Blood doping is the abuse of techniques and / or substances to increase the oxygen transporting capacity of the blood.

In this way, the body’s maximum oxygen absorption (aerobic capacity) increases, which is the most important performance limiting factor when it comes to endurance. Performance capacity can therefore be significantly increased by increasing the transport capacity of oxygen.

There are mainly three types of blood doping:

  1. Blood transfusions
  2. Synthetic oxygen transporters (HBOCs)
  3. Substances that stimulate blood formation, for example using different EPO variants (NESP, dynepo, CERA)


Blood doping involves a high risk of serious side effects.

We have examples of deaths among endurance practitioners that can be associated with different types of blood doping. In particular, the combination of blood doping and dehydration (fluid shortage) is dangerous because it leads to an increased risk of blood clots.

The introduction of blood profiles is an important part of the fight against blood doping. Direct detection of blood doping is demanding, but with systematic and frequent blood sampling, use of, for example, EPO or blood transfusion could be demonstrated in the athlete’s blood profile.

1. Blood transfusions.

There are two methods of “traditional” blood doping:

  • autologous (own blood) and
  • homologous (foreign blood) blood transfusions.

Autologous blood transfusions imply a certain amount of athlete’s blood a few weeks before the current competition. The red blood cells are separated from the rest of the blood and stored under optimal conditions. The red blood cells are then re-inserted into the body shortly before the competition. The body has meanwhile replaced the lost blood, thus achieving a higher concentration of red blood cells during the competition. The effect of high altitude training has the same increase on the blood, building more red blood cells, but this is not illegale in sport.

Homologous blood transfusions imply blood from another person with the same blood type, and is transferred before the current competition.

Both methods provide the same performance-enhancing effect. There are currently good analytical methods to reveal homologous blood doping while continuing to develop good analytical methods for autologous blood doping.


Side effects:

Homologous blood transfusion may lead to:

  • Transmission of infectious diseases (HIV, hepatitis, etc.)
  • Immunological reactions to foreign blood

Immunological response means that the recipient responds to the donor’s blood due to immunological differences in the red blood cells. Blood types must be used that can be combined. Such immunological reactions can be life threatening.

Homologue and autologous blood transfer:

  • There is a risk of too much blood, which can lead to increased risk of blood clots (stroke, pulmonary embolism) and heart failure.

2. Synthetic oxygen conveyors.

Synthetic hemoglobin-based oxygen transporters (HBOCs) or HemAssist are made by chemically modifying hemoglobin from cows and humans that are able to bind and transport oxygen into the bloodstream from the lungs to the tissues. Normally, hemoglobin is in the red blood cells, but these substances (HBOCs) circulate freely in the bloodstream.

The preparations are used in acute medical cases where human blood is not available or when there is not enough time to find blood that is compatible with the recipient’s blood type. In such cases, synthetic hemoglobin-based oxygen transporters can be life-saving.

This type of drug is now used as doping agents and has approximately the same performance-enhancing effect as other forms of blood doping, as they increase the oxygen transport capacity of the blood.

Why athletes use them:

HBOCs can carry up to four times more oxygen than regular human blood. They can deliver more oxygen than what is possible to the muscles even is the most well-trained athlete. They also are attractive to athletes because they have a very short life and they clear from the blood quickly. This makes the athletes be able to go undetected while using HBOCs.

Why athletes should not use them:

Using HBOCs can have a huge increase in cardiac events, myocardial events, and even death. They are considered performance-enhancing drugs so they are on the “banned substance list.” There is also no research studies that asses the drugs affect on sports performance and endurance so athletes should not take the risk!

What kind of athletes take it?

Cyclists, long distance runners, endurance performers, and military people use them. This is because these activities require a lot of hard work and training. Athletes feel that injecting HBOCs into them will help them train and perform better in endurance activities because you are constantly getting oxygen transported in your body.


Side effects:

  • Increased risk of blood clots (stroke, heart attack, pulmonary embolism) and heart failure
  • Severe allergic reactions

Using HBOCs can have a huge increase in cardiac events, myocardial events, and even death. They are considered performance-enhancing drugs so they are on the “banned substance list.” There is also no serious research studies that asses the drugs affect on sports performance and endurance so athletes should not take the risk!


3. EPO

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

EPO is produced in the kidneys and transported via the bloodstream to the bone marrow. There the EPO stimulates the formation of the red blood cells. Artificially produced EPOs in different variants are included in several approved medicines in f.ex. Norway. Legal use of EPO preparations are used primarily in the treatment of patients with anemia (anemia) due to renal failure and cancer.

Since the 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 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 break more slowly into the body and therefore have longer working time than the 1st generation EPO.

Side effects:

  • Reactions at the place of entry
  • Flu-like symptoms
  • Makes the blood thicker and increases the risk of blood clots and heart failure
  • Severe allergic reactions
  • Development of high blood pressure
  • Convulsions


Source: and anti-doping world