By Robin Parisotto
Michele Ferrari: The value of Hemoglobin=13.0 was taken the last day of the Giro, dated May 31, 2009, preceded by a Hemoglobin=13.6 dated 18/05/2009 and a Hemoglobin=14.8 at the start of the Italian race (May 7, 2009), a decrease of 12.2% (from 14.8 to 13.0) fully compatible with what is reported in the literature with regards to cyclists involved in stage races (Int J Sports Med 2009, 30:130-138): Hemoglobin decreases by an average of 11.5% from the beginning to the end of the event, with individual drops ranging between 7% and 20.5%.
This reduction is mainly due to an increase in PLASMA VOLUME and it is therefore normal for reticulocytes not to have increased...
Robin Parisotto: It is interesting that during the Giro there was a volume shift of 11.5% but not during the Tour, arguably a much more arduous race. In the Tour, Lance Armstrong’s Hemoglobin actually increased from 142 to 145 during the course of the race. While this represents only a 2% increase, it is a long way from the 11.5 and up to 20% decrease in Hemoglobin, typical of long races as proclaimed by Ferrari. You cannot have it both ways. Others have also made the same conclusions.
MF: The values of Hemoglobin=16.0 in the samples reported as numbers 14 and 15 were collected on two consecutive days (June 16, 2009 and June 17, 2009) at altitude.
RP: From the Cyclingnews article (see below) it is indicated that Armstrong had spent time at altitude between the low Hemoglobin value and the high Hemoglobin values, but it is unknown to me if the tests (conducted by the UCI) were while he ‘was’ at altitude as Ferrari has claimed. If these tests were conducted after returning from altitude then they are comparable to the Hemoglobin value of 16.1 when Lance Armstrong was tested at altitude on August 12, 2009 (I did not have this data point in the data set initially evaluated). It would be unusual for both of the tests in June to have been done while at altitude however. The Biological Passport is informed by data collected at different times, different places and different conditions in order to assess any influence that factors such as altitude exposure could have on the profile. This can only be done if you have other reference points such as tests performed at or near sea-level.
According to the Cycling News article, the blood samples show major fluctuations in his hematocrit ratio. For example, it said, his hematocrit on May 31 2009, was 38.2% but 45.7% only a few weeks later, on June 16.
Cycling News excerpt: It is expected that Armstrong will challenge this evidence “by summoning medical experts who may say that a person's hematocrit score could conceivably jump 7.5 percentage points in 16 days because of external influences like changes in altitude and heavy perspiration.” For example, he was in
, Aspen Colorado, USA, at
nearly 8000 feet above sea level
between the two above-mentioned tests.
MF: The Athletes Hematological Passport Interpretation Technical Document (2.09) recommends the adoption of correction factors in Hemoglobin values for athletes who reside in or have stayed at altitude in the two weeks prior to collection. For altitudes between 2000 and 2500m the correction factor is 0.8: therefore Hemoglobin=16.0 becomes 15.2. This value is perfectly in line with the results of the ten samples taken out of competition from October 15, 08 to April 30, 2009, which show an average value of Hb=14.8.
RP: If the values that were posted on the Lance Armstrong website were those of official tests the correction factor of 0.8 would have been applied if the Doping Control Form indicated that Lance Armstrong was at or had been at altitude. Therefore based on Ferrari’s view the actual Hemoglobin value was 16.8 and not 16.0. In any case, if the true (official) Hemoglobin value was 15.2 then surely Lance Armstrong would have posted that value rather than the higher value. I cannot think of a reason why an official anti-doping test would consist of ‘two’ results ie. one for the athlete and another for the Passport evaluation.
MF: The same Hemoglobin Z-score for samples 14 and 15 is equal to 0.75, when altitude is correctly taken into account. I remind you that this parameter is indicative of suspicion of doping when it is >3.19 (a value that corresponds to a 99.9% probability).
RP: This is unapplicable information as the Z-score is not utilized in the Biological Passport. The OFF-score, a formula based on Hemoglobin and reticulocytes values is used. Irrespective the passport does not just look at a single parameter and how abnormal it is or not but rather the pattern, the magnitude of changes of the four parameters involved and at what times they are occurring (in-competition, out-of-competition or pre-competition). This helps to form a picture by which an evaluation can be made.
MF: The values at altitude of Hemoglobin=16.0 in June 2009 are further confirmed by the sample taken on 12/08/2009, always collected in Aspen, with Hemoglobin=16.1; a value that Parisotto refrained from showing, but that can easily be found in the same source quoted by the Australian author (Cyclingnews.com, July 13, 2012), along with 37 other blood samples reported by USADA.
RP: The data I referenced did not contain any of this information. As part of the Biological Passport process this information only becomes available after an initial evaluation is conducted and where there is suspicion that would require the availability of such information to help guide a final conclusion/recommendation. My opinion was formed in the context of an initial evaluation.
The other point is that there is no explanation why the reticulocyte values associated with the two high Hemoglobin values (allegedly due to altitude exposure) have decreased when the Hemoglobin is increasing. Whether you are at altitude or not if you are making more Hemoglobin (therefore more red blood cells) then it is intuitive that you should have more young red blood cells (reticulocytes), not less. I mean that is the point of altitude exposure in the first place, ie. to accelerate and increase, NOT decelerate and decrease your red blood cell production.