American College of Sports Medicine Expert Consensus Statement: Blood Doping in Sport

This Consensus statement provides an update to the 1996 American College of Sports Medicine Position Stand: The Use of Blood Doping as an Ergogenic Aid. Red blood cell (RBC) mass directly influences exercise performance because RBCs are critical to the transport of oxygen to skeletal muscle, as well as their role in maintaining acid-base status and regulating blood flow. Blood doping is defined as the practice of artificially increasing RBC volume for the purpose of improving exercise performance. Blood doping methods have classically included reinfusion of stored blood as well as administration of pharmaceutical agents such as recombinant human erythropoietin, hypoxia-inducible factor stabilizers or nonpharmaceutical substances, like cobalt or xenon, which stimulate the erythropoietic pathway. It is clear through scientific consensus that other methods to naturally increase hemoglobin, such as hypoxic or hyperoxic exposure, are not considered blood doping. More recently, emerging blood doping threats through gene manipulation have received new attention. In the last 25 yr, the science and technology surrounding oxygen sensing and erythropoiesis, pharmacological intervention, and doping detection has advanced substantially, dictating this updated review. It is the position of the American College of Sports Medicine that any blood doping procedure used with the actual or potential to improve athletic performance is unethical and unfair and exposes the athlete to unwarranted and potentially serious health risks.