Hepcidin and Erythroferrone Complement the Athlete Biological Passport in the Detection of Autologous Blood Transfusion

Purpose: We investigated whether hepcidin and erythroferrone (ERFE) could complement the athlete biological passport (ABP) in indirectly detecting a 130-mL packed red blood cells (RBC) autologous blood transfusion. Endurance performance was evaluated. Methods: Forty-eight healthy men (n = 24) and women (n = 24) participated. Baseline samples were collected weekly followed by randomization to a blood transfusion (BT, n= 24) or control group (CON, n= 24). Only the BT group donated 450 mL whole blood from which 130 mL red blood cell was reinfused 4 wk later. Blood samples were collected 3, 7, 14, 21, and 28 d after donation, and 3, 6, and 24 h and 2, 3, and 6 d after reinfusion. In the CON group samples were collected with the same frequency. Endurance performance was evaluated by a 650-kCal time trial (n = 13) before and 1 and 6 d after reinfusion. Results: A time-treatment effect existed (P < 0.05) for hepcidin and ERFE. Hepcidin was increased (P < 0.01) similar to 110 and 89% 6 and 24 h after reinfusion. Using an individual approach (99% specificity, e.g., allowing similar to 100 false-positive), sensitivities, i.e., true positives, of 30% and 61% was found for hepcidin and ERFE, respectively. For the ABP, the most sensitive marker was Off-hr score ([Hb] (g.L-1) - 60 x root RET%) (P < 0.05) with a maximal sensitivity of similar to 58% and similar to 9% after donation and reinfusion, respectively. Combining the findings for hepcidin, ERFE, and the ABP yielded a sensitivity across all time-points of 83% after reinfusion in BT. Endurance performance increased 24 h (+6.4%, P < 0.01) and 6 d after reinfusion (+5.8%, P < 0.01). Conclusions: Hepcidin and ERFE may serve as biomarkers in an antidoping context after an ergogenic, small-volume blood transfusion.

Automated summary

This study examined the use of hepcidin and erythroferrone (ERFE) as biomarkers for indirectly detecting autologous blood transfusion. The results showed that hepcidin and ERFE could complement the athlete biological passport (ABP) in detecting blood transfusion. Besides, the endurance performance of the participants improved after the transfusion.