effects onknown blood doping patterns (esas , blood withdrawal and reinfusion) effects on . hgb,...
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Known blood doping patterns
(ESAs , blood withdrawal and reinfusion)
effects on
HGB, RET% and OFF-score values
ABP Symposium Rome November 5-7, 2018 ROME
Michel AUDRAN
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0
1
2
3
4
5
0 5 10 15 20 25 30 35 40 45 50Days
RET%
13
14
15
16
17
18
0 5 10 15 20 25 30 35 40 45 50Days
HGB g/dl
0
20
40
60
80
100
120
140
0 5 10 15 20 25 30 35 40 45 50
Days
OFF-score
Audran M et al. Med Sci Sports Exerc. 1999.
« ON-phase » « OFF-Phase »
rHuEPO NESP
Rentsch RL, et a J Appl Physiol 2006l
« ON-phase »: High Ret% + High HGB« OFF-phase »: Low RET% + High HGB = High OFFS
Effects of ESAs administrations
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Date HB g/dl
Ret%
OFFS
1 08/05 15.8 0.93 100.12 19/05 15.6 1.36 86.03 28/05 16.1 1.82 80.14 01/06 17.6 0.64 128.05 11/06 17.3 0.41 134.6
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GORE et al. Haematologica 2003
Date HB g/dl
Ret%
OFFS
1 08/05 15.8 0.93 100.12 19/05 15.6 1.36 86.03 28/05 16.1 1.82 80.14 01/06 17.6 0.64 128.05 11/06 17.3 0.41 134.6
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J Physiol (2007)C. Lundby and al.
8 healthy subjects receiving 5000 IU recombinant rhuEpo for 15 weeks at a dose frequency aimed to increase and maintain haematocrit at approximately 50%.
5
RET♯Hb
MCHC MCV
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Week 1 Week 2 Weeks 3/4 iron IVVit B12
rHuEPO 300UI/kg1/08 2/08 3/08 4/08
iron IVVit B12
WORD Championship
hypoxic tent
19/08 20/08 24/08
Date HGB g/dl
HCT RET%
OFFS
24/08 15.7 44.8 0.66 108.2620/08 16.7 48.4 0.51 124.1514/07 14.1 39.2 1.08 78.6004/06 14.8 41.3 1.59 72.34
test ESA negative
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P3 P10 P17 P23 P30D0 D2 D4 D7 D9 D11
250 UI/Kg
D0 D2 D4 D7 D9 D11 P3 P10 P17 P23 P30
a single 100 mg dose
of intravenous iron
Clark B. et al. Drug Test Anal. 2017
HGB: ≈ 14.3 ≈ 16.3
RET% : ≈0.75 ≈ 2.6 ≈ 0.4
OFFS ≈ 91 ≈ 68 ≈128
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00.5
11.5
22.5
33.5
44.5
0 5 10 15 20 25 30 35 40 45
Ret%
020406080
100120140
0 5 10 15 20 25 30 35 40 45
OFF-score
12
14
16
18
20
0 40
Hb g/dl
Days Hb g/dl RET% OFFS
J0 14.0 1,19 74,6 265 UI (SC)J2 15.1 1,6 75,1 265 UI (SC)J4 14.5 2,92 42,5 265 UI (SC)J7 15.3 4,29 28,7 265 UI (SC)J9 16.3 4,43 36,7 265 UI (SC)
J11 16.5 4,31 39J14 18.6 3,43 61,4J17 16.4 1,13 100,2 10 UI (IV)J18 16.6 1,06 104,2J19 6,7 UI (IV)J21 17.0 0,59 123,9J23 15.7 0,48 115,4J24 10 UI (IV)J25 17.1 0,51 128,1J28 6,7 UI (IV)J30 16.7 0,51 124,1 6,7 UI (IV)J31 17 0,57 124,7J32 5 UI (IV)J36 16.2 0,38 125J37 6,7 UI (IV)J44 16.2 0,45 121,7
Ashenden M et al.Haematologica. 2006
Subject receving: high rHuEPO doses to increase Hb around 16-17 g/dllow rHuEPO doses to maintain Hb at high level
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250 UI/Kg
D0 D2 D4 D7 D9 D11 D15 D17 D19 D22 D24 D26 D29 D31 D33 P3 P10 P17 P23 P30
6-15 UI/Kg
HGB: ≈15.0 ≈17.2 ≈16.5
Ret %: ≈0.8 ≈ 3.4 ≈ 0.35
Off-score: ≈ 90 ≈ 65 ≈ 140
Clark et al. Drug Test Anal. 2017a single 100 mg dose
of intravenous iron
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13
14
15
16
17
-10 -5 0 5 10 15 20 25
Days
Hb g/dl
0
0.5
1
1.5
2
-10 -5 0 5 10 15 20 25
Days
Ret%
60
70
80
90
100
110
-10 -5 0 5 10 15 20 25
Days
Off-score
8 subjects, ≈10 UI/Kg, 3/week for 2weeks
Low EPO doses
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0
0.5
1
1.5
2
0 2 4 6 8 10 12 14 16 18 20 22
Ret%
11.512
12.513
13.514
14.515
15.5
0 2 4 6 8 10 12 14 16 18 20 22
Hb g/dl
40
50
60
70
80
90
100
0 2 4 6 8 10 12 14 16 18 20 22
Off score
weeks
weeks
weeks
Malm CB et al. Plos One 2016
W0 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10W11W12W13W14W15W16W17W18W19W20W21D
450 ml
D 450 ml
BT: 2 unitsRBCs
W16 W 17 W18
Hb g/dl 13.9 ±0.8 14.8 ±0.3 14.5 ±0.5RET% 1.0 ±0.3 1.0 ±0.3 0.8 ±0.4
OFF-sc 79 88 91.3
100 mg Iron/d
Group transfusion N=11, group placebo N=8
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Sallet et al Int J Hematol 2008
reinfusion 250 ml RBCs + 200ml plasma
D-1 D0 D+2 D+5 D+12Hb
g/dl15.0 ±0.7 16.1 ±0.9 15.8 ±1.1 15.5 ±0.9
Ret% 1.07 ±0.23 0.89 ±0.22 0.77 ±0.2 0.79 ±0.16OFFS 87.7 ±11 104.5 ±11.9 105.6 ±12.9 101.9 ±9.3
blood transfusion 1 unit