...Thats a hunch of mine though maybe some did.

 

[dienekes88]

plasma will dissipate over time, but not overnight. Someone will answer this better. Landis and Kohl's 'crit rose a few points. I would like to see the results of other riders' crits in the public forum. Ofcourse, there are techniques to manipulate this and warp the results.

Something I don't quite seem to understand:
Kohl said that he didn't need to dilute his blood if he injected whole blood - but wont you body excrete the excess plasma thus giving you a high HCT? (leaving you only with extra RBC's - not extra blood volume)

How do they deal with the high (above 50) hct's during the race? Surely they can't show up to tests after the race with a hct of 56%.

I think this is similar to a case of isotonic volume expansion. The baroreceptors in the atria would respond and release atrial natriuretic peptide... and a decrease in antidiuretic hormone would lead to peeing relatively soon after.

Taking albumin would counteract some of this by allowing your body to hold onto more water, because of the increase in the oncotic pressure in the glomerulus would counteract the increased hydrostatic pressure of having greater renal blood flow (secondary to ANP release). Albumin doesn't go through the glomerular basement membrane, because both are negatively charged and Albumin isn't exactly small.

That's my understanding of it.

 

[Krebs cycle]

D
Their best hope lies in shutting down the doctors and / or DNA matching bags to riders. The past few years have shown us that governments want to protect their athletes.

This is something that confuses me. They should have DNA evidence from the regular blood testing. I don't understand why they can't for example, cross check Contadors DNA from recent blood tests with the bags from operacion puerto?

 

[Krebs cycle]

I think this is similar to a case of isotonic volume expansion. The baroreceptors in the atria would respond and release atrial natriuretic peptide... and a decrease in antidiuretic hormone would lead to peeing relatively soon after.

Taking albumin would counteract some of this by allowing your body to hold onto more water, because of the increase in the oncotic pressure in the glomerulus would counteract the increased hydrostatic pressure of having greater renal blood flow (secondary to ANP release). Albumin doesn't go through the glomerular basement membrane, because both are negatively charged and Albumin isn't exactly small.

That's my understanding of it.

My guess is that the volume expansion can be accomodated by the venous circulation (which is extremely compliant), so that the increase in MAP and afterload is not as large as what you might otherwise expect.

 

[blackcat]

I think this is similar to a case of isotonic volume expansion. The baroreceptors in the atria would respond and release atrial natriuretic peptide... and a decrease in antidiuretic hormone would lead to peeing relatively soon after.

Taking albumin would counteract some of this by allowing your body to hold onto more water, because of the increase in the oncotic pressure in the glomerulus would counteract the increased hydrostatic pressure of having greater renal blood flow (secondary to ANP release). Albumin doesn't go through the glomerular basement membrane, because both are negatively charged and Albumin isn't exactly small.

That's my understanding of it.

My guess is that the volume expansion can be accomodated by the venous circulation (which is extremely compliant), so that the increase in MAP and afterload is not as large as what you might otherwise expect.

the reason why the crit decreases over the course of high intensity racing and GT's is because plasma increases, is my understanding.

So this naturally defrays the phenomenon of excess plasma being shunted. Qualifier: all from a lay person, NOT a boffin here.

 

[elapid]

This is something that confuses me. They should have DNA evidence from the regular blood testing. I don't understand why they can't for example, cross check Contadors DNA from recent blood tests with the bags from operacion puerto?

There are two possible scenarios:

1. The Spanish judiciary has ruled that the evidence (ie, bags of blood) cannot be used in further cases because the laws as they existed at that time stated that doping was only illegal if it harmed the athlete's health. The judge ruled that they did not harm the health of athletes. Spain does have antidoping laws now, but these could not be applied retrospectively to OP. This is where the Valverde case will get interesting because CONI have basically violated the judicial ruling of another country.

2. Contador has no blood bags. This is unlikely because he has refused to his give DNA. Other riders, such as Allan Davis, were offering their DNA immediately to clear their names (and the UCI refused and kept them in the wilderness). When I asked the same question as you, I was told that some of the athletes named or implicated were so eager to prove their innocence because they did not have bags of blood stored and hence DNA evidence would clear them of their involvement in OP.

 

[Cobber]

There are two possible scenarios:

1. The Spanish judiciary has ruled that the evidence (ie, bags of blood) cannot be used in further cases because the laws as they existed at that time stated that doping was only illegal if it harmed the athlete's health. The judge ruled that they did not harm the health of athletes. Spain does have antidoping laws now, but these could not be applied retrospectively to OP. This is where the Valverde case will get interesting because CONI have basically violated the judicial ruling of another country.

