Author: Charles Frank

Blood Doping and EPO: An Anti-Doping FAQ

A low oxygen level may indicate a diminished number of red blood cells (anemia), or hemoglobin molecules that carry oxygen through the body. If EPO levels are too high the body will produce too many red blood cells which can thicken the blood, leading to clotting, heart attack and stroke. Repeated doses of EPO can also stimulate the development of antibodies directed against EPO, which can result in anaemia.

Damaged kidneys can’t produce as much EPO, leading to low levels. When cells in your kidneys sense that there’s sufficient oxygen in your blood, they reduce the production of erythropoietin. Erythropoietin—more commonly known as EPO—is a type of blood doping that can help improve an athlete’s endurance. Only a small amount of unchanged epoetin alfa is found in the urine 8.

1. EPO’s half-life may vary between endogenous and various recombinant versions.
2. In rare cases, certain tumors can also cause your kidneys to release inappropriately excessive EPO.
3. However, sometimes your body inappropriately produces too many or too few red blood cells, which can cause health problems.
4. Chemically, erythropoietin a protein with an attached sugar (a glycoprotein).

An approved test for EPO was first introduced at the Sydney 2000 Olympic Games. The test used a combination of urine testing, which would identify the presence of EPO (direct test) and blood testing, which would show the residual ‘footprints’ of EPO drug use over time (indirect test). Your healthcare provider will carefully interpret your results and let you know if your levels are healthy or out of range. Once the lab finishes testing your blood sample, a healthcare provider will contact you to discuss your test results and answer any questions. Some human blood products have transmitted certain viruses to people who have received them, although the risk is low.

Human donors and donated blood are both tested for viruses to keep the transmission risk low. This medicine may cause serious allergic reactions, including anaphylaxis and angioedema. These can be life-threatening and require immediate medical attention. Tell your doctor right away if you have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth after using this medicine. When used in patients with certain types of cancer (eg, breast, cervix, lymphoid, lung, head, or neck cancer), this medicine has shortened survival time and worsened the tumor or cancer in some patients.

Normally, when specialized cells in your kidneys detect low blood oxygen levels, they increase the production of EPO. EPO then tells the spongy tissue inside your bones (bone marrow) to make more red blood cells. There’s also a synthetic (man-made) form of erythropoietin that healthcare providers use to treat anemia that results from chronic kidney disease. Some athletes improperly use this drug to boost their performance because EPO increases the availability of oxygen to their muscles. A century ago, two French investigators reported that small amounts of plasma from anemic rabbits injected into normal animals caused an increase in red blood cell production (erythropoiesis) within a few hours.

However, EPO injections may deliver fewer benefits than initially thought. Atypical ABP profiles are used to facilitate target testing and guide further ESA analyses. It depends on many factors, including dose, frequency, route of administration, and type of ESA administered. The erythropoietin gene has been found on human chromosome 7 (in band 7q21). Different DNA sequences flanking the erythropoietin gene act to control liver versus kidney production of erythropoietin. Researchers are working on a detection method that will look for the effects of EPO in the body’s cellular anatomy as opposed to its presence in urine or blood.

However, medicines given by injection are sometimes used at home. If you will be using epoetin at home, your doctor will teach you how the injections are to be given. Be sure that you understand exactly how the medicine is to be injected. Chronic kidney disease (CKD) is the most common cause of low EPO levels.

Tell your doctor right away if you or your child see blood clots forming in the access port. When epoetin begins to work, usually in about 6 weeks, most people start to feel better. It has no effect on kidney disease, cancer, or any other medical problem that needs regular medical attention.

What causes low levels of erythropoietin?

But erythropoietin (EPO)—a drug used to boost red blood cell counts in a practice called “blood doping”—falls under the same umbrella of forbidden substances. The drug has been a source of widespread abuse and controversy among professional cyclists since the 1980s. Erythropoietin stimulates the bone marrow to produce more red blood cells.

Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco. Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine. Blood doping is in violation of standards set by the World Anti-Doping Agency (WADA) and is banned in professional sports. Even with rigorous testing among athletes, that hasn’t stopped some from doing it anyway.

The Story of Erythropoietin

Check with your doctor right away if you or your child start having dizziness, fainting spells, severe tiredness, chest pain, trouble with breathing, sudden or severe headache, or problems with vision, speech, or walking. The dose of this medicine will be different for different patients. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so. Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines.

Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully. Erythropoietin is produced by interstitial fibroblasts in the kidney in close association with the peritubular capillary and proximal convoluted tubule.

What is the function of erythropoietin?

Normal levels of erythropoietin range from 4 up to 24 mU/ml (milliunits per milliliter). Healthcare providers measure EPO in your blood in milliunits per milliliter (mU/mL). A normal range for your EPO levels may be between 4 and 26 mU/mL. Even if your EPO levels are within a normal range, you may still require treatment. Check with your doctor right away if you have blistering, peeling, or loosening of the skin, red skin lesions, severe acne or a skin rash, sores or ulcers on the skin, or fever or chills with this medicine. Epoetin sometimes causes seizures, especially during the first 90 days of treatment.

Usage as doping product

Long-term (chronic) exposure to low levels of oxygen can increase your EPO levels. This may be due to chronic smoking or living in a high-altitude environment where air oxygen levels are lower. Elevated EPO from a high-altitude environment is normal and appropriately high. This medicine may increase your risk of having serious heart and blood vessel problems, such as congestive heart failure, heart attacks, or stroke.

To keep your kidney disease or your high blood pressure from getting worse, it is very important that you or your child follow your special diet and take your medicines regularly, even if you are feeling better. EPO is part of a class of substances called Erythropoiesis-Stimulating Agents (ESAs). In a clinical setting, EPO is primarily used for kidney failure, chemotherapy, and other medical conditions involving red blood cell loss and anemia. For example, erythropoietin has been misused as a performance-enhancing drug in athletes such as cyclists (in the Tour de France), long-distance runners, speed skaters, and Nordic (cross-country) skiers. Erythropoietin has been banned by the Tour de France, the Olympics, and other sports organizations. Inappropriately high levels of erythropoietin can cause high levels of red blood cells.

Binding of erythropoietin and epoetin alfa to EPO-R leads to cellular internalization, which involves the degradation of the ligand. Erythropoietin and epoetin alfa may also be degraded by the reticuloendothelial scavenging pathway or lymphatic system 4. In healthy volunteers, the volume of distribution of intravenous epoetin alfa was generally similar to the plasma volume (range of 40–63.80 mL/kg), indicating limited extravascular distribution 4,2. If you notice any other effects, check with your healthcare professional. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur.