Hb_mass for Anti-Doping Purposes Should be Assessed in Combination with Hemoglobin and Blood Volume

In a recent article, Eastwood et al. showed that detraining decreases hemoglobin mass (Hb_mass) in triathletes [3]. Recently, Hb_mass assessment has been suggested as an anti-doping approach to identify blood doping including the use of erythropoiesis stimulating agents or autologous blood transfusions [4] [8] [9]. Hb_mass is not sensitive to plasma volume changes and is crucial to detect cheating, since it is not affected by artificial hemodilution. Nevertheless, the decrease in hemoglobin [Hb] with training parallels the disproportionately large expansion in plasma blood volume that occurs in endurance sports [3] [7] [10]. As was shown in Table 2 of the Eastwood et al. manuscript [3], the decrease of Hb_mass is mainly sustained by a reduction of blood volume since Hb increases from pre values at all study points.

Although important progress has been made on the appropriate application of Hb_mass for anti-doping testing, so that this parameter appears sufficiently accurate to be introduced [1], some drawbacks still exist, such as the poor standardization and lack of quality control assessment which emerged recently. Interestingly, Garvican et al. showed that Hb_mass remains stable over 6 days of racing in professional cyclists [5]. In another study, the same team of authors reported that Hb_mass decreases by approximately 3% in female cyclists during a competitive season [6]. Eastwood et al. failed to observe any significant variation in Hb_mass after 40 days of physical activity in previously untrained adults [2], while Ulrich et al. did not observe any difference in Hb_mass in endurance-trained and non-endurance-trained adolescent athletes after 6, 12 and 18 months of regular training [11].

The identification of artificial hemodilution is critical to detect blood doping in sport, as it is the natural blood volume expansion induced by training. Thus, Hb_mass is likely to become an important and crucial weapon in anti-doping testing. In our opinion, however, Hb_mass measurement should be assessed in combination with [Hb] and blood volume to prevent misinterpretations due to blood volume changes induced by athletes training load or detraining, as shown by Eastwood and colleagues, as it would provide a reliable clue to discriminate between licit or illicit haemoglobin changes in elite athletes.

• References

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