Claudia Pechstein Part 1 - Facts. Blood Counts of the years 2000 to 2009 as Determined at the Doping Controls

Transcription

1 )-2-! ( *+)-2-7" ( 8. 9 : 2 *- : 2 *; < -2 < 24. August 2010 Claudia Pechstein Part 1 - Facts Blood Counts of the years 2000 to 2009 as Determined at the Doping Controls Summary 2 1 Introduction 3 2 Methods 3 3 Comparison of blood counts determined at top events, at world cup races and during training phases 4 Instances of increased haemoglobin concentration greater than 1 g/dl within 2 months 5 What happens after high reticulocyte counts above 2.4%? 17 6 What were the reticulocyte counts one to three weeks before the highest haemoglobin values? 7 World Championship in Hamar Annex 1: Blood counts of the top event season Annex 2: Blood counts of the top event season Page Annex 3: Official blood counts of the ISU doping control system !"#$%&' ()**+ $,-./" / " " 3 42 $-

2 Summary Claudia Pechstein has been found guilty of blood doping on the basis of increased reticulocyte counts at the ISU World Championships in Hamar in I have evaluated the anti-doping blood tests of Claudia Pechstein organized by the International Skating Union since 2000 and come to the conclusion: The increased reticulocyte counts at the World Championships in Hamar in 2009 are not due to blood doping using an erythropoiesis stimulating agent (ESA). Arguments against doping are: Hamar 2009 The aim of blood doping is to increase haemoglobin concentration without exceeding the limit of 16.5 g/dl (for women). There has been no increase in hemoglobin level or hematocrit in the course of the season 2008/2009 and there has been no increase in both parameters during January and February Stimulating blood doping must start early enough to provide a sufficient rise of haemoglobin level. Since it is impossible to have a relevant rise of the haemoglobin level within six days, the suspected doping must have started prior to 30 th und 31 st of January - 6 and 7 days before the world championship in Hamar. At that time, Mrs. Pechstein had two doping tests which proved negative and the reticulocyte counts were in the normal range as defined by the ISU. 95 doping tests Hemoglobin levels, hematocrit calculations and reticulocyte counts were the same wherever Mrs. Pechstein s blood was analyzed from 2000 to There were no differences to be observed in blood taken during Olympic or world championchips compared to world cup competitions or compared to tests taken during training phases. There is no systematic increase in any hematologic parameter during the training and competitive season from September to March. There is no increase in haemoglobin during the last 40 days prior to a top event like Olympic Games. In conclusion, there is no evidence for doping aiming at manipulating blood for top events. Rising reticulocyte counts since the year 2000 without any increase of haemoglobin The reticulocyte count shows a rising trend during the observation period from the year 2000 to the year 2009, whereas the haemoglobin level shows an opposite trend. This phenomenon strongly argues for natural causes of the haematological phenomena. Retics/Haemoglobin Elevated reticulocyte counts were never followed by a relevant increase of haemoglobin, e.g., greater than 1 g/dl. Prior to the highest hemoglobin levels of Mrs. Pechstein above 15 g/dl no reticulocyte above the ISU-limit of 2.4% was measured during the doping controls MCHC Mrs. Pechstein had increased MCHC values and increased numbers of hyperchromic red cells at various occasions indicative of a red cell abnormality. 2

3 1 Introduction Claudia Pechstein has been found guilty of blood doping on the basis of increased reticulocyte counts at the ISU World Championships in Hamar in This paper is a description of attempts to find evidences of blood doping within the data provided by the antidoping authorities of the ISU using the blood counts determined since the year 2000 up to the year Reticulocytes are young red blood cells (erythrocytes) that need four days for maturing. They generally remain at their place of origin in the bone marrow for three days. Then, they migrate into the blood, where they take another day to become mature erythrocytes. They are thus a very sensitive parameter of the erythrocyte production of the last three to seven days. The normal range of the reticulocyte count is 0.5 to 1.8% in healthy subjects without any abnormality of the blood. However, the upper limit of normality is specified differently. The lowest specified limit is 1.4% according to the textbook by Prof. Thomas' Laboratory and Medicine. Other laboratories provide reference ranges up to a maximum of 2.5%. For the purpose of sport controls the limit was set by 2.4%. 2 Methods The Excel-table of Claudia Pechstein s blood counts provided by the ISU was used. The analysis was based on the hypothesis that any blood doper aims at obtaining best blood counts at top events like world championships and Olympic Games. European championships were not considered as top events and are included in the world cup series. In a separate analysis in which the European championships were counted as top events, the small differerences in blood counts between top events and other occasions were reduced. Any effort was undertaken to detect evidences of blood doping. This was done by analyzing Mrs. Pechstein s data in any reasonable way. The blood counts of all top events since the year 2000 were analyzed altogether in cumulative way. This method was used to get a chance to see small variations that might be indicative of blood doping. Small changes occurring repeatedly every year might be overlooked in case of looking at individual top events. In addition, any single top-event season was analyzed separately to search for blood doping used just for one top event season, e.g., 2006 or

4 3 Comparison of blood counts determined at top events, at world cup races and during training phases Overall results Every blood doper tries to increase his/her haemoglobin concentration especially for top events like Olympic Games and world championships. Thus the question arises whether blood counts of Mrs. Pechstein have been better at top events than at world cup races and during unannounced inspections during training phases. It must be noted that increases of the haemoglobin level due to training in high altitude are allowed. Higher haemoglobin levels at top events following training at high altitude would not be a proof of blood doping. As the following figure shows, no difference in blood counts were observed whether the blood was taken at top events, at world cup races and at training controls, at least as long as overall data are analyzed.! "#!"!$!"%& ' #!"%!# % (# %!"#% ) WM Olympia Weltcup EM Training 10 0 Hb-Wert Hämatokrit Retis in Promille 4

5 Detailed results: Reticulocytes show an upward trend over the 10 years, particularly apparent at top events whereas a slight decrease of haemoglobin values is apparent, especially at top events. Retikulocytes at top events, at world cups and during training phases Normal range ISU: up to 2.4% Top World cup Training 4.0 Retikulocytes % Haemoglobin concentration at top events, at world cups und during training phases Normal range 12 to 16.5 g/dl Top World cup Training 16.0 Haemoglobin

6 Haematocrit levels at top events, at world cups and during training phases. Normal range %; normal range ISU: bis 46% Top World cup Training 46 Haematocrit %

7 A closer look at day zero results Comparison of day zero blood counts taken at top events (day before the start of Olympic Games and before world championships) with blood counts analyzed at all other situations Haemoglobin Haemoglobin levels tend to decrease during endurance sports. Consequently, it might be that a doping effect will be overlooked if day-zero blood-counts and post-competition counts are lumped together. Therefore it seems appropriate to compare haemoglobin levels of day zero before the start of the world championships and Olympic Games with data obtained at world cup races and during training. Mrs. Pechstein s mean haemoglobin concentration was 14.8 g/dl at top events on day zero before the start of the competitions. This is 0.2 g/dl higher than the mean of the random checks during training and 0.3 g/dl higher than at world cup events and European championships. This could be an indication for artificially raised haemoglobin level at top events. That would basically be suspicious of doping. But it would be legal if this higher level of haemoglobin concentration was due to training at high altitude. When comparing day zero blood counts at top events and those of world cup competitions and those of training phases one would have to know whether the latter blood samples were taken under resting conditions like on day zero or under endurance conditions like postcompetition tests. They are probably a mixtum compositum. Consequently, it is expected that haemoglobin levels at top events do not significantly differ from those in training and at world cup events. 7

8 A closer look: How do the blood counts change in the months prior to top events? Mean blood counts Mean blood counts Next point is to analyze mean blood counts in the months prior to top events like world championships and Olympic Games. In case of blood-doping by Mrs. Pechstein one would expect raising haemoglobin levels with best values in February and March. The following figure shows no raising haemoglobin levels at top events and no specific Figure: Mean reticulocyte and hemoglobin values from 2000 to 2009 summarized monthly presented by starting in July to the World Championship/Olympic season in February and March (very few measurements in the months of July and August. Retikulozyten % WM - Olympia Monate Hämoglobin g/dl Monate

