Floyd Landis doping case
The Floyd Landis doping case is a doping scandal that featured Floyd Landis, the initial winner of the 2006 Tour de France. After a meltdown in Stage 16, where he had lost ten minutes, Landis came back in Stage 17, riding solo and passing his whole team. However, a urine sample taken from Landis after his Stage 17 win has twice tested positive for banned synthetic testosterone as well as a ratio of testosterone to epitestosterone nearly three times the limit allowed by World Anti-Doping Agency rules; the International Cycling Union stripped him of his 2006 Tour title. Second place finisher Óscar Pereiro was declared the winner; the only previous Tour de France winner to be disqualified was 1904 Tour de France winner Maurice Garin. Landis was wearing the yellow jersey as leader of the general classification prior to Stage 16, but lost eight minutes and seemed finished. However, Landis spectacularly came back in Stage 17, winning the stage and cutting his deficit to leader Óscar Pereiro to half a minute.
Overtaking him after the Stage 19 time trial, Landis was celebrated as the winner of the 2006 Tour de France. On July 27, 2006, four days after the Tour had finished, the Phonak cycling team announced Landis had a urine test come back positive, having an unusually high ratio of the hormone testosterone to the hormone epitestosterone after his epic performance in Stage 17. Landis denied having placed faith in a test using his backup sample. Phonak stated that he would be dismissed should the backup sample test positive, it did, Landis was suspended from professional cycling and dismissed from his team. Landis's personal physician Arnie Baker disclosed that his test had found a T/E ratio of first 12:1 11:1, far above the maximum allowable ratio of 4:1; the test on Landis's Stage 17 A sample had been performed by the French government's anti-doping clinical laboratory, the National Laboratory for Doping Detection, a division of the Ministry of Youth and Social Life and accredited by the World Anti-Doping Agency.
The B sample confirmed the A sample, tested positive for an unnatural source of testosterone. Following the reported positive drug test on his A sample, Landis suggested that the results had been improperly released by the UCI. On August 9, 2006, UCI president Pat McQuaid rejected the claim. We informed the team, the rider, the federation that there had been an irregularity. We issued a press release saying that an unnamed rider had been found positive in the Tour. Landis's team published his name, two days later... I have full faith in that laboratory, there are stringent measures kept in place by the anti-doping agencies to ensure they proceed correctly."Landis has written a book titled Positively False, which contains his personal account of the case and in which he maintains his innocence. On May 14, 2007 an arbitration hearing began between the United States Anti-Doping Agency and Landis regarding the doping allegations. On September 20, the arbitrators found Landis guilty of doping. On August 1, 2006, The New York Times reported that, according to a UCI source, Landis's urine test had revealed synthetic testosterone in his body.
Despite this, Landis claimed his innocence, promising to "explain to the world why this is not a doping case, but a natural occurrence" and that the testosterone in his body was "natural and produced by my own organism." The variety of explanations offered up by Landis provided fodder for many skeptical columns by sports journalists and inspiration for comedians such as David Letterman, who presented the "Top 10 Floyd Landis Excuses" on his show. Several experts have refuted Landis's assertions. Landis at first blamed consumption of whisky for his unusual results, an approach, ridiculed. Prof. Christiane Ayotte, director of Montreal's anti-doping laboratory, said that, "In 25 years of experience of testing testosterone... such a huge increase in the level of testosterone cannot be expected to come from any natural factors." David Black, a forensic toxicologist for Nashville-based Aegis Sciences, said, "There are not hundreds of plausible explanations. If the tests were so unreliable that there were hundreds of possible reasons, there would be no point in performing the tests."
