Total Hemoglobin Mass

[Anonymous]

Many people here advocate the "total hemoglobin mass test". I don't know if our talk about it here had anything to do with it but a Cyclingnews reporter asked one of the Passport experts about it last week. He said it involved breathing carbon monoxide and seemed unclear on what that would mean for the athletes.

When I Google (total body hemoglobin test) it I get more references to this forum than anything else.

Change it to "total hemoglbin mass" and I get more.
Here's a pretty good one.

http://www.wada-ama.org/rtecontent/document/Schmidt_2008.pdf

Someone here said it was a pinprick blood test. I'm not finding it so. It appears to be some kind of carbon monoxide rebreathing apparatus followed by the blood test. I saw the test described as taking only ten minutes. If the equipment is not portable and expensive how do you test the whole field?

I don't see any base line science on this that makes it at all possible to use as a basis for banning riders as dopers.

I can find no description of the equipment so it doesn't appear that this is any kind of off the shelf commonplace thing.

Am I correct in thinking this appears to be more of a research project than a test that's ready to use?

I see no normal parameters, no studies on the influence of illness, injury, altitude, mineral deficiencies, or even the effects of long term training.

I'm must be missing something but at least this gets the ball rolling.

 

[Cobblestones]

The method works the following:

An athlete is asked to breathe air mixed with CO (carbon mono oxide) through a re-breathing apparatus. Then, after some time, a small blood sample is taken to check how many hemoglobin molecules have bonded to CO.

The science behind this is that CO does not occur naturally in the atmosphere, hence, by using a re-breathing apparatus, the amount of CO an athlete takes up is very well controlled. Second, CO binds much more tightly to hemoglobin molecules than either oxygen or CO2 (carbon di oxide).

Hence by knowing how many CO molecules an athlete breathes in (and you know they stay in the system for some time, many minutes in fact), and by then counting the fraction of hemoglobin molecules which have bonded to said CO molecules, a simple calculation reveals the total number of hemoglobin molecules in the body of an athlete.

The assumption is that the CO stays with the hemoglobin molecule for at least as long until the total blood volume becomes well mixed (maybe 10 minutes).

It's really rather simple and gives an accurate measure of total hemoglobin volume (Hb mass). If you add a pint of compacted blood cells, that should show up as increased Hb mass.

 

[BroDeal]

The method works the following:

An athlete is asked to breathe air mixed with CO (carbon mono oxide) through a re-breathing apparatus. Then, after some time, a small blood sample is taken to check how many hemoglobin molecules have bonded to CO.

The science behind this is that CO does not occur naturally in the atmosphere, hence, by using a re-breathing apparatus, the amount of CO an athlete takes up is very well controlled. Second, CO binds much more tightly to hemoglobin molecules than either oxygen or CO2 (carbon di oxide).

Hence by knowing how many CO molecules an athlete breathes in (and you know they stay in the system for some time, many minutes in fact), and by then counting the fraction of hemoglobin molecules which have bonded to said CO molecules, a simple calculation reveals the total number of hemoglobin molecules in the body of an athlete.

The assumption is that the CO stays with the hemoglobin molecule for at least as long until the total blood volume becomes well mixed (maybe 10 minutes).

It's really rather simple and gives an accurate measure of total hemoglobin volume (Hb mass). If you add a pint of compacted blood cells, that should show up as increased Hb mass.

Is the equipment portable?

If the AFLD were willing to do this before the Tour start and about once per week for the top riders it would do a huge amount to restore confidence in the results. Although the initial value would have to be believable.

 

[Cobblestones]

Is the equipment portable?

If the AFLD were willing to do this before the Tour start and about once per week for the top riders it would do a huge amount to restore confidence in the results. Although the initial value would have to be believable.

I do not know whether the equipment is portable. I assume (and again, I do not know precisely) that the blood analysis has to be done on the spot, which probably does not make it very portable. I assume that in a stored blood sample, the CO would slowly be released or it might react otherwise.

Also, since CO is really a toxic gas (when it bonds to the hemoglobin molecule, it blocks the normal function of it, which is to transport oxygen to the muscles and CO2 away), it will definitely lower a rider's performance for some time (and again, I don't know precisely for how long, but I guess it's at most a few hours). Something to consider when picking random athletes for testing.

