Int J Sports Med 2000; 21(5): 380-385
DOI: 10.1055/s-2000-3785
Orthopedics and Clinical Science
Georg Thieme Verlag Stuttgart · New York

Haemoglobin, Haematocrit and Red Blood Cell Indices in Elite Cyclists. Are the Control Values for Blood Testing Valid?

Y. O. Schumacher,  D. Grathwohl,  J. M. Barturen,  M. Wollenweber,  L. Heinrich,  A. Schmid,  G. Huber,  J. Keul
  • Department Rehabilitation, Prevention and Sports Medicine, University of Freiburg, Freiburg, Germany
Further Information

Publication History

Publication Date:
31 December 2000 (online)

Background: In international cycling and cross-country skiing competitions, blood tests are used to unmask the performance enhancing misuse of erythropoietin. Haematocrit (cycling) and haemoglobin (cross-country skiing) limits have been set by international sporting federations (haematocrit 50 %, haemoglobin 18.5 g/dl). Athletes tested above these cut-off values are declared unfit for competition. To investigate the validity of these regulations, we studied haemoglobin, haematocrit and red blood cell indices of elite cyclists before erythropoietin became commercially available. Material and Methods: We investigated 523 blood samples of 92 male elite cyclists (age 16 - 31 years) from 1978 to 1987. Haematocrit, haemoglobin and red blood cell count were analysed automatically, erythrocyte indices were calculated. Results: Haemoglobin (- 0.3 ± 1 g/dl), haematocrit (- 1.2 ± 2.8 %) and red blood cell count (- 0.2 ±0.4 × 106/mm3) decreased significantly (p < 0.05) with increasing training workload. The erythrocyte indices showed no significant change. Fifty-four blood samples (10.3 %) showed a haematocrit above 50 %, one sample presented a haemoglobin mass higher than 18.5 g/dl. During periods of increased workload, less athletes tested above the haematocrit limit. Conclusion: The current haematocrit limit used in blood tests might lead to a high number of false positive tests.