Landis backtracked from some of the assertions, saying, "The whisky idea was not mine and the dehydration was a theory from the lawyers I hired in Spain to represent me."On September 8, 2006, Landis's attorney announced that he would formally request that the case be dropped on the grounds that LNDD's 370-page report revealed inconsistencies in the way the samples were handled. Media reports said that synthetic testosterone had been detected in the A sample, using the carbon isotope ratio test, CIR, conducted at LNDD; the presence of synthetic testosterone means that some of the testosterone in Landis’s body came from an external source and was not produced by his own system. These results conflicted with Landis's public assertion; the CIR test is used to distinguish between testosterone produced by the athlete's body and synthetic testosterone introduced from an outside source. The test is performed by Isotope Ratio Mass Spectrometry. According to Gary I. Wadler, M. D. a member of the World Anti-Doping Agency, the carbon isotope ratio test needs to be done only once, on either an A or on a B sample if the athlete’s T/E ratio is high as in Landis's case.
It has been suggested that Landis may have been using testosterone over the long term but was either masking it or diluting it to avoid detection. The positive test result would therefore have been from a mistake with the alleged doping program on one day. Landis gave a total o
Stanozolol, sold under many brand names, is an androgen and anabolic steroid medication, derived from dihydrotestosterone. It was developed by American pharmaceutical company Winthrop Laboratories in 1962, has been approved by the U. S. Food and Drug Administration for human use, though it is no longer marketed in the USA, it is used in veterinary medicine. Stanozolol has been discontinued, remains available in only a few countries, it is given by injection into muscle in animals. Unlike most injectable AAS, stanozolol is not esterified and is sold as an aqueous suspension, or in oral tablet form; the drug has a high oral bioavailability, due to a C17α alkylation which allows the hormone to survive first-pass liver metabolism when ingested. It is because of this that stanozolol is sold in tablet form. Stanozolol is one of the AAS used as performance-enhancing drugs and is banned from use in sports competition under the auspices of the International Association of Athletics Federations and many other sporting bodies.
Additionally, stanozolol has been used in US horse racing. Stanazol has been used with some success in treated venous insufficiency, it stimulates blood fibrinolysis and has been evaluated for the treatment of the more advanced skin changes in venous disease such as lipodermatosclerosis. Several randomized trials noted improvement in the area of lipodermatosclerosis, reduced skin thickness, faster ulcer healing rates with stanozolol. Stanozolol is used for physique- and performance-enhancing purposes by competitive athletes and powerlifters. Side effects of stanozolol include virilization and others; as an AAS, stanozolol is an agonist of the androgen receptor to androgens like testosterone and DHT. Its affinity for the androgen receptor is about 22% of that of dihydrotestosterone. Stanozolol is not a substrate for 5α-reductase as it is 5α-reduced, so is not potentiated in so-called "androgenic" tissues like the skin, hair follicles, prostate gland; this results in a greater ratio of anabolic to androgenic activity compared to testosterone.
In addition, due to its 5α-reduced nature, stanozolol is non-aromatizable, hence has no propensity for producing estrogenic effects such as gynecomastia or fluid retention. Stanozolol does not possess any progestogenic activity of significance; because of the presence of its 17α-methyl group, the metabolism of stanozolol is sterically hindered, resulting in it being orally active, although hepatotoxic. Stanozolol has high oral bioavailability, due to the presence of its C17α alkyl group and the resistance to gastrointestinal and liver metabolism that it results in; the medication has low affinity for human serum sex hormone-binding globulin, about 5% of that of testosterone and 1% of that of DHT. Stanozolol is metabolized in the liver becoming glucuronide and sulfate conjugates, its biological half-life is reported to be 9 hours when taken by mouth and 24 hours when given by intramuscular injection in the form of an aqueous suspension. It is said to have a duration of action of more via intramuscular injection.
