Hemoglobin and Packed-Cell Volume in Endurance Athletes Prior to rhEPO

The move by the word cycling union (UCI) and the world ski federation (FIS) to discourage the use of recombinant human erythropoietin (rhEPO) by excluding subjects with high packed-cell volume (PCV) or high hemoglobin (Hb) levels has stimulated discussion [1] [2] [3]. Cross-country skiiers, ski-orienteers, and orienteer runners of both sexes participated in direct maximal oxygen uptake (V˙O₂max) measurements at our laboratory between 1974 and 1986. Most of these endurance athletes were members of the Finnish national teams and included many world championship and Olympic Game medal winners. We have now re-examined the PCV, Hb, and V˙O₂max values from their last visit during that study period to evaluate whether the UCI and FIS regulations would have been fair to endurance athletes prior to rhEPO. PCV and Hb were determined using routine laboratory methods from antecubital venous blood samples drawn from sitting subjects before exercise tests. The values for the 238 men and 97 women aged 16 to 39 are shown in Table [1]. As expected, there was a high correlation between Hb and PCV among both men (r = 0.93) and women (r = 0.90). V˙O₂max value correlated significantly (p < 0.05) only with Hb level among women (r = 0.24). It is known that total red-blood cell (RBC) mass correlates with V˙O₂max but in athletes the physiologic increase in RBC mass is associated with expansion of plasma volume. All athletes were within the Hb limit set by FIS (185 g/L for men and 165 g/L for women) for participation. However, three men exceeded the PVC limit (0.50) of the UCI, giving a risk of exclusion of 1.3 % (95 % Cl 0.3 - 3.6 %) among the studied men. There were 21 men with a PVC of 0.48 - 0.50 at their last visit. They had mean of 2.6 test visits during the study period but none of their PCV value measurements exceeded 0.50. Permitted adjustments in training methods and nutrition mean that the risk of exceeding the Hb or PCV limit may be higher among today's athletes.

In accordance with the opinion of Vergouwen et al. [3] we think that excluding athletes from competitions on the basis of using variation in physiological parameters is a complex issue, and when indicated to protect the health of ambitious athletes, such methods should represent a transition stage. We consider it imperative that all parties understand the difference between traditional doping tests (specific for detecting drug use) and the use of Hb and PCV limits. If this is not understood by athletes and their support teams, they may erroneously make straightforward comparisons between the apparent exclusion risk associated with physiologically abnormal Hb and PCV levels and the very minimal risk of wrong positive finding in traditional doping test, which entail more severe sanctions.

Table 1Hemoglobin, packed-cell volume, and maximal oxygen uptake in athletes Men Women Mean (SD) Range Mean (SD) Range Hb (g/L) 149.2 (8.7) 121 - 178 136.1 (7.2) 118 - 152 PCV (%) 44.7 (2.4) 37 - 53 41.1 (2.1) 37 - 46 V˙O2max (ml/kg/min) 70.4 (6.2) 54 - 86 60.0 (5.7) 46 - 74

References

• 1 Marx J JM, Vergouwen P CJ. Packed-cell volume in elite athletes.  Lancet. 1998;  352 451
• 2 Saris W HM, Senden J MG, Brouns F. What is normal red-blood cell mass for professional cyclists?.  Lancet. 1998;  352 1758
• 3 Vergouwen P CJ, Collee T, Marx J JM. Haematocrit in elite athletes.  Int J Sports Med. 1999;  20 538-541