2. Contador has no blood bags. This is unlikely because he has refused to his give DNA. Other riders, such as Allan Davis, were offering their DNA immediately to clear their names (and the UCI refused and kept them in the wilderness). When I asked the same question as you, I was told that some of the athletes named or implicated were so eager to prove their innocence because they did not have bags of blood stored and hence DNA evidence would clear them of their involvement in OP.

I guess another possibility would be that it is illegal to use blood from an antidoping control to perform DNA fingerprinting analysis that is unrelated to that particular control.

On the subject of an autologous blood doping test, I wonder if a test for exogenous albumin could be developed? Albumin that is administered at the time of blood doping is presumably pooled from donors, and thus if there is significant variation in the albumin proteins between different donors then a test could be developed to detect these variants. Normally, there should be only one or two variants in the blood, depending if a person is homo- or heterozygous, correct?

 

[dienekes88]

My guess is that the volume expansion can be accomodated by the venous circulation (which is extremely compliant), so that the increase in MAP and afterload is not as large as what you might otherwise expect.

To some extent. The increase in unstressed volume (venous blood) increases the filling pressures of the heart and increases cardiac output due to the frank-starling relationship. The venous system is quite compliant, but there's still some elasticity, i.e. volume expansion leads to a slight increase in pressure. If you're volume overloaded, you're going to get rid of that volume. If you drink a liter of gatorade, an hour later you have to pee. Doesn't matter how well trained you are.

 

[Bala Verde]

I guess another possibility would be that it is illegal to use blood from an antidoping control to perform DNA fingerprinting analysis that is unrelated to that particular control.

I think I read that somehwere too, that they can't use DNA, obtained through taking samples for 'regular testing' to match it with blood bags, in order to get a conviction. Unless a rider gives explicit permission to use DNA for purposes known in advance....

Might this also be a problem n the Valverde case?

 

[usedtobefast]

i have to say, thanks to all the knowledgeable posters who are giving those of
us who are not scientists a chance to understand the biology of doping.

just as an observation, the whole "bags of blood" thing opens up a lot of "issues" on so many levels.

 

[M Sport]

There are two possible scenarios:

1. The Spanish judiciary has ruled that the evidence (ie, bags of blood) cannot be used in further cases because the laws as they existed at that time stated that doping was only illegal if it harmed the athlete's health. The judge ruled that they did not harm the health of athletes. Spain does have antidoping laws now, but these could not be applied retrospectively to OP. This is where the Valverde case will get interesting because CONI have basically violated the judicial ruling of another country.

2. Contador has no blood bags. This is unlikely because he has refused to his give DNA. Other riders, such as Allan Davis, were offering their DNA immediately to clear their names (and the UCI refused and kept them in the wilderness). When I asked the same question as you, I was told that some of the athletes named or implicated were so eager to prove their innocence because they did not have bags of blood stored and hence DNA evidence would clear them of their involvement in OP.

1. Correct.

2. That's incorrect. The assumption that if he did not give DNA then he must have something to hide. I wouldn't give my DNA for anything if requested and I have nothing to hide. I believe it violates my rights. That being said, Alberto has actually consented, he signed the charter. So refer to point No.1.

 

[red_explosions]

Contadope is as shifty as hell. It's hardly rocket science.

For example, the police accuse you of a crime. You know you didn't do it. Your DNA will put you in the clear. Do you:

a) Give a DNA sample and exonerate yourself.

b) Refuse to give for reasons known only to yourself, and put yourself under a cloud of suspicion.

It's a no-brainer.

 

[elapid]

1. Correct.

2. That's incorrect. The assumption that if he did not give DNA then he must have something to hide. I wouldn't give my DNA for anything if requested and I have nothing to hide. I believe it violates my rights. That being said, Alberto has actually consented, he signed the charter. So refer to point No.1.

The DNA debate is definitely controversial and I can see both sides of the argument.

I am not sure if you are correct in regards to point 2 though. Firstly, from Wikipedia: "According to French daily Le Monde, he (Contador) refused then to undergo a DNA test that would have judged whether or not he had any link to the blood bags that were found in the investigation."

Secondly, the antidoping charter was introduced in June 2007. This is after Operation Puerto became public and the judge's ruling, so I would presume that any DNA collected from Contador could not be applied retrospectively to a previous allegation. But you kind of said that already anyway.