Stanozolol known as 17α-methyl-2'H-androst-2-enopyrazol-17β-ol, is a synthetic 17α-alkylated androstane steroid and a derivative of 5α-dihydrotestosterone with a methyl group at the C17α position and a pyrazole ring attached to the A ring of the steroid nucleus. Chemical syntheses of stanozolol have been published. Stanozolol is subject to extensive hepatic biotransformation by a variety of enzymatic pathways; the primary metabolites are unique to stanozolol and are detectable in the urine for up to 10 days after a single 5–10 mg oral dose. Methods for detection in urine specimens involve gas chromatography-mass spectrometry or liquid chromatography-mass spectrometry. In 1962, Stanozolol was brought to market in the US by Winthrop under the tradename "Winstrol" and in Europe by Winthrop's partner, under the name "Stromba". In 1962, the Kefauver Harris Amendment was passed, amending the Federal Food and Cosmetic Act to require drug manufacturers to provide proof of the effectiveness of their drugs before approval.
The FDA implemented its Drug Efficacy Study Implementation program to study and regulate drugs, including stanozolol, introduced prior to the amendment. The DESI program was intended to classify all pre-1962 drugs that were on the market as effective, ineffective, or needing further study; the FDA enlisted the National Research Council of the National Academy of Sciences to evaluate publications on relevant drugs under the DESI program. In June 1970 the FDA announced its conclusions on the effectiveness of certain AAS, including stanozolol, based on the NAS/NRC reports made under DESI; the drugs were classified as effective as adjunctive therapy in the treatment of senile and postmenopausal osteoporosis but only as an adjunct, in pituitary dwarfism, as lacking substantial evidence of effectiveness for several other indications. The FDA found a lack of efficacy for stanozolol as "an adjunct to promote body tissue-building processes and to reverse tissue-depleting processes in such conditions as malignant diseases and chronic nonmalignant diseases.
Doping in sport
In competitive sports, doping is the use of banned athletic performance-enhancing drugs by athletic competitors. The term doping is used by organizations that regulate sporting competitions; the use of drugs to enhance performance is considered unethical, therefore prohibited, by most international sports organizations, including the International Olympic Committee. Furthermore, athletes taking explicit measures to evade detection exacerbates the ethical violation with overt deception and cheating. Speaking, the origins of doping in sports go back to the creation of sport itself. From ancient usage of substances in chariot racing to more recent controversies in baseball and cycling, popular views among athletes have varied from country to country over the years; the general trend among authorities and sporting organizations over the past several decades has been to regulate the use of drugs in sport. The reasons for the ban are the health risks of performance-enhancing drugs, the equality of opportunity for athletes, the exemplary effect of drug-free sport for the public.
Anti-doping authorities state that using performance-enhancing drugs goes against the "spirit of sport". The use of drugs in sports goes back centuries, about all the way back to the invention of the concept of sports. In ancient times, when the fittest of a nation were selected as athletes or combatants, they were fed diets and given treatments considered beneficial to help increase muscle. For instance, Scandinavian mythology says Berserkers could drink a mixture called "butotens", to increase their physical power at the risk of insanity. One theory is that the mixture was prepared from the Amanita muscaria mushroom, though this has been disputed; the ancient Olympics in Greece have been alleged to have had forms of doping. In ancient Rome, where chariot racing had become a huge part of their culture, athletes drank herbal infusions to strengthen them before chariot races. More a participant in an endurance walking race in Britain, Abraham Wood, said in 1807 that he had used laudanum to keep him awake for 24 hours while competing against Robert Barclay Allardyce.
By April 1877, walking races had stretched to 500 miles and the following year at the Agricultural Hall in Islington, London, to 520 miles. The Illustrated London News chided: It may be an advantage to know that a man can travel 520 miles in 138 hours, manage to live through a week with an infinitesimal amount of rest, though we fail to perceive that anyone could be placed in a position where his ability in this respect would be of any use to him what is to be gained by a constant repetition of the fact; the event proved popular, with 20,000 spectators attending each day. Encouraged, the promoters soon held similar races for cyclists. "...and much more to endure their miseries publicly. That's much more fun"; the fascination with six-day bicycle races spread across the Atlantic and the same appeal brought in the crowds in America as well. And the more spectators paid at the gate, the higher the prizes could be and the greater was the incentive of riders to stay awake—or be kept awake—to ride the greatest distance.
