Blood Doping - the risks of boosting your blood

Blood doping is used by sports athletes to improve endurance and performance. By using methods or medicines to produce more red blood cells, the blood can carry more oxygen.

In medicine blood transfusion is given to patients with a low blood percentage, e.g. in situations of significant acute blood loss.

This article will inform about what blood doping is and the consequences of using illegal methods to manipulate the blood.

Mexico City – the start of blood boosting

Leading up to the 1968 Mexico City Olympics (which were held at an altitude of 2,300 m), exercise physiologists became aware that altitude generally inhibited/impaired performance in endurance exercise, since less oxygen was available to be delivered to the muscle groups being used. Shortly after the Olympic Games were completed, they discovered that the increased number of circulating red blood cells had the opposite effect, improving performance.

Since the Olympics in 1968 athletes has used altitude training to naturally increase the number of red blood cells. High altitude training is nowhere near as effective as with blood doping. This type of blood boosting is very often used in endurance sports like cycling, skiing, and athletics.

For instance, it is quite common for Norwegian cross-country skiers to travel to the Italian alps during the summer to train on high altitude. We also know that track and field athletes travel to Switzerland before the season.

For some years Norwegian skiers used High Altitude rooms. These rooms are constructed like a pressure chamber. The aim is to simulate the oxygen pressure at high altitude. These rooms are not allowed to be used by athletes in Norway.

The two types of blood doping

There are two ways to do blood doping. One method is to use blood from a blood donor (homologous blood transfusion) or by taking a quantity of blood out of the body yourself, cooling or freezing it until the body itself has restored the removed quantity. It is then given back to the donor to increase the amount of red blood cells (autologous blood transfusion).

Using your own blood or other people’s blood is not risk free. When blood doping, the viscosity (thickness) of the blood increases, which makes it more difficult for the blood to flow through the blood vessels. This can result in high blood pressure and, in the worst case, blood clots and heart attacks.

In addition, there is a clear risk of transmission of infections, contagion, contracting virus and allergic reactions if the blood used for blood doping comes from another person.

It has been written news reports that athletes, especially cyclists have died because of blood doping.

Usages in doping

In the Summer Olympic Games in 1972 there were rumored that a Finnish long-distance runner had used the blood doping technique. The Finnish runner was Lasse Viren. He won double gold medals on the track in 5,000m and 10,000m. Nothing was proven. Viren himself claims altitude training, running in the snow, and 'reindeer milk' were the keys to his success.

12 years later, in January 1984, Francesco Moser cycled 51.151 km in 1 hour and thereby shattered the previous record set by Eddy Merkcx in 1972 by more than 1.5 km. The time wasn’t a result of hard training, but the fact that Moser had been using blood transfusions before the event. Moser got help from the Italian doctor Francesco Conconi.

During the Olympic Games in Los Angeles in 1984, the American track cycling team use the same method to several medals. In the IOC meeting on June 6, 1985, the Medical Commission at IOC decides to ban blood opding. Even though there weren't a test to detect the procedure.

Blood doping – A method becoming more popular

The purpose of blood doping is to increase the amount of hemoglobin – a protein in red blood cells that carries oxygen. Those who have used it can tell that the effects on performance are enormous.

According to a paper published by Professor Christer Malm at the Umeå University “Blood transfusion is the most effective means to increase the number of red bloods cells and enhance athletic performance in endurance events.”

A study funded by the Partnership for clean competition (PCC) the Department of Nutrition, Exercise and Sporst at the University of Copenhagen in Denmark, showed that even a small blood transfusion of only 135 ml of red blood cells can improve performance in cycling and other endurance sports.

The findings may substantiate widely held fears that not all doping practices are detected.

The Danish study took two years to complete and, although this type of study typically involves few participants due to a high resource demand, the study design provides highly valid results as the participants acted as their own control group.

According to the website, the persons participated in this study was nine healthy, well-trained men with an average age of 29 years participated in the study. They had at least three years of experience in endurance sports - cycling or triathlon. The men participated in two rounds of experimentation. They randomly received either a blood transfusion or a placebo in the first round of testing. In the second round of testing, they received the opposite. The study was blinded for both the test manager and test subjects. In both rounds of testing the subject performed a time trial of approximately 40 minutes on an ergometer bike before and after receiving a blood transfusion of their own blood or a placebo.

A whole bag of blood contains 450 ml blood, which consists of 45% red blood cells and 55% plasma. This study only stored the red blood cells and injected approximately half of the stored cells back into the test subjects.

- We investigated if smaller than usual transfusions are performance enhancing, which they are. The conclusion is that anti-doping authorities need to be aware that even ‘small’ manipulations will provide a possible and illegal performance advantage. Thus, it is important to have very sensible methods in place to detect fraud, says Associate Professor Nikolai Nordsborg at the Department of Nutrition, Exercise and Sports at University of Copenhagen.

The research was done by PhD student Jacob Bejder.

Test Methods to Detect Autologous Blood Doping in Development

Christer Malm sat up a company, Pro Test Diagnostic, to developing a novel method to detect autologous blood doping. It is not easy to detect the usage of your own blood. The reason, according to professor Malm is:

-Since it is the person's own blood, the same surface markers are found on Red Blood Cells, so infused blood cannot be "seen" by the immune system/spleen.

