Regulating Autologous Blood Transfusions

[WillemS]

I was just reading about the risks of autologous blood transfusions in several medical journals. Within medicine, it's a method sometimes used for preoperative autologous blood donation (for instance, to give blood well before surgery, so that the patient can be transfused during or after surgery, with his own blood). It's more common, I believe, in countries where there are shortages in blood for allogeneic transfusions (transfusion of blood between two different people with the same blood type).

Why don't we regulate the use of autologous transfusion within cycling? As far as I can tell, there are far less risks involved than with PED's and the current testing methods are still not sufficient to detect, while the future methods are still doubtful. Currently, I think it's extensively used within sports, as it is virtually non-detectable at the moment. The only times we are really able to tell, is when things go awry because of bad blood handling (which might have happened with Ricco). With regulation, there's no need for secret, unsafe transport of blood (wrong temperature for instance) or failure to obtain professional assistance (applying a transfusion without presence of a doctor or nurse).

So, tell me, as I know there are some strong opponents out here and there might be some some strong proponents out here too, why don't we allow it?

(Disclaimer: I am not necessarily claiming I am one of those strong proponents of allowing these kinds of procedures, but I like to know what pro and con arguments you all have.)

 

[Anonymous]

I was just reading about the risks of autologous blood transfusions in several medical journals. Within medicine, it's a method sometimes used for preoperative autologous blood donation (for instance, to give blood well before surgery, so that the patient can be transfused during or after surgery, with his own blood). It's more common, I believe, in countries where there are shortages in blood for allogeneic transfusions (transfusion of blood between two different people with the same blood type).

Why don't we regulate the use of autologous transfusion within cycling? As far as I can tell, there are far less risks involved than with PED's and the current testing methods are still not sufficient to detect, while the future methods are still doubtful. Currently, I think it's extensively used within sports, as it is virtually non-detectable at the moment. The only times we are really able to tell, is when things go awry because of bad blood handling (which might have happened with Ricco). With regulation, there's no need for secret, unsafe transport of blood (wrong temperature for instance) or failure to obtain professional assistance (applying a transfusion without presence of a doctor or nurse).

So, tell me, as I know there are some strong opponents out here and there might be some some strong proponents out here too, why don't we allow it?

(Disclaimer: I am not necessarily claiming I am one of those strong proponents of allowing these kinds of procedures, but I like to know what pro and con arguments you all have.)

firstly, its very close to being detectable, the test is in place, and is expected that it will be ratified in time for the 2012 olympics. British anti doping are actually one of the leaders in creating the test. By this time next year, I think they will be detectable and we will start seeing bans (by what ive read retroactive testing wont be available as they work partly by comparing degredation of cells within the sample.)

Secondly, if you allow something, within certain parameters, there will always be those who push the parameters. You also end up with a situation where those that can afford the best, get the best, and those that cant end up doing it in their living room and ending up like Ricco.

i can also not agree with legalised doping in any form. What next, we raise the crit level to 60, we allow small doses of epo. No chance,.

 

[WillemS]

Secondly, if you allow something, within certain parameters, there will always be those who push the parameters. You also end up with a situation where those that can afford the best, get the best, and those that cant end up doing it in their living room and ending up like Ricco.

i can also not agree with legalised doping in any form. What next, we raise the crit level to 60, we allow small doses of epo. No chance,.

I think there's a substantial difference between injecting one's own blood and the use of synthetic doping agents to alter one's body function.

About the tests, I'm aware of their development, but I am not aware of it already being extensively peer-reviewed and marked as reliable. I hope I am wrong, but I would like to know it's sensitivity and specificity and I would like to see them confirmed by a number of replication studies before they get allowed into anti-doping testing. I hope we'll see that anytime soon, but something like that usually takes some time. It might even turn-out that the test is either not specific enough or sensitive enough and then what do we have? Faith in a test that isn't that reliable in detecting dopers and only the dopers.

 

[mb2612]

I think there's a substantial difference between injecting one's own blood and the use of synthetic doping agents to alter one's body function.

