Blood doping/boosting ins&outs

[sniper]

Reference thread for blood doping, which means all forms of (legal, illegal, semi-legal) blood boosting, across sports, across nationalities, and across eras.

I'm personally particularly interested in the questions of feasibility, spread and types of blood doping in the 60s, 70s and 80s, and even more particularly in the use of blood transfusions in cycling (particularly GTs) in the 70s and 80s.

Taking this from the Lemond thread:

thanks, MI, very clarifying.

I'm still confused about djpbaltimore's description of homologous transfusion as containing a 'real risk'.
If a qualified doctor takes all the necessary steps, compatibility testing, screening for any alloantibodies, etc., and both the donor and recipient are perfectly healthy people, what kind of risks are we realistically left with?

You are not understanding the immunology of transfusions. Every transfusion runs the risk of a person developing an allergy to the donor blood which it sees as 'non-self'. But it is like the example of poison ivy where the first exposure leads to sensitization, but no overt symptoms. A second exposure would potentially lead to a systemic allergic reaction. This has nothing to do with screening before the transfusion, whether the people involved are healthy, or whether a doctor was present during the transfusion. Since repeated transfusions from the same donor are not typically done for the fear of allergy, there will be no stats to determine the exact degree of risk. But speaking as an Immunologist, repeated transfusions without white blood cell depletion from a single source is foolish and dangerous. It would be much preferable to vary the source of the donor blood, or as most riders later discovered; to use their own.

thanks, djp, for clarifying.
So are you saying white blood cell depletion makes repeated transfusions from one and the same donor safe?
Was white blood cell depletion possible in the 80s?

 

[djpbaltimore]

Leukoreduction was not universally done until the late 1990s. The US FDA made an advisory in 1998, but it is not mandatory in the USA even now. Places like Canada have made it mandatory for all transfusions. The main reason is safety as you will have less possibility for allergic sensitization. WBCs have more antigens (HLA proteins etc) than RBCs. Many viruses are also cell associated like EBV or CMV, so it also decreases the risk of viral spread from donor to recipient. But with the proper lab equipment and resources, the methodology is not difficult (just not very cheap). It was already being discussed in the late 1950s.

Patients who receive multiple transfusions of blood may be isoimmunized to the leukocytes and probably also the platelets in the transfused blood..... such transfusion reactions..... can be prevented by removal of the buffy coat prior to administration of blood.

http://www.ncbi.nlm.nih.gov/pubmed/13649627

Current protocols eliminate about 99.995% of WBCs. I don't know the efficacy of older methods. But it would make it safer in this particular example.

 

[sniper]

fascinating, thanks.

Later, in the 1980s, advancement in technology led to the development of the first generation cellulose acetate filters, with a leukocyte removal efficiency of 98 percent. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847337/

The link also explains some complications that could occur with leukoreduction in the 80s, but it surely seems it was already possible.

Assuming for the argument that Lemond's team wanted to do leukreduction during a GT, what in your view would have been the major risk factor?

 

[djpbaltimore]

Maintaining the sterility of the samples and finding someone with the technical know-how and equipment to do the procedure safely. I would be surprised if anybody was this sophisticated in the 80s, but who knows...

 

[sniper]

cheers, djp.

 

[jmdirt]

I know that athletes have used/use homologous (allogenic), but isn't autologous the preferred method because it eliminates potential issues?

 

[sniper]

Re:

I know that athletes have used/use homologous (allogenic), but isn't autologous the preferred method because it eliminates potential issues?

indeed.

an argument against the (widespread) use of blood transfusions during GTs in the 70s and (early) 80s is that refrigeration/preservation of ones own blood during three-plus weeks would have been too difficult to organize logistically in that period.
Imo that is still open to discussion, but if it was indeed the case, it might mean that some riders may have experimented with homologous transfusions instead, because refrigeration is not an issue there.

 

[djpbaltimore]

It is really easy to determine whether a person has two types of red blood cells in their body. (Hello Tyler Hamilton!). Autologous transfusion is much harder to detect in a lab test. I don't know if autologous became the preferred option out of safety or to beat the test. Probably the latter. Going from arm to arm would be the more straightforward approach, but it is not without medical risks.

http://www.ncbi.nlm.nih.gov/pubmed/17614019

The resulting method allowed to clearly identify mixed red blood cell populations in homologous blood transfusion samples containing 0.3 - 2.0 % of donor blood.