Previous studies have shown that a greater than 5% increase in circulating hemoglobin is necessary to improve performance suggesting that athletes would need to infuse at least one unit of blood to obtain a surreptitious performance advantage. Assuming a blood volume of 4-5 L for an adult, transfusing a single unit of blood would result in approximately 10% of the red cell population being of donor origin. The antigenic profile of cells from any individual is under genetic control, and except in certain rare malignancies, hematopoiesis in the bone marrow produces red cells which have an identical and specific spectrum of blood group antigens.
In a clinical setting, the course of red cell engraftment after allogeneic bone marrow or peripheral stem cell transplantation may be followed by quantification of antigenically distinct donor and recipient red cells using flow cytometry. This technology has been used to determine the original phenotype of multi-transfused patients and to determine zygosity in paternity testing. Since the flow cytometer has a sensitivity of approximately 0.07%, this technology should be capable of detecting the transfusion of a single unit of blood, provided there is at least one antigen unmatched between donor and recipient. It should be noted that sibling transplant donors matched for histocompatibility A, B and DR antigens are rarely identical with regard to blood group antigens. Antibodies suitable for flow cytometry should be of class IgG, and some blood group antigens, notably A and B, M and N, stimulate a predominantly IgM response. It must also be assumed that blood intended for transfusion to athletes shortly before a competition would be matched for at least the groups ABO and Rh(D).
We report here the results from preliminary trials of phenotyping packed red cell samples, some of which were deliberately spiked with 10% red cells from another donor matched only for ABO and Rh(D). These samples were intended to mimic blood doping through transfusion. Both series were tested blind, the first using a panel of 10 antibodies (Table 1), and the second a panel of 12 antibodies (Table 2). Cells were labeled for flow cytometry through use of a secondary antibody, a fluorescein-conjugated sheep anti-human immunoglobulin.
In the first series, 6 of the 7 spiked samples and the 3 unadulterated samples were correctly identified. One spiked sample was not detected, and on closer examination the mixed bloods were found to be identical except for expression of the antigen S, for which no antibody was available at the time of testing. For the second series, there was clear evidence for 7 spiked samples and 3 unadulterated samples.
The chance of two blood samples matched for ABO and Rh(D) being identical for the panel of 12 blood group antigens is less than 1:500, the probability based on the most common phenotypic frequency of each antigen in a Western European population. Other populations may have a very different antigenic pattern and require a modified panel for testing.
Flow cytometry appears to be a technique capable of detecting homologous transfusion with a high degree of sensitivity. False positive results do not appear to present a problem. The half-life of transfused red cells is about 55 days and blood samples are stable for some weeks if refrigerated at 4°C. The technology thus seems well suited for application as a test method to detect homologous blood doping even 2-3 weeks after infusion.