Their exhaustion was countered by helpers akin to seconds in boxing. Among the treatments they supplied was nitroglycerine, a drug used to stimulate the heart after cardiac attacks and, credited with improving riders' breathing. Riders suffered hallucinations from the exhaustion and the drugs; the American champion Major Taylor refused to continue the New York race, saying: "I cannot go on with safety, for there is a man chasing me around the ring with a knife in his hand."Public reaction turned against such trials, whether individual races or in teams of two. One report said: An athletic contest in which the participants'go queer' in their heads, strain their powers until their faces become hideous with the tortures that rack them, is not sport, it is brutality, it appears from the reports of this singular performance that some of the bicycle riders have become temporarily insane during the contest... Days and weeks of recuperation will be needed to put the racers in condition, it is that some of them will never recover from the strain.
The father of anabolic steroids in the United States was John Ziegler, a physician for the U. S. weightlifting team in the mid-20th century. In 1954, on his tour to Vienna with his team for the world championship, Ziegler learned from his Russian colleague that the Soviet weightlifting team's success was due to their use of testosterone as a performance-enhancing drug. Deciding that U. S. athletes needed chemical assistance to remain competitive, Ziegler worked with the CIBA Pharmaceutical Company to develop an oral anabolic steroid. This resulted in the creation of methandrostenolone, which appeared on the market in 1960. During the Olympics that year, the Danish cyclist Knud Enemark Jensen collapsed and died while competing in the 100-kilometer race. An autopsy revealed the presence of amphetamines and a drug called nicotinyl tartrate in his system; the American specialist in doping, Max M. Novich, wrote: "Trainers of the old school who supplied treatments which had cocaine as their base declared with assurance that a rider tired by a six-day race would get his second breath after absorbing these mixtures."
John Hoberman, a professor at the University of Texas in Austin, said six-day races were "de facto experiments investigating the physiology of stress as well as the substances that might all
Doping in the United States
Doping, or the use of restricted performance-enhancing drugs in the United States has a systemic nature, most notably in the sports of baseball and football. Restrictions regarding drug use like synthetic hormones by athletes for enhanced performance in competition did not come around until the 20th century; the International Olympic Committee established its initial list of prohibited substances in 1967 and introduced the first drug tests at the France and Mexico Olympic games in 1968. Thirty years the World Anti-Doping Agency was founded. WADA was founded at a time when individual governments, sport federations, the IOC all had differing definitions and sanctions for doping. WADA bridged these differences by setting unified anti-doping standards and coordinating the efforts of sports organizations and public authorities worldwide; the United States, a WADA Foundation Board Member, followed suit by establishing the United States Anti-Doping Agency in 2000. USADA is recognized by the United States Congress as the official anti-doping agency for Olympic, Pan American and Paralympic sport in the United States.
The agency has adjudication powers and abides by WADA’s World Anti-Doping Code, which provides the global framework for anti-doping policies and regulations. Doping in sports is defined as using a prohibited / banned substance; as of December 19, 2008, the Code banned 192 performance-enhancing drugs and methods. Similar to the definitional disputes the international community faced in the 1990s, national professional sports leagues in the U. S. approach anti-doping policy differently and independently of U. S. government regulation, WADA guidelines, one another. They do not have the same list of banned substances or tests they require players to abide by, may not provide tests or sanctions for use of some prohibited substances, negotiate their anti-doping policies with their respective players associations through collective bargaining. In 2005, the United States House Committee on Oversight and Government Reform took an active interest on anti-drug policies in professional sports by opening an investigation into the matter following heightened media activity on steroid use in Major League Baseball.
