Blood transfusions in athletes. Old dogmas, new tricks

Blood doping consists of any illicit means used to increase and optimize oxygen delivery to the muscles and includes blood transfusions, administration of erythropoiesis-stimulating substances, blood substitutes, natural or artificial altitude facilities, and innovative gene therapies. The use of blood transfusion, an extremely straightforward, practical and effective means of increasing an athlete's red blood-cell supply in advance of competition, became rather popular in the 1970s, but it has suddenly declined following the widespread use of recombinant human erythropoietin among elite endurance athletes. Most recently, following implementation of reliable tests to screen for erythropoiesis-stimulating substances, blood transfusions have made a strong resurgence, as attested by several positive doping tests. Doping by blood transfusion can be classified as homologous, where the blood is infused into someone other than the donor, and autologous, where the blood donor and transfusion recipient are the same. The former case produces more clinically relevant side effects, but is easily detectable using current antidoping protocols based on erythrocyte phenotyping by flow cytometry and, eventually, erythrocyte genotyping by DNA testing. Since the donor and recipient blood are identical in autologous blood doping, this is less risky, though much more challenging to detect. Indirect strategies, relying on significant deviations from individual hematological profiles following autologous blood donation and reinfusion, are currently being investigated. For the time being, the storage of athletes' blood samples to allow testing and sanctioning of guilty athletes once a definitive test has been introduced may represent a reliable deterrent policy.