About the tests, I'm aware of their development, but I am not aware of it already being extensively peer-reviewed and marked as reliable. I hope I am wrong, but I would like to know it's sensitivity and specificity and I would like to see them confirmed by a number of replication studies before they get allowed into anti-doping testing. I hope we'll see that anytime soon, but something like that usually takes some time. It might even turn-out that the test is either not specific enough or sensitive enough and then what do we have? Faith in a test that isn't that reliable in detecting dopers and only the dopers.

This has to happen before any test actually gets official. Honestly the press releases make me fear that nothing is happening, because if there was a new test my hope would be we would hear of it when the positives roll in.

 

[lean mean &green]

autologous blood transfusions are minimally effective without the use of EPO. it's a sure bet that if someone is transfusing in this way they are employing other methods. this is a dead issue.

 

[Dr. Maserati]

I think there's a substantial difference between injecting one's own blood and the use of synthetic doping agents to alter one's body function.

About the tests, I'm aware of their development, but I am not aware of it already being extensively peer-reviewed and marked as reliable. I hope I am wrong, but I would like to know it's sensitivity and specificity and I would like to see them confirmed by a number of replication studies before they get allowed into anti-doping testing. I hope we'll see that anytime soon, but something like that usually takes some time. It might even turn-out that the test is either not specific enough or sensitive enough and then what do we have? Faith in a test that isn't that reliable in detecting dopers and only the dopers.

Medically, perhaps (although Ricco might not agree) - but looking at it as cheating or enhancing ones performance through unnatural* means then there is no difference.

*Blood is obviously natural - but having it chilling in the fridge to inject later isn't.

 

[WillemS]

Medically, perhaps (although Ricco might not agree) - but looking at it as cheating or enhancing ones performance through unnatural* means then there is no difference.

*Blood is obviously natural - but having it chilling in the fridge to inject later isn't.

Yeah, but what then is unnatural? A bike itself is an artificial thing, may mechanical developments, such as rapid and precise electric shifting systems, be considered just a legal mechanical addition, while preparation or a human body to function optimally, without much health risks, isn't? I think performing a prolonged bike race, like the Tour, without transfusions is actually medically more dangerous than with transfusions. I am just trying to figure out the border between legal improvements and illegal (mechanical) doping stuff. I am not saying I'm pro-transfusions.

As to the studies into testing: I cannot be totally confident in tests that are only studied by the doping laboratory that is going to use them later to earn money. I know that in the current test development team there are 'scientists' involved (not apostrophing to demote the scientists involved, it just feels strange for me to use the term), but who's pays the research bills? I will scout PubMed (database of medicine-related scientific journals) next week for publications on the new test, to see who's done what and if there are any publications. Without those, I am skeptical of any results.

 

[Dr. Maserati]

Yeah, but what then is unnatural?

I'm sorry but we have this discussion of the "what is" and "what isn't", every few months.

But in short - we are discussing Performance Enhancing Drugs, that give an unfair advantage.

A bike itself is an artificial thing, may mechanical developments, such as rapid and precise electric shifting systems, be considered just a legal mechanical addition, while preparation or a human body to function optimally, without much health risks, isn't? I think performing a prolonged bike race, like the Tour, without transfusions is actually medically more dangerous than with transfusions. I am just trying to figure out the border between legal improvements and illegal (mechanical) doping stuff. I am not saying I'm pro-transfusions.

A bike is a machine - and even then it is subject to a lot of regulation, electric shifting is allowed as it makes the gear changing (because everyone is allowed have and change gears) more efficient.
But your gears cannot be hooked up to an engine that drives the bike - so the basic principle of human powered motion remains.

As to the studies into testing: I cannot be totally confident in tests that are only studied by the doping laboratory that is going to use them later to earn money. I know that in the current test development team there are 'scientists' involved (not apostrophing to demote the scientists involved, it just feels strange for me to use the term), but who's pays the research bills? I will scout PubMed (database of medicine-related scientific journals) next week for publications on the new test, to see who's done what and if there are any publications. Without those, I am skeptical of any results.