The use, distribution, dispensing, or selling of steroids is a punishable federal offense under the Controlled Substances Act which, in addition to steroids, lists other performance-enhancing drugs and substances as Schedule III drugs. A series of hearings were held, most notably with MLB, the National Football League, the National Basketball Association; each league’s anti-drug policy was compared to that of the IOC, each fell short of the IOC requirements. Response to the congressional investigation by sports league representatives resulted with push back and a “we can police our own” mentality, but the Committee felt differently and introduced the Clean Sports Act—one of six bills introduced that year in both chambers —addressing the need to adopt uniform national anti-drug policy standards among professional sports leagues that are consistent with, as stringent as, those enforced by the USADA. While most of the bills were voted out of committee, none were enacted; as of 2013, professional sports leagues continue to negotiate their anti-doping policies through collective bargaining.
United States has had 8 Olympic medals stripped for doping violations. In all cases, the US government or the United States Olympic Committee had nothing to do with it, sanctioned athletes acted on their own. In the case of Rick DeMont, the United States Olympic Committee has recognized his gold medal performance in the 1972 Summer Olympics in 2001, but only the IOC has the power to restore his medal, it has as of 2017 refused to do so. DeMont won the gold medal in 4:00.26. Following the race, the International Olympic Committee stripped him of his gold medal after his post-race urinalysis tested positive for traces of the banned substance ephedrine contained in his prescription asthma medication, Marax; the positive test following the 400-meter freestyle final deprived him of a chance at multiple medals, as he was not permitted to swim in any other events at the 1972 Olympics, including the 1,500-meter freestyle for which he was the then-current world record-holder. Before the Olympics, DeMont had properly declared his asthma medications on his medical disclosure forms, but the U.
S. Olympic Committee had not cleared them with the IOC's medical committee. NCAA banned substances Drugs of abuse: In December 2007 George Mitchell released Report to the Commissioner of Baseball of an Independent Investigation into the Illegal Use of Steroids and Other Performance Enhancing Substances by Players in Major League Baseball. Major League Baseball asked Mitchell to conduct an independent investigation to see how bad steroid use was in baseball. In the report Mitchell covers many topics and he interviewed over 700 witnesses, he covers the effects of steroids on the human body. He touches on human growth hormone effects, he reports on baseball's drug testing policies before 2002 and the newer policies after 2002. Mitchell named 86 players in the report that had some kind of connection to steroids. Among those named were: Andy Pettitte, Roger Clemens, Barry Bonds, Eric Gagne, and to finish his report he made suggestions to the commissioner of baseball about drug testing and violations of t
Doping in auto racing
Some racing drivers have used doping in auto racing to enhance their performance. Deemed unsafe and illegal by the Fédération Internationale de l'Automobile. Appendix A to the International Sporting Code determines which substances are banned and mandates penalties; the Appendix regarding doping in auto racing was added on 1 December 2010 after consultation with the World Anti-Doping Agency. The regulations apply to all FIA and national sanctioned events; the FIA adopts the banned substance list issued by WADA. The FIA has added beta blockers to the list; the FIA will test at random from a pre determined pool of drivers. The national sanctioning body will test a number of athletes during their events. In case of a positive doping test, the driver in question will be disqualified, have his/hers results forfeited and has to return all their winnings. In case of negligence by the driver will only be disqualified for the event on hand. In case of a second violation the driver will be banned from the sport for six months.
More severe penalties could be imposed, depending on the circumstances. The driver has to pay back price money won. A fine of up to € 15.000 can be imposed. Since the series inception in 1996, INDYCAR has a substance abuse policy in place; the policy is applied to all series sanctioned by INDYCAR the IndyCar Series, Indy Lights, Pro Mazda, USF2000 and Global MX-5 Cup. Drivers and officials can be subjected to testing; the INDYCAR organisation can subject subjects to test at random. INDYCAR may require a drug test in events of'reasonable suspicion'. Reasonable suspicion includes, but is not limited to, violent temper or an accident during the event; when a driver is tested positive for performance enhancing drugs the driver will be suspended for one year. A fine of $5.000 wil be imposed. With a non-PED positive test the driver will be suspended for no less than sixty days. A fine of $2.500 wil be imposed. In the case of multiple violations the driver will be penalized again; the height of the penalty will be determined by the specific circumstances.