References

  • 1 Adamson J W, Vapnek D. Recombinant erythropoietin to improve athletic performance (letter).  N Engl J Med. 1991;  324 698-699
  • 2 Anonymous .UCI Press release. Lausanne; UCI 99 A.D 1999
  • 3 Anonymous . “Anaemia” in athletes. (Editorial).  Lancet. 1985;  1 1490-1491
  • 4 Anonymous . Normal reference values.  N Engl J Med. 1986;  39 314
  • 5 Anonymous . Blood doping. A statement from the Medical Commissionof the International Olympic Committee.  Br J Sports Med. 1989;  23 60
  • 6 Anonymous .Undetectable dialysis drug is tied to athletes dead. Los Angeles Times 1990
  • 7 Anonymous .Sporting safety and condition commission. Procedure of the medical examination for the detection of hematocrit. Lausanne; UCI 1997
  • 8 Anonymous .UCI Sporting safety and condition regulations. Lausanne; UCI 1997 Chapter XIII: 13.01.023
  • 9 Audran M, Gareau R, Matecki S, Durand F, Chenard C, Sicart M T, Marion B, Bressolle F. Effects of erythropoietin administration in training athletes and possible indirect detection in doping control.  Med Sci Sports Exerc. 1999;  31 639-645
  • 10 Berglund B, Birgegard G, Wide L, Pihlstedt P. Effects of blood transfusions on some hematological variables in endurance athletes.  Med Sci Sports Exerc. 1989;  21 637-642
  • 11 Berglund B, Hemmingson P. Effect of reinfusion of autologous blood on exercise performance in cross-country skiers.  Int J Sports Med. 1987;  8 231-233
  • 12 Bland J M, Altman D G. Statistical methods for assessing agreement between two methods of clinical measurement.  Lancet. 1986;  1 307-310
  • 13 Brien A, Simon T L. The effects of red blood cell infusion on 10 km race time.  JAMA. 1987;  257 2761-2765
  • 14 Buick F, Gledhill N, Froese A B, Spriet L, Meyers E C. Effect of induced erythrocythemia on aerobic work capacity.  J Appl Physiol. 1980;  48 R636-R642
  • 15 Casoni I, Ricci G, Ballarin E, Borsetto C, Grazzi G, Guglielmini C, Manfredini F, Mazzoni G, Patracchini M, De P V. Hematological indices of erythropoietin administration in athletes.  Int J Sports Med. 1993;  14 307-311
  • 16 Celsing F, Svedenhag J, Pihlstedt P, Ekblom B. Effects of anaemia and stepwise-induced polycythaemia on maximal aerobic power in individuals with high and low haemoglobin concentrations.  Acta Physiol Scand. 1987;  129 47-54
  • 17 Convertino V A. Blood volume: its adaptation to endurance training (Review).  Med Sci Sports Exerc. 1991;  23 1338-1348
  • 18 Convertino V A, Brock P J, Keil L C, Bernauer E M, Greenleaf J E. Exercise training-induced hypervolemia: role of plasma albumin, renin, and vasopressin.  J Appl Physiol. 1980;  48 R665-R669
  • 19 Dill D B, Costill D L. Calculation of percentage changes in volumes of blood, plasma, and red cells in dehydration.  J Appl Physiol. 1974;  37 247-248
  • 20 Dinkelaar R B, Engels E Y, Hart A A, Schoemaker L P, Bosch E, Chamuleau R A. Metabolic studies on erythropoietin (EP): II. The role of liver and kidney in the metabolism of Ep.  Exp Hematol. 1981;  9 796-803
  • 21 Eichner E. The anaemia of athletes.  Phys Sportsmed. 1986;  14 1490-1491
  • 22 Eichner E. Better dead then second.  J Lab Clin Med. 1992;  120 359-360
  • 23 Ekblom B, Berglund B. Effect of erythropoietin administration on maximal aerobic power.  Scand Med Sci Sports. 1991;  1 88-93
  • 24 Ekblom B, Goldbarg A N, Gullbring B. Response to exercise after blood loss and reinfusion.  J Appl Physiol. 1972;  33 175-180
  • 25 Gareau R, Audran M, Baynes R D, Flowers C H, Duvallet A, Senecal L, Brisson G R. Erythropoietin abuse in athletes (letter).  Nature. 1996;  380 113
  • 26 Gore C J, Scroop G C, Marker J D, Catcheside P G. Plasma volume, osmolarity, total protein and electrolytes during treadmill running and cycle ergometer exercise.  Eur J Appl Physiol. 1992;  65 302-310
  • 27 Green H J, Sutton J R, Coates G, Ali M, Jones S. Response of red cell and plasma volume to prolonged training in humans.  J Appl Physiol. 1991;  70 1810-1815
  • 28 Guglielmini C, Patracchini M, Manfredini F, Grazzi G, Ferrari M, Conconi F. Reduction of Hb levels during the racing season in nonsideropenic professional cyclists.   Int J Sports Med. 1989;  10 352-356
  • 29 Hagan R D, Diaz F, Horvath S M. Plasma volume changes with movement to supine and standing positions.  J Appl Physiol. 1978;  45 R414-R417
  • 30 Hagan R D, Diaz F J, McMurray R G, Horvath S M. Plasma volume changes related to posture and exercise.  Proc Soc Exp Biol Med. 1980;  165 155-160
  • 31 Halberg I, Magnusson B. The etiology of 'sports anaemia'.  Acta Med Scand. 1984;  216 145-148
  • 32 Harrison M H. Effects on thermal stress and exercise on blood volume in humans.  Physiol Rev. 1985;  65 149-209
  • 33 Harrison M H. Heat and exercise. Effects on blood volume.  Sports Med. 1986;  3 214-223
  • 34 Hundling A, Jordal R, Paulev P E. Runner's anaemia and iron deficiency.  Acta Med Scand. 1981;  209 315-318
  • 35 Klein H G. Blood transfusion and athletics. Games people play.  N Engl J Med. 1985;  312 854-856
  • 36 Marx J J, Vergouwen P C. Packed-cell volume in elite athletes.  Lancet. 1998;  352 451
  • 37 Mayer G, Thum J, Cada E M, Stummvoll H K, Graf H. Working capacity is increased following recombinant human erythropoietin treatment.  Kidney Int. 1988;  34 525-528
  • 38 Rosenlof K, Gronhagen-Riska C, Sovijarvi A, Honkanen E, Tikkanen I, Ekstrand A, Piirila P, Fyhrquist F. Beneficial effects of erythropoietin on haematological parameters, aerobic capacity, and body fluid composition in patients on haemodialysis.  J Int Med. 1989;  226 311-317
  • 39 Saris W H, Senden J M, Brouns F. What is a normal red-blood cell mass for professional cyclists? (Letter).  Lancet. 1998;  352 1758
  • 40 Saris W H, van Erp-Baart M A, Brouns F, Westerterp K R, ten Hoor F. Study on food intake and energy expenditure during extreme sustained exercise: the Tour de France.  Int J Sports Med. 1989;  10 S26-S31
  • 41 Sawka M N, Joyner M J, Miles D S, Robertson R J, Spriet L L, Young A J. American College of Sports Medicine position stand. The use of blood doping as an ergogenic aid.  Med Sci Sports Exerc. 1996;  28 i-viii
  • 42 Schmidt W, Bönning D, Maassen N, Schneider G. Die Bedeutung des Blutvolumens für den Ausdauersportler.  Leistungssport. 1994;  5 27-37
  • 43 Schmidt W, Maassen N, Tegtbur U, Braumann K M. Changes in plasma volume and red cell formation after a marathon competition.  Eur J Appl Physiol. 1989;  58 453-458
  • 44 Selby G B, Eichner E R. Endurance swimming, intravascular hemolysis, anemia and iron depletion. New perspective on athlete's anemia.  Am J Med. 1986;  81 791-794
  • 45 Selby G B, Eichner E R. Hematocrit and performance: the effect of endurance training on blood volume.  Sem Hematol. 1994;  31 122-127
  • 46 Weight L M, Darge B L, Jacobs P. Athlete's pseudoanaemia.  Eur J Appl Physiol. 1991;  62 358-362
  • 47 Whiting P H, Maughan R J, Miller J D. Dehydration and serum biochemical changes in marathon runners.  Eur J Appl Physiol. 1984;  52 183-187
  • 48 Wide L, Bengtsson C, Berglund B, Ekblom B. Detection in blood and urine of recombinant erythropoietin administered to healthy men.  Med Sci Sports Exerc. 1995;  27 1569-1576
  • 49 Wilkerson J E, Gutin B, Horvath S M. Exercise-induced changes in blood, red cell, and plasma volumes in man.  Med Sci Sports. 1977;  9 155-158
  • 50 Williams W J, Beutler E, Erslev A J, Lichtman M A. Examinations of the blood.  In: Haematology. New York; Mc Graw Hill 1986: 9
  • 51 Wishnitzer R, Vorst E, Berrebi A. Bone marrow iron depression in competitive distance runners.  Int J Sports Med. 1983;  4 27-30

Yorck Olaf Schumacher,MD 

Abteilung Rehabilitation, Prävention und Sportmedizin Medizinische Universitätsklinik Freiburg

Hugstetter Straße 55 79106 Freiburg Germany

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