 

[Cobblestones]

By the way, I did a little bit of googling myself, and a group of researchers from Freiburg (yes THAT place), came up with a different way to measure CO saturation of blood, by simply looking at the exhaled CO concentration (so, no blood test). They claim 'a fully automated and integrated technique for measuring blood volume becomes feasible' which I assume solves the portability question.

Here's the article.

 

[karlboss]

This sounds a reasonable test to be integrated into the passport system and the bolus and washout system appears as though it would have less an effect on the rider and could be applied in competition. For the former test the blood test should be a simple one you only need to know how many CO bonded cells are there vs non bonded, and cells per unit volume, shouldn't be hard to do this in a portable (back of converted truck) lab. The testing equipment could be made portable. The newer test without the need for a blood test needs to be proven for accuracy, though the scientists involved claim it is more accurate. I think the obstacle will be accuracy and effect on riders especially in comp, breathing CO until saturation(former test) doesn't sound like it is conduvcive to effective recovery.

I've always thought the passport system is a good one, but i think it will start lax and become tighter and tighter. If, one day, you bring it in with every test known to man you may find yourself realising your worst fears and banning the entire peleton. By bringing it in slowly the peleton can clean itself up and gradually and you can announce we always thought most riders were clean. Also so there isn't a marked decrease in the performance of riders from one tour to the next this way.

Edit: baselines for values for these tests may take some time to establish in athletes to ban on a passport system or as one offs.

 

[Alpe d'Huez]

Perfect test to perform on several dozen riders on the day before the Prologue, or on the prologue, and on the rest day, and day after the Tour.

Michael Ashenden lead a group that wrote a report on the CO test that made it sound reasonable to implement. Let me see if I can dig up that link.

Glad you made the thread, Jack.

 

[BigBoat]

The method works the following:

An athlete is asked to breathe air mixed with CO (carbon mono oxide) through a re-breathing apparatus. Then, after some time, a small blood sample is taken to check how many hemoglobin molecules have bonded to CO.

The science behind this is that CO does not occur naturally in the atmosphere, hence, by using a re-breathing apparatus, the amount of CO an athlete takes up is very well controlled. Second, CO binds much more tightly to hemoglobin molecules than either oxygen or CO2 (carbon di oxide).

Hence by knowing how many CO molecules an athlete breathes in (and you know they stay in the system for some time, many minutes in fact), and by then counting the fraction of hemoglobin molecules which have bonded to said CO molecules, a simple calculation reveals the total number of hemoglobin molecules in the body of an athlete.

The assumption is that the CO stays with the hemoglobin molecule for at least as long until the total blood volume becomes well mixed (maybe 10 minutes).

It's really rather simple and gives an accurate measure of total hemoglobin volume (Hb mass). If you add a pint of compacted blood cells, that should show up as increased Hb mass.

Yeah... They will not do this though.

I doubt it until Lance boogie's again.

 

[BigBoat]

I do not know whether the equipment is portable. I assume (and again, I do not know precisely) that the blood analysis has to be done on the spot, which probably does not make it very portable. I assume that in a stored blood sample, the CO would slowly be released or it might react otherwise.

Also, since CO is really a toxic gas (when it bonds to the hemoglobin molecule, it blocks the normal function of it, which is to transport oxygen to the muscles and CO2 away), it will definitely lower a rider's performance for some time (and again, I don't know precisely for how long, but I guess it's at most a few hours). Something to consider when picking random athletes for testing.

Yeah, it would be tough to make it stand in court, but the result would be clear right away.

The gas wouldnt really do anything. Its just a tiny amount from what I understand (like taking a puff of a cigarette.)

 

[Anonymous]

The gas wouldnt really do anything. Its just a tiny amount from what I understand (like taking a puff of a cigarette.)

That would be great if it was true.

But in what I've read so far it's more like several minutes worth.

Big Boat's stand will always be, everybody dopes and we can't catch them unless we do the next great test and when we do that one he'll come back with a semi-plausible sci-fi/horror story about how they could get around that one too.

 

[Anonymous]

Fantastic thread so far. I guess the most heartening thing is that in the face of systemic and thoroughly researched measures to produce clean tests for dirty riders, it is good to see that at least the ideas for real testing are in the realm of physiological changes that mark doping versus better detection tests for specific substances. As is clear with steroids, where you can change the molecule just enough to not produce a positive, the dopers and their doctors will always be ahead of the test game.

