Abstract
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.
Similar content being viewed by others
References
Jelkmann W, Lundby C (2011) Blood doping and its detection. Blood 118(9):2395–2404. https://doi.org/10.1182/blood-2011-02-303271
Mørkeberg J (2012) Detection of autologous blood transfusions in athletes: a historical perspective. Transfus Med Rev 26(3):199–208. https://doi.org/10.1016/j.tmrv.2011.09.007
Segura J, Lundby C (2014) Blood doping: potential of blood and urine sampling to detect autologous transfusion. Br J Sports Med 48(10):837–841. https://doi.org/10.1136/bjsports-2014-093601
Pottgiesser T, Sottas PE, Echteler T, Robinson N, Umhau M, Schumacher YO (2011) Detection of autologous blood doping with adaptively evaluated biomarkers of doping: a longitudinal blinded study. Transfusion 51(8):1707–1715. https://doi.org/10.1111/j.1537-2995.2011.03076.x
Schumacher YO, Saugy M, Pottgiesser T, Robinson N (2012) Detection of EPO doping and blood doping: the haematological module of the Athlete Biological Passport. Drug Test Anal 4(11):846–853. https://doi.org/10.1002/dta.406
Salamin O, De Angelis S, Tissot JD, Saugy M, Leuenberger N (2016) Autologous Blood Transfusion in Sports: emerging Biomarkers. Transfus Med Rev 30(3):109–115. https://doi.org/10.1016/j.tmrv.2016.05.007
Guglielmini C, Casoni I, Patracchini M, Manfredini F, Grazzi G, Ferrari M, Conconi F (1989) Reduction of Hb levels during the racing season in nonsideropenic professional cyclists. Int J Sports Med 10(5):352–356. https://doi.org/10.1055/s-2007-1024927
Damsgaard R, Munch T, Mørkeberg J, Mortensen SP, González-Alonso J (2006) Effects of blood withdrawal and reinfusion on biomarkers of erythropoiesis in humans: implications for antidoping strategies. Haematologica 91(7):1006–1008
Leuenberger N, Barras L, Nicoli R, Robinson N, Baume N, Lion N, Barelli S, Tissot JD, Saugy M (2016) Hepcidin as a new biomarker for detecting autologous blood transfusion. Am J Hematol 91(5):467–472. https://doi.org/10.1002/ajh.24313
Leuenberger N, Barras L, Nicoli R, Robinson N, Baume N, Lion N, Barelli S, Tissot JD, Saugy M (2016) Urinary di-(2-ethylhexyl) phthalate metabolites for detecting transfusion of autologous blood stored in plasticizer-free bags. Transfusion 56(3):571–578. https://doi.org/10.1111/trf.13408
Nikolovski Z, De La Torre C, Chiva C, Borràs E, Andreu D, Ventura R, Segura J (2012) Alterations of the erythrocyte membrane proteome and cytoskeleton network during storage—a possible tool to identify autologous blood transfusion. Drug Test Anal 4(11):882–890. https://doi.org/10.1002/dta.1342
Reichel C (2011) OMICS-strategies and methods in the fight against doping. Forensic Sci Int 213(1–3):20–34. https://doi.org/10.1016/j.forsciint.2011.07.031
Fairbanks VF, Klee GG (1999) Biochemical aspects of hematology. In: Burtis CA, Ashwood ER (eds) Tietz Textbook of Clinical Chemistry, 3rd edn. WB Saunders Company, Philadelphia, pp 1657–1669
Risso A, Fabbro D, Damante G, Antonutto G (2012) Expression of fetal hemoglobin in adult humans exposed to high altitude hypoxia. Blood Cells Mol Dis 48(3):147–153. https://doi.org/10.1016/j.bcmd.2011.12.004
Cao H (2004) Pharmacological induction of fetal hemoglobin synthesis using histone deacetylase inhibitors. Hematology 9(3):223–233. https://doi.org/10.1080/10245330410001701512
Bureau MA, Shapcott D, Berthiaume Y, Monette J, Blouin D, Blanchard P, Begin R (1983) Maternal cigarette smoking and fetal oxygen transport: a study of P50, 2,3-diphosphoglycerate, total hemoglobin, hematocrit, and type F hemoglobin in fetal blood. Pediatrics 72(1):22–26
Bard H, Lachance C, Widness JA, Gagnon C (1994) The reactivation of fetal hemoglobin synthesis during anemia of prematurity. Pediatr Res 36(2):253–256. https://doi.org/10.1203/00006450-199408000-00018
Sarakul O, Vattanaviboon P, Tanaka Y, Fucharoen S, Abe Y, Svasti S, Umemura T (2013) Enhanced erythroid cell differentiation in hypoxic condition is in part contributed by miR-210. Blood Cells Mol Dis 51(2):98–103. https://doi.org/10.1016/j.bcmd.2013.03.005
Mabaera R, West RJ, Conine SJ, Macari ER, Boyd CD, Engman CA, Lowrey CH (2008) A cell stress signaling model of fetal hemoglobin induction: what doesn’t kill red blood cells may make them stronger. Exp Hematol 36(9):1057–1072. https://doi.org/10.1016/j.exphem.2008.06.014
