European Journal of Applied Physiology

, Volume 111, Issue 9, pp 2307–2314 | Cite as

Current markers of the Athlete Blood Passport do not flag microdose EPO doping

  • Michael Ashenden
  • Clare E. Gough
  • Andrew Garnham
  • Christopher J. Gore
  • Ken Sharpe
Original Article


The Athlete Blood Passport is the most recent tool adopted by anti-doping authorities to detect athletes using performance-enhancing drugs such as recombinant human erythropoietin (rhEPO). This strategy relies on detecting abnormal variations in haematological variables caused by doping, against a background of biological and analytical variability. Ten subjects were given twice weekly intravenous injections of rhEPO for up to 12 weeks. Full blood counts were measured using a Sysmex XE-2100 automated haematology analyser, and total haemoglobin mass via a carbon monoxide rebreathing test. The sensitivity of the passport to flag abnormal deviations in blood values was evaluated using dedicated Athlete Blood Passport software. Our treatment regimen elicited a 10% increase in total haemoglobin mass equivalent to approximately two bags of reinfused blood. The passport software did not flag any subjects as being suspicious of doping whilst they were receiving rhEPO. We conclude that it is possible for athletes to use rhEPO without eliciting abnormal changes in the blood variables currently monitored by the Athlete Blood Passport.


