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On January 14, during an exclusive interview with TV host Oprah Winfrey, Lance Armstrong—winner of seven consecutive Le Tour De France (1999-2005) and a testicular cancer survivor— confessed to using performance-enhancing drugs (PEDs) during his career. The sportsman had already received a lifetime ban from competition by the United States Anti-Doping Agency last year after he refused to continue to fight the allegations against him. USADA had also stripped Armstrong of his titles at the time. While the professional cyclist has been accused of using many drugs over time, the one which has caught worldwide attention is “EPO”, a synthetic version of the natural hormone erythropoietin. Blood doping, specifically through EPO use, if done in a calculated, timed and scientific manner, remains largely undetected by current laboratory testing.
Types of blood doping:
According to Wold Anti-Doping Agency (WADA), there are three known substances or methods used for blood doping, namely, erythropoietin (EPO), synthetic oxygen carriers and blood transfusions. Each is prohibited under WADA’s List of Prohibited Substances and Methods.
How EPO works:
EPO, a peptide hormone that is produced naturally by the human body and is released from the kidneys, acts on the bone marrow to stimulate red blood cell production. Though widely prescribed by the medical community to treat a number of health conditions and diseases, the illegal use of EPO is widespread in the endurance sports community, most notably in professional cycling. The drug artificially increases endurance and stamina by increasing the oxygen-carrying ability of the blood, that is, the function of Red Blood Cells. As RBCs die, the human body, under normal conditions, manufactures them at a rate equal to the breakdown rate. Using EPO, however, dramatically revs up the production of RBCs. More RBCs mean smore oxygen can be picked up in the lungs and used by the body.
How does it help athletes?
By adding extra EPO to the blood via injection, an athlete artificially increases the amount of RBCs circulating in his or her blood. This leads to abnormally high RBC levels, which in turn leads to increased oxygen delivery to muscles, allowing them to work longer and harder. Thus, in an endurance sport like cycling which relies on strong leg muscles, use of EPO use can prove a huge advantage over the field.
Consequences of blood doping:
Abnormally high levels of RBCs can lead to a condition called “polycythemia” — EPO, by thickening the blood, leads to an increased risk of several deadly diseases, such as heart disease, stroke, and cerebral or pulmonary embolism. While proper use of EPO can have a therapeutic effect in the treatment of anaemia, its misuse can lead to serious health risks for athletes. According to WADA, the misuse of recombinant human EPO may also lead to autoimmune diseases with serious health consequences.
Blood doping via transfusions can also have serious medical consequences such as transmission of a virus or health risks due to improper storage of the blood during transfusion.
Why is EPO use difficult to detect?
Athletes often use saline infusions (directly adding salt water to the blood through an IV) — this way, they dilute their blood to avoid detection of abnormally high RBC percentage in their blood composition — if it is more than 50 per cent that is. They can also inject EPO directly into their veins, allowing it to be cleared from the body more quickly.
Alternatively, athletes can remove their own blood temporarily, allow their body to make up for the difference and add the removed blood back into their blood stream immediately prior to racing. This method of “self blood doping” remains undetectable by labs.