Great information!

 

[BigBoat]

That would be great if it was true.

But in what I've read so far it's more like several minutes worth.

Big Boat's stand will always be, everybody dopes and we can't catch them unless we do the next great test and when we do that one he'll come back with a semi-plausible sci-fi/horror story about how they could get around that one too.

Okay...smoking a cigarette.

Yeah gene doping now too. Blood doping isnt rocket science though like you think. It does take one well trained physician in charge...or a good manager.

 

[Anonymous]

By the way, I did a little bit of googling myself, and a group of researchers from Freiburg (yes THAT place), came up with a different way to measure CO saturation of blood, by simply looking at the exhaled CO concentration (so, no blood test). They claim 'a fully automated and integrated technique for measuring blood volume becomes feasible' which I assume solves the portability question.

Here's the article.

I find it unsettling that they want to call this non-invasive just because they've removed the need for a finger stick.

I find the idea of inhaling several minutes of carbon monoxide to be extreemly invasive.

Any racers out there want to chime in on that? Any doctors?

The very first thing that has to addressed is the rider's health.

Next is that none of this stuff appears to exist outside of research facilities. There's now way anybody could plug this stuff in if it was decided to do so tomorrow. This can't be things that are thrown together by a PhD and a bunch of grad students and be expected to withstand scrutiny.

And there the fact that there appears to be no knowledge base as to what norms are, how findings are affected by variables like illness, injury, altitude, and many other things that I'm probably leaving out because I'm not a blood expert. I'm sure someone out there can add to that list. It's completely unlike the blood testing now done that has a huge knowledge and statistical base.

Then, finally I think, there's the issue of baseline testing without which none of this works. I have many nuts and bolts questions about that and I'd love to have someone else lay out how they think that could work.

Thanks for the posts. It was great reading about the science behind the test. Should we give karlboss credit and call it "bolus and washout system"?

 

[Anonymous]

I find it unsettling that they want to call this non-invasive just because they've removed the need for a finger stick.

I find the idea of inhaling several minutes of carbon monoxide to be extreemly invasive.

Any racers out there want to chime in on that? Any doctors?

The very first thing that has to addressed is the rider's health.

Next is that none of this stuff appears to exist outside of research facilities. There's now way anybody could plug this stuff in if it was decided to do so tomorrow. This can't be things that are thrown together by a PhD and a bunch of grad students and be expected to withstand scrutiny.

And there the fact that there appears to be no knowledge base as to what norms are, how findings are affected by variables like illness, injury, altitude, and many other things that I'm probably leaving out because I'm not a blood expert. I'm sure someone out there can add to that list. It's completely unlike the blood testing now done that has a huge knowledge and statistical base.

Then, finally I think, there's the issue of baseline testing without which none of this works. I have many nuts and bolts questions about that and I'd love to have someone else lay out how they think that could work.

Thanks for the posts. It was great reading about the science behind the test. Should we give karlboss credit and call it "bolus and washout system"?

The process of developing a indicator such as this is a process. It sounds to me that there is a test in development that does not necessitate breathing in CO, though we all breathe is daily.

 

[Anonymous]

By the way, I did a little bit of googling myself, and a group of researchers from Freiburg (yes THAT place), came up with a different way to measure CO saturation of blood, by simply looking at the exhaled CO concentration (so, no blood test). They claim 'a fully automated and integrated technique for measuring blood volume becomes feasible' which I assume solves the portability question.

Here's the article.

i want to make sure i'm reading this right.

when they say "Our new technique is based on the characteristic compartmental distribution of an inhaled CO-bolus" they're talking about inhaling carbon monoxide correct?

 

[BigBoat]

i want to make sure i'm reading this right.

when they say "Our new technique is based on the characteristic compartmental distribution of an inhaled CO-bolus" they're talking about inhaling carbon monoxide correct?

Well Jackhammer, nobody's forced to ride the Tour if they dont want to smoke. This isnt a public school system.

They'd only have to do this once on the entire top 10...If they busted the top 10 guys or just did the test that would almost certainly end blood doping on the Tour out of sheer FEAR from the managers and riders themselves.

A jacked crit really does give a huge bang. Lance probably sees 15% increase in FTP with a fifty crit, 20% at fifty-four crit, and maybe 25% at a sixty if he can go that high without seeing a loss in power. 15% is about 1st to 50th place in a Grand Tour. Seriously.