Apologies, but I have no idea what tests you are on about - and moreso why any tests would be relevant.

The principle is simple - we like sports to be contested by athletes who train and use natural methods.

 

[WillemS]

I'm sorry but we have this discussion of the "what is" and "what isn't", every few months.

A bike is a machine - and even then it is subject to a lot of regulation, electric shifting is allowed as it makes the gear changing (because everyone is allowed have and change gears) more efficient.
But your gears cannot be hooked up to an engine that drives the bike - so the basic principle of human powered motion remains.

Actually, there's a motor/actuator in the gearing system to change the gears for you. But I get your point. But how about electric breaking? It saves you energy, as you don't have to pull your breaks that hard. It might make them more precise, with sensors tracking traction to counter slipping. How about electric steering, with sensors to minor imbalances in the steering? We might live to see technology that reads minds to lower breaking reaction times. How about automatic oil dispensers to minimize chain resistance after a long day on the French cobbles? We might introduce automatic tire inflation stuff, to be able to deflate and inflate tires with regard to the terrain (downhill vs uphill, cobbles vs concrete).

Apologies, but I have no idea what tests you are on about - and moreso why any tests would be relevant.

The principle is simple - we like sports to be contested by athletes who train and use natural methods.

Are special food additives, synthetically produced, desirable then? I don't think they're that natural. I think the border between natural and unnatural is rather thin, even philosophically debatable (I know I had to at my Metaphysics 101 course in Uni).

 

[Dr. Maserati]

Actually, there's a motor/actuator in the gearing system to change the gears for you. But I get your point. But how about electric breaking? It saves you energy, as you don't have to pull your breaks that hard. It might make them more precise, with sensors tracking traction to counter slipping. How about electric steering, with sensors to minor imbalances in the steering? We might live to see technology that reads minds to lower breaking reaction times. How about automatic oil dispensers to minimize chain resistance after a long day on the French cobbles? We might introduce automatic tire inflation stuff, to be able to deflate and inflate tires with regard to the terrain (downhill vs uphill, cobbles vs concrete).

Again - none of those things are by definition "Performance Enhancing".

Are special food additives, synthetically produced, desirable then? I don't think they're that natural. I think the border between natural and unnatural is rather thin, even philosophically debatable (I know I had to at my Metaphysics 101 course in Uni).

For some products it is thin - which is why there is a list and also why caffeine was on the banned list and then taken off.
But for most methods and substances there is a clear distinction.

 

[mb2612]

Actually, there's a motor/actuator in the gearing system to change the gears for you. But I get your point. But how about electric breaking? It saves you energy, as you don't have to pull your breaks that hard. It might make them more precise, with sensors tracking traction to counter slipping. How about electric steering, with sensors to minor imbalances in the steering? We might live to see technology that reads minds to lower breaking reaction times. How about automatic oil dispensers to minimize chain resistance after a long day on the French cobbles? We might introduce automatic tire inflation stuff, to be able to deflate and inflate tires with regard to the terrain (downhill vs uphill, cobbles vs concrete).



Are special food additives, synthetically produced, desirable then? I don't think they're that natural. I think the border between natural and unnatural is rather thin, even philosophically debatable (I know I had to at my Metaphysics 101 course in Uni).

There is an official definition of doping, basically something has to fulfill 2/3 of these

1) Improves performance
2) Health Risk
3) Contrary to the spirit of sport.

Blood doping clearly fulfills 1, probably 2 as well, depending on how it's done, and I feel it is also 3, as it is an expensive procedure and also involves injecting things into your body and as such clearly isn't in the spirit.

 

[Altitude]

Covered extensively here:

http://forum.cyclingnews.com/showthread.php?t=12216

 

[Merckx index]

by what ive read retroactive testing wont be available as they work partly by comparing degredation of cells within the sample

As linked in another auto transfusion thread, there are several possible tests for autologous transfusion (not even including the DEHP test, which could be used retroactively). Some of these tests look at changes in RNA in red blood cells. If these are changes in sequence, as a result of changes in expression (as is the case for the test based on altered immune function, which I linked in the other auto transfusion thread), then they would be preserved in stored samples, to the extent the RNA was preserved. RNA is very easily degraded, and would probably be degraded to some extent in any stored sample, but this degradation would simply affect the amount available for analysis, not the sequence of any remaining.