There are also challenges when it comes to developing a test method to detect the usage of your own blood. The reason is that there are no changes in the red blood cells. It is the “normal” blood variables like Hb (hemoglobin), Hct (hematocrit) and so on those changes, according to professor Malm.

Pro Test Diagnostics has a vision to become the dominating choice for test kit and test methods for autologous blood doping, supporting anti-doping organizations and test laboratories (WADA and private labs). 

The company has worked on the development of a test method for years and are currently looking at different ways to detect blood doping. 

The discovery of erythropoietin (EPO) simplified blood doping in sports, but it is believed that improved detection methods for EPO has forced cheating athletes to return to blood transfusion. Autologous blood transfusion with red blood cells is the method of choice, since no valid method exists to accurately detect such event.

Why athletes are using blood doping

One athlete who can confirm the effectiveness of Blood Doping is the Austrian Cross-Country skier Max Hauke.

In 2019 he was caught by Austrian police using autologous blood transfusions. He told the Norwegian newspaper Dagbladet that in a 30-minutes competition, his time would improve with 30 seconds.

- In a race lasting an hour, I could gain one minute, he said.

Hauke used blood doping in the years 2016-2019 and was caught during the FIS Nordic Ski World Championships in Seefeld. The Austrian was one of many athletes who used the services of the German doctor Mark Schmidt. Austrian and German police investigated the network orchestrated by Schmidt and was named Operation Aderlass (In English Operation Bloodletting).

This operation came to light during the 2019 FIS Nordic World Ski Championships in Seefeld, Austria, when police raided and arrested several athletes and support personnel.

The investigation revealed that Schmidt had been running a systematic blood doping operation since at least 2011, affecting various sports, particularly cycling and cross-country skiing. Athletes from multiple countries, including Austria and Germany, were implicated. Among those arrested were Austrian cyclists Georg Preidler and Stefan Denifl. Besides Hauke, cross -country skier Dominik Baldauf were also arrested

Both skiers were banned from competition for four years.

The operation uncovered over 100 blood bags and evidence of growth hormone misuse, leading to a series of arrests and trials. Schmidt, along with his accomplices, faced charges for using prohibited doping methods and aiding and abetting in their application.

How is blood doping detected

Blood doping, and especially the autologous method where you use your own blood, is very hard to detect. A test method for detecting blood from other persons is in place and was already in use at the 2004 Summer Olympic Games in Athens, Greece.

Because it is hard to detect blood doping where the athlete used his or her own blood, the Anti-Doping community developed the Athlete Biological Passport. The Athlete Biological Passport program was initiated in 2009 by WADA to make the anti-doping program more effective and stronger.

The ABP is a personalized, electronic record of an athlete’s biological measurements. During sample collection blood and urine samples are collected at regular intervals.

The primary goal of the ABP is to identify unusual changes in an athlete’s biological parameters. Differences in the profile may suggest the use of banned substances or methods.

Two examples on the use of ABP are the suspensions of the two Italian cyclists Franco Pellizotti and Pietro Caucchioli. Pellizotti was suspended by the International Cycling Union (UCI) in 2010 after his ABP profile showed irregularities. The rider appealed to the Court of Arbitration for Sport (CAS), but his ban was upheld.

The year after Caucchioli was also banned for two years after abnormalities were detected in his ABP. He also appealed to CAS. The result was the same for him. CAS upheld the ban.

In the Anti-Doping Database, we have registered more than 100 cases where athletes has been banned after their ABP showed abnormalities or irregularities.

How big is the Blood Doping problem?

Since there currently is no official test method to detect autologous blood doping, no one is really sure how big the problem is. But in 2006 a large blood doping operation might have shed some light on how big blood doping is.

In the investigation in the Operation Puerto in Spain in 2006, police confiscated more than 100 blood bags from different athletes. In Operation Aderlass (operation bloodletting, 2019), 50 people from nine countries were charged by the authorities during the investigation. 16 athletes were suspended.

In the Anti-Doping Database, we have registered 28 athletes who has been banned after testing positive or admitting use of blood doping. We have also registered more than 100 cases where ABP was used to prove use of banned methods or substances.

We have also registered 608 cases involving the different generations of EPO. (EPO, 523; NESP, 32; CERA,53).



Validation of a novel test for autologous blood doping: High altitude, gender and strenuous endurance exercise:


Blood Doping and EPO (In Norwegian):

Blood Doping (in Norwegian):

What is Blood Doping:

What is Blood Doping (Norwegian):

The impact of blood doping:

Blood Dopes of the 1984 Olympic Games:

Blood Doping article at Pro Test Diagnostics:

Viren's talent not just in the blood:

Blood-Doping Unethical, U.S. Olympic Official Says -

The coronavirus pandemic made collecting blood and urine samples extremely difficult. It also made 2020 an ideal opportunity for those who wanted to cheat.

A forensic science approach to doping detection:

Small Amount of Blood Doping: Large Impact -

Operation Aderlass:

Operation Aderlass – four cyclists provisionally suspended -

Operation Aderlass – Nurse admits blood transfusions  -

Die Chronik der Operation Aderlass (Paywall) -

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