The driver may return to competition after medical evaluation. NASCAR has its own anti doping regulations; the substance abuse policy was first implemented in the late 1980s. Flaws in the systems allowed drivers to continue to use banned substances. One notorious case was that of Aaron Fike. After being arrested for heroin possession, Fike admitted using black tar heroin during race weekends. In 2009, Jeremy Mayfield failed a drug test for methamphetamine with his stepmother declaring Mayfield has used meth as early as 1998. After sitting out the initial penalty, Mayfield tested positive again. Mayfield could return to NASCAR competition after completing the Road to Recovery; the driver however has questioned the credibility of the testing laboratory recognized by NASCAR. Following the case of Fike and the case of Mayfield, the policy was overhauled. A. J. Allmendinger was one of the first big name drivers failing a drug test. Allmendinger tested positive for Adderall. Allmendinger was suspended, fired by team owner Roger Penske, returned to competition 2,5 months.
Because of the nature of the NASCAR garage and crew members can be tested by the organisation because performance enhancing drugs can be abused by crew members. Crew chief Todd Parrott, for driver Aric Almirola, tested positive for an'undisclosed substance'; the NASCAR policy is consistent with the FIA's policy. In 2018 28-year old Spencer Gallagher won his first NASCAR Xfinity Series race on 28th of April. On May 1st Gallagher failed the drug test. Gallagher was suspended indefinitely and agreed to join the Road to Recovery program.n After testing positive for a banned substance, the person in question is suspended indefinitely. To return to competition the person needs to complete the NASCAR Road to Recovery and have a Road to Recovery Plan approved; the plan includes treatment, rehabilitation and other measures necessary to prevent repetition. The United States Auto Club has implemented a substance abuse policy since 2008. USAC has a self determined list of banned substances, with the exclusion of prescription medication.
The policy states. The policy states a list of symptoms for drug and/or alcohol use. USAC has the right to test at random. With a positive drug or alcohol test the USAC Director of Competition may suspend the driver indefinitely. After the failure of a drug test, the driver can return to competition after a negative drug test after the suspension period. After a failed alcohol test, the driver only has to sit out the suspended period. In both cases the driver will be subjected to more frequent tests in the future; the World Racing Group, sanctioning body of the World of Outlaws and DIRTcar series, started testing the sprint car and late model series drivers in 2017. Drivers will only be tested through urinalysis; the random selection process will take place on the day of the event, treating full season drivers and parttime drivers equally. After a positive test, the driver will be banned from competition. After three failed tests the driver can only return to competition after two negative tests and approval from World Racing Group.
Justin Ratliff was the first driver hit with a penalty. Ratliff refused a drug test after the 2017 DIRTcar Nationals at Volusia Speedway Park in February; because of the refusal Ratliff was fined in accordance of the first offense with a 90 day suspension. In June 2017, Brian Lay tested positive after the World of Outlaws event at Eldora Speedway. He
Blood doping is the practice of boosting the number of red blood cells in the bloodstream in order to enhance athletic performance. Because such blood cells carry oxygen from the lungs to the muscles, a higher concentration in the blood can improve an athlete’s aerobic capacity and endurance. Many methods of blood doping are illegal in professional sports. Blood doping is defined as the use of illicit products and methods in order to enhance the O2 transport of the body to the muscles; the body undergoes aerobic respiration in order to provide sufficient delivery of O2 to the exercising skeletal muscles and the main determining factors are shown in figure 1. The rate of maximum O2 uptake depends on O2 extraction and hemoglobin mass; the cardiac output of an athlete is difficult to manipulate during competitions and the distribution of cardiac output is at the maximum rate during competitions. In addition, the O2 extraction is 90% at maximal exercise. Therefore, the only method to enhance the physical performance left is to increase the O2 content in the artery by enhancing the hemoglobin mass.