Schaeffer EK, West RJ, Conine SJ, Lowrey CH (2014) Multiple physical stresses induce γ-globin gene expression and fetal hemoglobin production in erythroid cells. Blood Cells Mol Dis 52(4):214–224. https://doi.org/10.1016/j.bcmd.2013.10.007
Sugimoto T, Hashimoto M, Hayakawa I, Tokuno O, Ogino T, Okuno M, Hayashi N, Kawano S, Sugiyama D, Minami H (2014) Alterations in HbA1c resulting from the donation of autologous blood for elective surgery in patients with diabetes mellitus. Blood Trans 12(Suppl 1):s209–s213. https://doi.org/10.2450/2013.0271-12
Spencer DH, Grossman BJ, Scott MG (2011) Red cell transfusion decreases hemoglobin A1c in patients with diabetes. Clin Chem 57(2):344–346. https://doi.org/10.1373/clinchem.2010.157321
Ou CN, Rognerud CL (1993) Rapid analysis of hemoglobin variants by cation-exchange HPLC. Clin Chem 39(5):820–824
Bianchi N, Finotti A, Ferracin M, Lampronti I, Zuccato C, Breveglieri G, Brognara E, Fabbri E, Borgatti M, Negrini M, Gambari R (2015) Increase of microRNA-210, decrease of raptor gene expression and alteration of mammalian target of rapamycin regulated proteins following mithramycin treatment of human erythroid cells. PLoS One 10(4):e0121567. https://doi.org/10.1371/journal.pone.0121567
Veith R, Papayannopoulou T, Kurachi S, Stamatoyannopoulos G (1985) Treatment of baboon with vinblastine: insights into the mechanisms of pharmacologic stimulation of Hb F in the adult. Blood 66(2):456–459
Barkemeyer BM, Hempe JM (2000) Effect of transfusion on hemoglobin variants in preterm infants. J Perinatol 20(6):355–358
Karami A (2014) Baradaran A (2014) Comparative evaluation of three different methods for HbA1c measurement with High-performance liquid chromatography in diabetic patients. Adv Biomed Res. 3:94. https://doi.org/10.4103/2277-9175.129364
Dijkstra A, Lenters-Westra E, de Kort W, Bokhorst AG, Bilo HJ, Slingerland RJ, Vos MJ (2017) Whole blood donation affects the interpretation of hemoglobin A1c. PLoS One 12(1):e0170802. https://doi.org/10.1371/journal.pone.0170802
Hellman R (2016) When are HbA1C values misleading? AACE Clin Case Rep 2(4):e377–e379. https://doi.org/10.4158/EP161209.CO
Cohen RM, Franco RS, Khera PK, Smith EP, Lindsell CJ, Ciraolo PJ, Palascak MB, Joiner CH (2008) Red cell life span heterogeneity in hematologically normal people is sufficient to alter HbA1c. Blood 112(10):4284–4291. https://doi.org/10.1182/blood-2008-04-154112
Hess JR, Biomedical Excellence for Safer Transfusion (BEST) Collaborative (2012) Scientific problems in the regulation of red blood cell products. Transfusion 52(8):1827–1835. https://doi.org/10.1111/j.1537-2995.2011.03511.x
Bosman GJ (2013) Survival of red blood cells after transfusion: processes and consequences. Front Physiol. 2013(4):376. https://doi.org/10.3389/fphys.2013.00376
Luten M, Roerdinkholder-Stoelwinder B, Schaap NP, de Grip WJ, Bos HJ, Bosman GJ (2008) Survival of red blood cells after transfusion: a comparison between red cells concentrates of different storage periods. Transfusion 48(7):1478–1485. https://doi.org/10.1111/j.1537-2995.2008.01734.x
Finotti A, Lamberti N, Gasparello J, Bianchi N, Fabbri E, Cosenza LC, Milani R, Lampronti I, Dalla Corte F, Reverberi R, Manfredini F, Gambari R (2016) Possible detection of Autologous Blood Transfusion (ABT) based on circulating plasma microRNAs involved in erythroid differentiation and fetal hemoglobin induction. Int J Mol Med 38(1):S70–S70
Little RR, Roberts WL (2009) A review of variant hemoglobins interfering with hemoglobin A1c measurement. J Diabetes Sci Technol 3(3):446–451. https://doi.org/10.1177/193229680900300307
Acknowledgements
We thank the personnel of immunohematological and transfusional service for their kind cooperation, and all the athletes that voluntarily participated in the study.
Funding
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.
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
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 http://dx.doi.org/10.17632/2ypv6744p6.1.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Lamberti, N., Finotti, A., Gasparello, J. et al. Changes in hemoglobin profile reflect autologous blood transfusion misuse in sports. Intern Emerg Med 13, 517–526 (2018). https://doi.org/10.1007/s11739-018-1837-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11739-018-1837-7