Blood doping boosts athletic performance by increasing the number of red blood cells in the bloodstream.

Blood doping is commonly associated with endurance sports such as cycling, distance running, and cross-country skiing. While it may offer temporary performance advantages, it raises serious health concerns.

Red blood cells carry oxygen from your lungs to your muscles and organs. The more red blood cells you have, the more oxygen your body can deliver to working muscles.

Enhanced oxygen delivery allows your muscles to work more efficiently for longer periods. This means you can maintain a higher level of performance without experiencing fatigue as quickly.

In endurance sports, oxygen delivery is a limiting factor in performance. By artificially boosting red blood cell levels, you can improve your maximal oxygen uptake (VO₂ max), which is a key indicator of aerobic endurance.

For elite athletes, even a small increase in VO₂ max can translate into significant improvements in race times or training output.

There are several methods used to carry out blood doping, including:

Autologous transfusion

Autologous blood doping (ABD) uses autologous blood transfusion (ABT) to increase your red blood cell count.

It involves drawing your own blood weeks or months before competition, storing it, and then re-infusing it back into your body before the event. Using your own blood makes it harder to detect.

Homologous transfusion

Homologous blood doping uses homologous blood transfusion (HBT) to increase your red blood cell count.

This method requires blood from a compatible donor. The donor’s blood, matched for blood type, is transfused into your system to boost red blood cell levels. This approach carries a higher risk of detection and complications.

Erythropoietin (EPO) injection

EPO is a hormone produced by your kidneys that stimulates red blood cell production. Synthetic EPO can be injected to artificially boost red blood cell production.

This method became widely known through scandals in professional cycling and other endurance sports.

Synthetic oxygen carrier injection

These are chemical substitutes for red blood cells, such as hemoglobin-based oxygen carriers (HBOCs) or perfluorocarbons. They aren’t as commonly used due to their associated health risks and limited availability.

Increasing your red blood cell count thickens your blood, which makes it harder for your heart to pump. This can lead to:

Sterility and proper storage of blood are critical in transfusion-based methods. Contamination can lead to infections and sepsis.

Detecting blood doping has become more effective in recent years. Current techniques include:

  • Athlete Biological Passport (ABP): The ABP is a monitoring tool used to track changes in your blood values over time. It doesn’t detect substances directly but looks for unusual fluctuations that suggest doping.
  • Direct detection: Tests can identify synthetic EPO or detect differences in cell surface proteins that indicate the presence of homologous blood.
  • Advanced hematology testing: Techniques such as flow cytometry and mass spectrometry help identify unnatural patterns in blood composition.

Blood doping is banned by the World Anti-Doping Agency (WADA) and most international and national sports organizations. Many athletes and organizations view it as a form of cheating, regardless of the method used.

If you’re an athlete and are found to be using blood doping methods, you face serious consequences, including:

  • Suspension or disqualification
  • Stripped titles or records
  • Fines and bans from competition
  • Permanent damage to your reputation

In professional sports, anti-doping policies are strictly enforced. Testing can occur in or out of competition, and refusal to submit to a test is treated the same as a positive result.

The methods used to enhance red blood cell counts can lead to severe medical complications and are increasingly detectable through advanced anti-doping technologies.

Blood doping violates the rules of nearly every athletic governing body. If you’re serious about your sport, pursuing natural training, proper recovery, and legal performance strategies is the safest and most sustainable path forward.