Here is another point addressed to Publicus, GJB, and anyone else who thinks that a series of negative passport tests is a major piece of evidence supporting Bert‘s innocence. We have all been assuming that if Bert did get the CB from a transfusion, the withdrawal almost certainly had to occur between the DL and the Tour. We have also been assuming that if he had a passport test within a few days of the withdrawal, there is a good chance he would have failed the test. But there is a simple way Bert could have beaten any passport: follow the withdrawal immediately with a transfusion to replace the lost cells. The result would have been no net loss of cells, and therefore very little if any perturbation in the parameters the passport measures.
This procedure has another benefit that highly recommends itself to dopers: it allows the rider to regain full strength immediately, with no recovery period. In Bert’s case, this would be particularly important, because of the somewhat narrow window available to him from the end of the DL to the beginning of the Tour. Let‘s suppose he planned to withdraw blood, but not immediately replace it. He wouldn’t want to do it immediately after the DL, because his HT and other blood values would be somewhat low after a week-long stage race. He would want time for them to recover, to maximize the potency of the withdrawn blood. But neither would he want to do it too close to the Tour, because he would need time to recover from the withdrawal to be at full riding strength. And also, he would want to be sure to have recovered to near normal in order to pass the pre-Tour tests. By transfusing immediately following withdrawal, he would greatly expand the window. In particular, he could do this procedure as close to the beginning of the Tour that he wanted.
As has been discussed on this forum previously, there are two ways riders can follow this procedure of immediately replacing withdrawn blood. One is to make an initial withdrawal without replacement in the off-season or early in the season, well before any important races. This blood is then stored, refrigerated, for several weeks, after which another withdrawal is made, and the blood from the first withdrawal transfused to replace the blood lost in the second withdrawal. Further withdrawals are made at regular intervals during the season, each time replacing the blood taken with refrigerated blood from a previous withdrawal. The logic of this is while blood can be stored refrigerated only for a few weeks, constantly putting it back into your body while you take out fresh blood allows you to have fresh blood all the time. In effect, the rider is storing the blood in his body.
As I have described the procedure so far, it doesn’t provide any performance enhancement. All the transfused blood does is replace blood that was withdrawn. When a rider approaches a targeted race, he has to infuse the stored blood without replacing it without a withdrawal. At some point after the race, he would therefore have to make another withdrawal without infusion to restart the cycle. Since the net transfusion/withdrawal is the same, however, recovery should not be much of a problem. The same with the passport test. The rider’s blood parameter values are basically the same a few days after the race as they were before the race.
The main problem is the narrow window when he transfused without withdrawing. But transfusion is much easier to hide from the passport than withdrawal. The main effect of transfusion is to suppress reticulocyte synthesis, but this suppression can be overcome by micro dosing with EPO. The subsequent withdrawal of 500 ml without transfusion would normally be much more difficult to hide, but if the passport at that time is being compared to the passport before the race, there won’t be much of a difference.
In any case, there are ways to reduce further any vulnerability to testing. Suppose the rider initially withdrew 500 ml. of blood, and has been regularly withdrawing/infusing blood in this amount. Before an important race he could transfuse 250 ml, which would still provide a significant performance enhancing effect, while retaining the other 250 ml. Following the race, he could withdraw another 500 ml., and transfuse with the remaining 250 ml. The net effect, over a period of just a couple of days, is still to withdraw and infuse equal amounts of 500 ml., and the effective size of the withdrawal would be reduced.
The other approach is to use frozen cells, a technology surely available to elite riders with economic means. A relatively large amount of blood can be withdrawn during the offseason, when speedy recovery is not so much of an issue, the cells separated from plasma, and used later, after the season begins. Using this technique would allow a rider to skip at least some of the withdrawal/infusion cycles. He would just transfuse some of the frozen cells before every important race. But depending on his schedule, maybe there would not be enough cells. At some point he might find himself with only enough frozen cells for one more transfusion, with much of the season still ahead. In this case, he would withdraw fresh blood, replacing it with the last of the frozen cells, and from that time on use the regular withdrawal/infusion cycle.
Even if Bert, say, thought he had enough frozen cells for use throughout the entire season, he might still have felt that fresh, refrigerated blood would be a little more potent than cells stored for perhaps six months or longer. So for the biggest race of the season, he might have decided to withdraw fresh blood just a couple of weeks in advance, replacing it with frozen cells.
We have no way of knowing whether this happened, of course. But we do know that other riders have used this procedure, so certainly anyone judging Bert’s case has to entertain it as a serious possibility. WADA does not have to prove that Bert did or didn’t use a particular procedure. The burden is on Bert to show that transfusion is not a possible explanation of his CB positive. The fact that he could have withdrawn blood without failing a passport test is a major blow against his attempts to do this. Using this procedure, he could have passed a test not only during the time when he most likely would have withdrawn blood with CB in it, but at any other time during the season or offseason, save that one point when an initial withdrawal was made.
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