Biologic Passport & Other

02 Dec 2008

The following data have been collected in Lausanne by the Medical Commission of the UCI, concerning a professional cyclist, from March 29th until March 31st 1999. 
The athlete was subjected to 3 blood sample takings in 3 consecutive days at different times of the day (8.00 h, 12.00 h, 16.00 h). 
Each sample was double dosed, in rapid succession. 


Date: 29.3.99 

- Hour 8.00 - 
Hct: 45.4 Hb :15.9  
- Hour 12.00 - 
Hct: 44.1 Hb: 15.6 
- Hour 16.00 - 
Hct: 45.5 Hb: 16.0 

Date: 30.3.99 

- Hour 8.00 - 
Hct: 46.1 Hb: 16.2  
- Hour 12.00 - 
Hct: 45.8 Hb: 16.2  
- Hour 16.00 - 
Hct: 46.0 Hb: 16.2 

Date: 31.3.99 

- Hour 8.00 - 
Hct: 48.2 Hb: 17.0 
- Hour 12.00 - 
Hct: 49.2 Hb: 15.9  
- Hour 16.00 - 
Hct: 47.2 Hb: 15.3 


The Hematocrit (hct) within the space of 3 days shows a variation of 11.5% (from the 44.1 of 29.3.99 to the 49.2 of 31.3.99). 
The Hemoglobin (Hb) showed a variation of 11.1% in the same day (from 17.0 g/dl at 8.00 to 15.3g/dl at 16.00 of 31.3.99), while within the space of the 3 days the variation was 9% (from 15.6 of 29.3.99 to 17.0 of 31.3.99). 

I can guarantee that such variations are a very common find in top-level athletes, in relationship with the variations in plasma volume(PV), due to hydration, nutrition and physical activity. 

A very recent french study (Int.J.Hematol. 2008;88:362-368), financed by WADA, claimed that variations superior to 6% in Hct or 4% in Hb are “abnormal” (and an indication of hematic manipulations), if included within the space of 15 days. 

Another study (Haematologica 2005;91:1006-1007), maybe a more realistic one, concluded that variations in Hb superior to 15% and observed in the imminence of important competition events may indicate hematic manipulations. 

The introduction of the BIOLOGIC PASSPORT should help with matters concerning the variability of hematic parameters for single athletes. 

The chosen statistic criteria (Haematologica 2006;91:356-363) utilizes a formula to calculate a "Z-score" for Hb and an OFF-hr (index of stimulation which considers Hb and reticulocytes). 
Such formula is based on the individual calculation of VARIANCE, which is an index of the variability in values of a certain parameter. 

This STATISTIC valuation defines two suspicion thresholds: 

- the first one has a possibility of error of 1 over 500, if the Z-score result is higher than or equal to 3.09 
- the second one has a possibility of error of 1 over 50, if the Z-score is higher than or equal to 2.33 or inferior to -2.33. 

The Authors propose a "NO START" penalty for the first case, while for the second they qualify it as “SUSPICIOUS”, suggesting a close monitoring of the athlete involved. 
We shall see how the UCI will act: as of today, we still don’t know what criteria and penalties will be applied. 

Applying the criteria of the Biologic Passport to the variations in Hb measured (in the space of only 3 days) for our cyclist friend back in 1999, it would result in a NO-START for values higher than or equal to 17.4 g/dl, while values equal to or higher than 17.1 or inferior to 14.9 would be sufficient to classify the athlete as SUSPICIOUS. 

THE PIZZA TEST 

Six cyclists had their Hb values checked at 9 o’clock in the morning and repeated the same analyses the next morning, after a dinner of pizza with prosciutto. 
The results were: 


1st test - 2nd test 

Athlete 1: 16.8 - 15.3 (-9.8%) 
Athlete 2: 15.5 - 14.5 (-6.8%) 
Athlete 3: 14.2 - 13.7 (-3.6%) 
Athlete 4: 15.3 - 14.0 (-9.2%) 
Athlete 5: 14.6 - 13.2 (-10.6%) 
Athlete 6: 16.0 - 15.1 (-5.9%) 

Average 1st Test: 15.4; Average 2nd Test: 14.3 (-7.6%) 


CRAZY NUMBERS.... 

"As a principle, I refuse to subject myself to such controls… I don’t want one of my victories to be put in doubt by the fantasy of the analyses”. 
Jacques Anquetil (L'Equipe, May 4th 1966).