EPO – the synthetic Blood Doping Method

Artificially produced Erythropoietin was approved as a medicine in 1989. Not long after, athletes – especially in endurance sports – started using the substance.

Erythropoietin (EPO) is a hormone that stimulates the production of red blood cells in the bone marrow.

EPO is short for the hormone erythropoietin. The hormone is mainly produced in the kidneys, after which it is transported via the bloodstream to the bone marrow. Here it stimulates the maturation process of red blood cells in the bone marrow.

The red blood cells transport oxygen to the body's cells, and any drop in the oxygen content of the blood is registered in the kidneys and stimulates increased EPO production.

Medical use

Artificially produced EPO was approved as a medicine in 1989. The substance entered the Prohibited Substances List the following year. The International Olympic Organizing Committee (IOC) was governing the list in those days. The Prohibited Substances list is now maintained by WADA.

Artificially produced EPO in various variants is included in several approved medicines. The EPO preparations are primarily used in the treatment of patients with anemia (lack of blood) due to kidney failure and cancer.

According to National Center for Biotechnology, Human EPO was first isolated from the urine of anemic patients in 1977. In 1983, scientists discovered a method for mass producing a synthetic version of the hormone. Experiments were conducted to test the safety and effectiveness of EPO for treating anemia in patients with kidney failure. The results of these early clinical trials were dramatic. Patients who had been dependent on frequent blood transfusions were able to increase their red blood cell levels to near normal within just a few weeks of starting therapy. Patients' appetites returned, and they resumed their active lives.

Since EPO stimulates the production of red blood cells, the use of EPO preparations will increase the oxygen transport capacity of the blood. The preparations are therefore very effective as doping agents.

NESP and CERA are respectively 2nd and 3rd generation EPO preparations, and they stimulate the production of red blood cells. These EPO variants have a slightly different chemical structure than the body's own EPO. They are broken down more slowly in the body and therefore have a longer duration of action than 1st generation EPO.

How is EPO detected

EPO has also been hard to find since the window of detection is narrow. But over the years laboratories has become better at detecting the substance. In 2009 the World Anti-Doping Agency initiated a program to detect usage of EPO and other yet not detectable substances or methods.

WADA introduced the Athlete Biological Passport. It is a weapon to make the anti-doping 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 500 cases where athletes has been banned for using EPO.

Side effects

EPO can lead to cardiovascular problems, blood clots, and even death. The scientist Robin Parisotto claims in his book “Blood Sports: The Inside Dope on Drugs in Sport” that 18 cyclists died tragically and suddenly all from heart attack or stroke between 1987 and 1990. EPO was known to thicken the blood – the common cause of heart attack or stroke.”

Parisotto is a scientist who acted as principal researcher in the EPO 2000 project at the Australian Institute of Sport.

In the book “The death of Marco Pantani”, author Matt Rendell describes how cyclists in the 1990s monitored heart frequency during the night. An alarm would go of if the frequency went below a certain level. When this happened, the cyclists would wake up, get on the bike and ride for ten minutes on bike rollers inside the hotel room, just to get their hearts racing. The book also reproduces this statement from one of the cyclists who contributed anonymously: "During the day we live to ride, and at night we ride to live".

How big is the Blood Doping problem?

In 2006 it really became apparent how big of a problem blood doping is. In the investigation in the Operation Puerto in Spain, police confiscated more than 100 blood bags from different athletes. In Operation Aderlass (operation bloodletting), 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 636 cases involving the different generations of EPO. (EPO – 551, NESP 32, CERA 53).


Hemoglobin: https://www.mountsinai.org/health-library/tests/hemoglobin

Blood Doping and EPO (In Norwegian): https://www.antidoping.no/kunnskap-og-ressurser/bloddoping-epo

Blood Doping (in Norwegian): https://www.lommelegen.no/blod-og-lymfe/artikkel/bloddoping-epo/70260887

What is Blood Doping: https://cces.ca/faq/what-is-blood-doping

What is Blood Doping (Norwegian): https://nhi.no/trening/aktivitet-og-helse/doping/bloddoping

The impact of blood doping: https://nexs.ku.dk/english/news/news-archive/small-amount-of-blood-doping-large-impact/

Blood Dopes of the 1984 Olympic Games: https://web.stanford.edu/~learnest/cyclops/dopes.htm

Viren's talent not just in the blood: https://www.irishtimes.com/sport/viren-s-talent-not-just-in-the-blood-1.1165284

Blood-Doping Unethical, U.S. Olympic Official Says - https://www.nytimes.com/1985/01/13/sports/blood-doping-unethical-us-olympic-official-says.html

The coronavirus pandemic made collecting blood and urine samples extremely difficult. It also made 2020 an ideal opportunity for those who wanted to cheat. https://www.nytimes.com/2020/10/23/sports/olympics/covid-doping-usada-wada.html

A forensic science approach to doping detection: https://thetruthaboutforensicscience.com/athlete-biological-passport-abp-a-forensic-science-approach-to-doping-detection/

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