Internal and Emergency Medicine

, Volume 13, Issue 4, pp 517–526 | Cite as

Changes in hemoglobin profile reflect autologous blood transfusion misuse in sports

  • Nicola Lamberti
  • Alessia Finotti
  • Jessica Gasparello
  • Ilaria Lampronti
  • Christel Zambon
  • Lucia Carmela Cosenza
  • Enrica Fabbri
  • Nicoletta Bianchi
  • Francesca Dalla Corte
  • Maurizio Govoni
  • Roberto Reverberi
  • Roberto Gambari
  • Fabio Manfredini


The changes in hemoglobin (Hb) profile following autologous blood transfusion (ABT) for the first time were studied for anti-doping purposes. Twenty-four healthy, trained male subjects (aged 18‒40) were enrolled and randomized into either the transfusion (T) or control (C) groups. Blood samples were taken from the T subjects at baseline, after withdrawal and reinfusion of 450 ml of refrigerated or cryopreserved blood, and from C subjects at the same time points. Hematological variables (Complete blood count, Reticulocytes, Immature Reticulocytes Fraction, Red-cell Distribution Width, OFF-hr score) were measured. The Hb types were analyzed by high-performance liquid chromatography and the Hemoglobin Profile Index (HbPI) arbitrarily calculated. Between-group differences were observed for red blood cells and reticulocytes. Unlike C, the T group, after withdrawal and reinfusion, showed a significant trend analysis for both hematological variables (Hemoglobin concentration, reticulocytes, OFF-hr score) and Hb types (glycated hemoglobin-HbA1c, HbPI). The control charts highlighted samples with abnormal values (> 3-SD above/below the population mean) after reinfusion for hematological variables in one subject versus five subjects for HbA1c and HbPI. A significant ROC-curve analysis (area = 0.649, p = 0.015) identified a HbA1c cut-off value ≤ 2.7% associated to 100% specificity of blood reinfusion (sensitivity 25%). Hemoglobin profile changed in trained subjects after ABT, with abnormal values of HbA1c and HbPI in 42% of subjects after reinfusion. Future studies will confirm the usefulness of these biomarkers in the anti-doping field.


Hemoglobins Biomarkers Doping in Sports Blood transfusion autologous 



We thank the personnel of immunohematological and transfusional service for their kind cooperation, and all the athletes that voluntarily participated in the study.


This project has been carried out with the support of the World Anti-Doping Agency—Grant Number: 14C06FM. Funding source had no involvement in the trial conduction neither in the analysis and interpretation of the data.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of Ferrara (06/2014).

Informed consent

Written informed consent was obtained from all the participants.

Data availability

Research data reported in this manuscript are available at

Supplementary material

11739_2018_1837_MOESM1_ESM.pdf (182 kb)
Supplementary material 1 (PDF 182 kb)


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Copyright information

© SIMI 2018

Authors and Affiliations

  • Nicola Lamberti
    • 1
  • Alessia Finotti
    • 2
  • Jessica Gasparello
    • 2
  • Ilaria Lampronti
    • 2
  • Christel Zambon
    • 1
  • Lucia Carmela Cosenza
    • 2
  • Enrica Fabbri
    • 2
  • Nicoletta Bianchi
    • 2
  • Francesca Dalla Corte
    • 3
  • Maurizio Govoni
    • 3
  • Roberto Reverberi
    • 3
  • Roberto Gambari
    • 2
  • Fabio Manfredini
    • 1
  1. 1.Section of Sport Sciences, Department of Biomedical and Surgical Specialties SciencesUniversity of Ferrara, ItalyFerraraItaly
  2. 2.Section of Biochemistry and Molecular Biology, Department of Life Sciences and BiotechnologiesUniversity of Ferrara, ItalyFerraraItaly
  3. 3.Immunohematological and Transfusional ServiceUniversity Hospital of FerraraFerraraItaly

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