 

[karlboss]

The new test doesn't involve breathing CO for several minutes, it involves breathing a bolus (a bolus is a large one off) of CO. It is just the one maximal breath of CO. CO, in high enough concentrations, will kill you. So it will definitely be detrimental, the question is for how long after a test like this.

 

[BigBoat]

The new test doesn't involve breathing CO for several minutes, it involves breathing a bolus (a bolus is a large one off) of CO. It is just the one maximal breath of CO. CO, in high enough concentrations, will kill you. So it will definitely be detrimental, the question is for how long after a test like this.

Yeah... like a big puff or smoking a cigar...I'd take that over synthetic blood.

 

[Anonymous]

The new test doesn't involve breathing CO for several minutes, it involves breathing a bolus (a bolus is a large one off) of CO. It is just the one maximal breath of CO. CO, in high enough concentrations, will kill you. So it will definitely be detrimental, the question is for how long after a test like this.

Ok.. i thought bolus just meant a measured amount. This is a small bolus maybe?

It's great that it's in the works, but in the works is not here yet.

Then there's the other questions.

 

[BigBoat]

Ok.. i thought bolus just meant a measured amount. This is a small bolus maybe?

It's great that it's in the works, but in the works is not here yet.

Then there's the other questions.

They could shorten a transfer stage to like 30 miles (1 hour tops)...Then fly, drive/transport the entire top 5 G.C. out, along with 5 at random and do total body hemoglobins.

 

[Anonymous]

They could shorten a transfer stage to like 30 miles (1 hour tops)...Then fly, drive/transport the entire top 5 G.C. out, along with 5 at random and do total body hemoglobins.

yes.... in a couple of years.

 

[Alpe d'Huez]

Why not this year? Why wait a couple of years? Because you think the test is intrusive and there really isn't a serious doping problem in the sport?

No, the CO test won't detect everything. But it will detect the type of doping that by far offers the greatest benefit to dopers: blood doping (and other forms of O2 carrier builders, including all plasma expanders, and the ability to both drain off or dilute blood).

It won't stop HGH, testosterone, or other stimulants and anabolics, but those are of minor benefit to endurance athletes compared to blood boosters.

Why not just tell the riders the test is ready, and will be implemented soon, so don't dope. Let's see what that alone does.

 

[Epicycle]

Here is a study published last December on total hemoglobin mass. It provides a look at the methods' limitations, at least at this time.

Although this present study already shows that the effect size of several effects such as training is negligible, more data are required before these models can be applied to other conditions not studied here, such as exposure to altitude or after injury/disease. It further has to be pointed out that reliable data can only be obtained with very accurate blood gas analyzers (i.e., accuracy of COHb% concentration should not be less than ?0.1%) and experienced examiners. For practical reasons, it also should be considered that the method cannot be applied just before competition because V(dot)dot;O2max is reduced transiently by ~3% (22).

 

[karlboss]

Here is a study published last December on total hemoglobin mass. It provides a look at the methods' limitations, at least at this time.

Although this present study already shows that the effect size of several effects such as training is negligible, more data are required before these models can be applied to other conditions not studied here, such as exposure to altitude or after injury/disease. It further has to be pointed out that reliable data can only be obtained with very accurate blood gas analyzers (i.e., accuracy of COHb% concentration should not be less than ?0.1%) and experienced examiners. For practical reasons, it also should be considered that the method cannot be applied just before competition because V(dot)dot;O2max is reduced transiently by ~3% (22).

The transient reduction of O2max is the point for competition, how long does this last? Also the newer method would not have such a marked decrease, and I hate the terms accurate gas analyzers and experienced examiners...what else whould you use? Though as i mentioned before, baselines need to be established. In individuals (obviously), for allowable limits of change (negligible is no non-existent), and special circumstances, injury illness etc.

do you have the link to this article?

 

[Epicycle]

The transient reduction of O2max is the point for competition, how long does this last? Also the newer method would not have such a marked decrease, and I hate the terms accurate gas analyzers and experienced examiners...what else whould you use? Though as i mentioned before, baselines need to be established. In individuals (obviously), for allowable limits of change (negligible is no non-existent), and special circumstances, injury illness etc.

do you have the link to this article?

That would help. Here it is. You may have to register to see it.
http://www.medscape.com/viewarticle/584104