Blood doping Reticulocytes Sysmex Erythropoietin 


  1. Ashenden M, Varlet-Marie E, Lasne F, Audran M (2006) The effects of microdose recombinant human erythropoietin regimens in athletes. Haematologica 91:1143–1144PubMedGoogle Scholar
  2. Ashenden MJ, Sharpe K, Damsgaard R, Jarvis L (2004) Standardization of reticulocyte values in an antidoping context. Am J Clin Pathol 121:816–825PubMedCrossRefGoogle Scholar
  3. Audran M, Gareau R, Matecki S, Durand F, Chenard C, Sicart M-T, Marion B, Bressolle F (1999) Effects of erythropoietin administration in training athletes and possible indirect detection in doping control. Med Sci Sports Exerc 31:639–645PubMedCrossRefGoogle Scholar
  4. Banfi G, Tavana R, Freschi M, Lundby C (2010) Reticulocyte profile in top-level alpine skiers during four consecutive competitive seasons. Eur J Appl Physiol 109:561–568PubMedCrossRefGoogle Scholar
  5. Berglund B, Ekblom B (1991) Effect of recombinant human erythropoietin treatment on blood pressure and some haematological parameters in healthy men. J Intern Med 229:125–130PubMedCrossRefGoogle Scholar
  6. Borno A, Aachmann-Andersen NJ, Munch-Andersen T, Hulston CJ, Lundby C (2010) Screening for recombinant human erythropoietin using [Hb], reticulocytes, the OFF(hr score), OFF(z score) and Hb(z score): status of the Blood Passport. Eur J Appl Physiol 109:537–543PubMedCrossRefGoogle Scholar
  7. Damsgaard R, Munch T, Moerkeberg J, Mortensen SP, Gonzalez-Alonso J (2006) Effects of blood withdrawal and reinfusion on biomarkers of erythropoiesis in humans: implications for anti-doping strategies. Haematologica 91:1006–1008Google Scholar
  8. Gore CJ, Parisotto R, Ashenden MJ, Stray-Gundersen J, Sharpe K, Hopkins W, Emslie KR, Howe C, Trout GJ, Kazlauskas R, Hahn AG (2003) Second-generation blood tests to detect erythropoietin abuse by athletes. Haematologica 88:333–344PubMedGoogle Scholar
  9. Halstenson CE, Macres M, Katz SA, Schnieders JR, Watanabe M, Sobota JT, Abraham PA (1991) Comparative pharmacokinetics and pharmacodynamics of epoetin alfa and epoetin beta. Clin Pharmacol Ther 50:702–712PubMedCrossRefGoogle Scholar
  10. Lasne F (2001) Double-blotting: a solution to the problem of non-specific binding of secondary antibodies in immunoblotting procedures. J Immunol Methods 253:125–131PubMedCrossRefGoogle Scholar
  11. Lundby C, Achman-Andersen NJ, Thomsen JJ, Norgaard AM, Robach P (2008) Testing for recombinant human erythropoietin in urine: problems associated with current anti-doping testing. J Appl Physiol 105:417–419PubMedCrossRefGoogle Scholar
  12. Morkeberg J, Belhage B, Ashenden M, Borno A, Sharpe K, Dziegiel MH, Damsgaard R (2009a) Screening for autologous blood transfusions. Int J Sports Med 30:285–292PubMedCrossRefGoogle Scholar
  13. Morkeberg J, Saltin B, Belhage B, Damsgaard R (2009b) Blood profiles in elite cross-country skiers: a 6-year follow-up. Scand J Med Sci Sports 19:198–205PubMedCrossRefGoogle Scholar
  14. Morkeberg J, Sharpe K, Belhage B, Damsgaard R, Schmidt W, Prommer N, Gore CJ, Ashenden MJ (2009c) Detecting autologous blood transfusions: a comparison of three passport approaches and four blood markers. Scand J Med Sci Sports. doi:10.1111/j.1600-0838.2009.01033.x
  15. Morkeberg JS, Belhage B, Damsgaard R (2009d) Changes in blood values in elite cyclist. Int J Sports Med 30:130–138PubMedCrossRefGoogle Scholar
  16. Parisotto R, Wu M, Ashenden MJ, Emslie KR, Gore CJ, Howe C, Kazlauskas R, Sharpe K, Trout GJ, Xie M (2001) Detection of recombinant human erythropoietin abuse in athletes utilizing markers of altered erythropoiesis. Haematologica 86:128–137PubMedGoogle Scholar
  17. Russell G, Gore CJ, Ashenden MJ, Parisotto R, Hahn AG (2002) Effects of prolonged low doses of recombinant human erythropoietin during submaximal and maximal exercise. Eur J Appl Physiol 86:442–449PubMedCrossRefGoogle Scholar
  18. Schmidt W, Prommer N (2005) The optimised CO-rebreathing method: a new tool to determine total haemoglobin mass routinely. Eur J Appl Physiol 95:486–495PubMedCrossRefGoogle Scholar
  19. Schumacher YO, Wenning M, Robinson N, Sottas PE, Ruecker G, Pottgiesser T (2010) Diurnal and exercise-related variability of haemoglobin and reticulocytes in athletes. Int J Sports Med 31:225–230PubMedCrossRefGoogle Scholar
  20. Sharpe K, Ashenden MJ, Schumacher YO (2006) A third generation approach to detect erythropoietin abuse in athletes. Haematologica 91:356–363PubMedGoogle Scholar
  21. Sottas P-E, Robinson N, Saugy M (2008) A forensic approach to the interpretation of blood doping markers. Law, Probability Risk 7:191–210CrossRefGoogle Scholar
  22. Thomsen JJ, Rentsch RL, Robach P, Calbet JA, Boushel R, Rasmussen P, Juel C, Lundby C (2007) Prolonged administration of recombinant human erythropoietin increases submaximal performance more than maximal aerobic capacity. Eur J Appl Physiol 101:481–486PubMedCrossRefGoogle Scholar
  23. WADA (2009) Athlete biological passport operating guidelinesGoogle Scholar
  24. Zorzoli M (2005) Blood monitoring in anti-doping setting. In: Schanzer WHG, Gotzmann A (eds) Recent advances in doping analysis. Sport und Buch Strauss, Koln, pp 255–264Google Scholar
  25. Zorzoli M, Rossi F (2010) Implementation of the biological passport: the experience of the International Cycling Union. Drug Test Anal. doi:10.1002/dta.173

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Michael Ashenden
    • 1
  • Clare E. Gough
    • 2
    • 3
  • Andrew Garnham
    • 4
  • Christopher J. Gore
    • 2
    • 5
  • Ken Sharpe
    • 6
  1. 1.SIAB Research ConsortiumGold CoastAustralia
  2. 2.Department of PhysiologyAustralian Institute of SportBelconnenAustralia
  3. 3.Faculty of HealthUniversity of CanberraCanberraAustralia
  4. 4.School of Exercise and Nutrition Sciences, Deakin UniversityBurwoodAustralia
  5. 5.Exercise Physiology LaboratoryFlinders UniversityAdelaideAustralia
  6. 6.Statistical Consulting Centre, Department of Mathematics and StatisticsUniversity of MelbourneMelbourneAustralia

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