About the tests, I'm aware of their development, but I am not aware of it already being extensively peer-reviewed and marked as reliable.

As I discussed in the other auto thread, one such study was published more than two years ago, though I’m not sure if it’s still being developed:

http://onlinelibrary.wiley.com/doi/10.1111/j.1423-0410.2009.01169.x/full

But there frequently is a long lag between initial publication and the validation of a test. A study on DEHP was published almost two years ago, and we still don’t have an official test based on it.

autologous blood transfusions are minimally effective without the use of EPO.

This is a good point, though short-term effectiveness would be possible. EPO is used to stimulate reticulocyte formation, which is suppressed by transfusion. This is done in the short-term to beat the passport test, and in the long run to maintain a high number of red cells. But if one were not concerned about beating a test, and if one were transfusing for an immediate effect (e.g., for a one-day race or during a GT rest day with a mountain stage the following day), transfusion would be very effective, as one would preserve the elevated HT for probably several days. EPO might be needed, though, to maintain an elevated HT throughout a GT. There have been some studies of the long-term effects of transfusion on HT, and IIRC, the HT does remain somewhat elevated for some length of time.

 

[lean mean &green]

This is a good point, though short-term effectiveness would be possible. EPO is used to stimulate reticulocyte formation, which is suppressed by transfusion. This is done in the short-term to beat the passport test, and in the long run to maintain a high number of red cells. But if one were not concerned about beating a test, and if one were transfusing for an immediate effect (e.g., for a one-day race or during a GT rest day with a mountain stage the following day), transfusion would be very effective, as one would preserve the elevated HT for probably several days. EPO might be needed, though, to maintain an elevated HT throughout a GT. There have been some studies of the long-term effects of transfusion on HT, and IIRC, the HT does remain somewhat elevated for some length of time.

i'll explain better what i meant. there is a penalty for withdrawing blood. you aren't able to train with intensity immediately following the removal of RBC's from circulation. because of this lost time, autologous transfusions by themselves are only minimally effective, and sometimes they're a zero sum game. the interruption to training almost outweighs the benefit of reintroducing red blood a month or so later. the penalty phase can be shortened in dramatic fashion when drugs like EPO are used to speed up the production of red blood immediately following donation.

i'm also assuming we're using refrigerated blood. freezing and allowing for longer storage would change the dynamic a bit. methods for freezing blood are expensive and unavailable to most and i think for those reasons not what the OP had intended.

no one transfuses without EPO and no one would transfuse without EPO even if transfusions were legal. legalizing autologous transfusions is a dead end.

 

[luckyboy]

firstly, its very close to being detectable, the test is in place, and is expected that it will be ratified in time for the 2012 olympics. British anti doping are actually one of the leaders in creating the test. By this time next year, I think they will be detectable and we will start seeing bans (by what ive read retroactive testing wont be available as they work partly by comparing degredation of cells within the sample.)

Well this has passed me by. Any link to news of this test/what it is etc please? Its not CO rebreathing is it?

 

[Anonymous]

Well this has passed me by. Any link to news of this test/what it is etc please? Its not CO rebreathing is it?

i cant remember, it was over the last week or so, possibly in last weekends sunday times (which ive now thrown away). It was along similar lines as outlined about, RNA degredation, stored blood having certain elements that will degrade, so by looking at the blood you can discover if previously stored blood is present.

Cant remember the full details, didnt keep it because i assumed it would have been covered by a seperate article online. obviously not.

The article certainly said they hoped it would be ready for 2012 olympics.

edit: heres an article
http://news.sciencemag.org/scienceinsider/2011/09/cheaters-beware-new-doping-tests.html

From yesterday, but i certainly read something about a week ago.