In other words, hemoglobin concentration and blood volume contribute to hemoglobin mass. Many forms of blood doping stem from the misuse of pharmaceuticals; these drug treatments have been created for clinical use to increase the oxygen delivery when the human body is not able to do so naturally. Erythropoietin is a glycoprotein hormone produced by the interstitial fibroblasts in the kidney that signal for erythropoiesis in bone marrow; the increased activity of a Hemocytoblast allows the blood to have a greater carrying capacity for oxygen. EPO was first developed to counteract the effects of chemotherapy and radiation therapy for cancer patients. EPO stimulates increased wound healing; because of its physiological side effects increased hematocrit, EPO has become a drug with abuse potential by professional and amateur cyclists. Hypoxia-inducible factor stabilizer is a pharmaceutical used to treat chronic kidney disease. Like most transcription factors, the HIF transcription factor is responsible for the expression of a protein.
The HIF stabilizer activates the activity of EPO due to anemia induced hypoxia, metabolic stress, vasculogenesis—the creation of new blood vessels. HIF stabilizers as used by cyclists in combination with cobalt chloride/desferrioxamine stimulate and de-regulate the natural production of erythropoietin hormone. At physiologically low PaO2 around 40 mmHg, EPO is released from the kidneys to increase hemoglobin transportation; the combination of drugs releases EPO due to increased transcription at the cellular level. The effect wears off when the HIF stabilizers, cobalt chloride/desferrioxamine is excreted and/or decayed by the body. Myo-inositol trispyrophosphate known as compound number OXY111A, is an allosteric effector of hemoglobin which causes a rightward shift in the oxygen–hemoglobin dissociation curve, increasing the amount of oxygen released from red blood cells into surrounding tissue during each passage through the cardiovascular system. ITPP has been a subject of anti-doping research in both racehorses.
Blood transfusions can be traditionally classified as autologous, where the blood donor and transfusion recipient are the same, or as allogeneic/homologous, where the blood is transfused into someone other than the donor. Blood transfusion begins by the withdrawal of 1 to 4 units of blood several weeks before competition; the blood is centrifuged, the plasma components are reinfused, the corpuscular elements, principally red blood cells, are stored refrigerated at 4 °C or frozen at −80 °C. As blood stored by refrigeration displays a steady decline in the number of RBCs, a substantial percentage, up to 40%, of the stored RBCs may not be viable; the freezing process, limits the aging of the cells, allowing the storage of the blood for up to 10 years with a 10% to 15% loss of RBCs. Stored RBCs are reinfused 1 to 7 days before a high-endurance event; as a significant amount of iron is removed by each autologous transfusion, an adequate time for recovery of not less than 3 days from the last donation, appropriate iron supplements, are required for patients undergoing autologous donations.
Nearly 50% of autologous donations are not used by the donor and are discarded, as current standards do not allow transfusion of these units to another patient for safety reasons. Biochemical and biotechnological development has allowed novel approaches to this issue, in the form of engineered O2 carriers known as “blood substitutes.” The blood substitutes available are chiefly polymerized haemoglobin solutions or haemoglobin-based oxygen carriers and perfluorocarbons. Hemoglobin-based oxygen carriers are intra/ inter-molecularly engineered human or animal hemoglobins, only optimized for oxygen delivery and longer intravascular circulation; the presence of 2,3-diphosphoglycerate within erythrocytes maintains the normal affinity of hemoglobin for oxygen. HBOCs do not contain erythrocytes and lose this interaction, unmodified human HBOC solutions have a high oxygen affinity which compromises their function. Chemical methods developed to overcome this problem have resulted in carriers that release oxygen at the physiological pO2 of peripheral tissues.
A common feature of all HBOCs is their resistance to dissociate when dissolved in media, which contrasts hemoglobin of natural dissociation under non-physiological conditions