title: 'Blood doping' from Armstrong to prehabilitation: manipulation of blood to improve performance in athletes and physiological reserve in patients.
abstract: Haemoglobin is the blood's oxygen carrying pigment and is encapsulated in red blood corpuscles. The concentration of haemoglobin in blood is dependent on both its total mass in the circulation (tHb-mass) and the total plasma volume in which it is suspended. Aerobic capacity is defined as the maximum amount of oxygen that can be consumed by the body per unit time and is one measure of physical fitness. Observations in athletes who have undergone blood doping or manipulation have revealed a closer relationship between physical fitness (aerobic capacity) and total haemoglobin mass (tHb-mass) than with haemoglobin concentration ([Hb]). Anaemia is defined by the World Health Organisation (WHO) as a haemoglobin concentration of <130 g/L for men and <120 g/L for women. Perioperative anaemia is a common problem and is associated with increased mortality and morbidity following surgery. Aerobic capacity is also associated with outcome following major surgery, with less fit patients having a higher incidence of mortality and morbidity after surgery. Taken together, these observations suggest that targeted preoperative elevation of tHb-mass may raise aerobic capacity both directly and indirectly (by augmenting preoperative exercise initiatives- 'prehabilitation') and thus improve postoperative outcome. This notion in turn raises a number of questions. Which measure ([Hb] or tHb-mass) has the most value for the description of oxygen carrying capacity? Which measure has the most utility for targeting therapies to manipulate haemoglobin levels? Do the newer agents being used for blood manipulation (to increase tHb-mass) in elite sport have utility in the clinical environment? This review explores the literature relating to blood manipulation in elite sport as well as the relationship between perioperative anaemia, physical fitness and outcome following surgery, and suggests some avenues for exploring this area further.
authors.affiliation: Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK ; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Road, Southampton, UK ; Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, UK ; Faculty of Medicine University of Southampton, Southampton General Hospital Mailpoint 801 South Academic Block, Tremona Road Southampton, Southampton, SO16 6YD UK.
authors.forename: James O M
authors.initials: JO
authors.lastname: Plumb
authors.affiliation: Division of Surgery and Interventional Science c/o, Institute of Sport, Exercise and Health (ISEH), 170 Tottenham Court Road, London, UK.
authors.forename: James M
authors.initials: JM
authors.lastname: Otto
authors.affiliation: Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK ; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Road, Southampton, UK ; Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, UK ; Faculty of Medicine University of Southampton, Southampton General Hospital Mailpoint 801 South Academic Block, Tremona Road Southampton, Southampton, SO16 6YD UK.
authors.forename: Michael P W
authors.initials: MP
authors.lastname: Grocott
keywords: Altitude; Anaemia; Autologous blood transfusion; Blood doping; Blood manipulation; Cycling; Hypoxia-inducible factors; Perioperative; Prehabilitation; Recombinant human erythropoietin rHuEPO; Surgery; Surgical outcomes; Total haemoglobin mass; [Formula: see text]O2max