9 A closer look: How do the blood counts change in the months prior to top events? All blood counts Details The next two figures show all blood counts in relation to world championships and Olympic Games. World championships and Olympic Games take place during the months of February and March. This period is indicated in gray in the figures. The time course is indicated at the x-axis and 23.6 stands for 23 th of June of the 10 years that have been analyzed. The laboratory tests indicated at 15.3 and earlier have been obtained in years in which Mrs. Pechstein did not participate at world championships or after championships which took place in February. Figure: Haemoglobin concentrations and reticulocyte counts in relation to world championships and Olympic Games from 2000 to 2009 starting in February of the preceeding year after completion of the last top event 16,0 Hämoglobin g/dl 15,0 14,0 13,0 12, ,0 Retikulozyten % 3,0 2,0 1,0 0,

10 A closer look: The last 40 days prior to top events How do the blood counts change during the last 40 days prior to top events? The next question is what happened with the blood counts immediately before world championships and Olympic Games. Are there indications of blood doping. This analysis was done by combining all the top events of the years The results are shown in the following figures. The haemoglobin concentration does not show any increase during the last 40 days prior to the championships. The reticulocyte counts tend to increase during that period from 1.8% to 2.2%. After the competition there is a slight decrease from 2.2% to 1.8%. Figure: Haemoglobin concentrations and und reticulocyte counts prior to and at world championships and at Olympic Games starting at day minus 40 prior to each championship (the year 2000 was excluded since there were no doping tests during the training phases) Hb Reti

11 A closer look: The 40 days following top events How do the blood counts change after top events? Figure: Haemoglobin concentrations and und reticulocyte counts during and after world championships and at Olympic Games starting at day zero of each championship (the year 2000 was excluded since there were no doping tests during the training phases) Hb Reti

12 Official blood counts of the ISU doping control system Top events World cup events Controls during training phases Hb Hct Ret MCHC Hb Hct Ret MCHC Hb Hct Ret MCHC ics ics ics g/dl % % g/dl % % g/dl % % Limits , , ,

13 (13.7) (37.0) (3.4) Mittel

14 4 Instances of increased haemoglobin concentration greater than 1 g/dl within 2 months Six cases Six cases of an increasing haemoglobin concentration greater than 1 g/dl have been observed from 2000 to The first three cases of these have been mentioned by the judges of the CAS. Case 1 European Championship in Collabo: The CAS-judges quote that the haemoglobin level increased from 13,9 at Dezember14 th 2006 to 15,1 at January 11 th Haemo- Hemato- Retics globin crit g/dl % % Normal ,5-1,4 Advia 120 Range For athletes Limits ,4 Limits ISU Training EC Collabo This is no increase of the haemoglobin concentration. Instead of, this is a case of especially low level of haemoglobin on December 14 th. Case 2 The CAS-judges quote that the haemoglobin level increased from 14,3 at February 4 th to 16,1 g/dl at March 1 st In contrats to the judges statement, this is an increase from 15,1 g/dl to 16,1 g/dl, as can be depicted from the table just above. The lower haemoglobin level of February 4 th results from physiological haemodilution after endurance sports. I think blood doping is rather unlikely in this situation since this was no doping test at a world championship. Why should Mrs. Pechstein use ESAs like erythropoietin prior to the last world cup race of the season. 14

15 Case 3 European Championship in Heerenveen: The CAS-judges quote that the haemoglobin level increased from 13,9 at November 13 th to 15,3 g/dl at December 18 th Europ. Championship This is no relevant increase of the haemoglobin concentration. Instead of, this is a case of especially low level of haemoglobin on November 13 th. In addition, it does not seem rational to do blood doping for Christmas holidays and to go to the European Championship in Heerenveen with a low haemoglobin level. Hb increase January 6 th: haemoglobin 14.9 g/dl Febuary 6 th 16.5 g/dl Hb increase January 9 th haemoglobin 14.3 g/dl March 2 nd 15.4 g/dl Hb increase March 4 th haemoglobin 13.7 g/dl March 17 th 15.0 g/dl Details of No. 4 Increase No. 4 is the most dramatic one. However, three days later the haemoglobin concentration was determined at 13.8 g/dl in a postcompetition control. Hb Hct Retics MCHC EC Heerenveen WC Hamar WC Hamar Three explanations for increase number 4 are conceivable. One possibility would be using ESA-doping in January between the two blood tests. In this case, the decrease of the haemoglobin concentration three days later would have been managed by artificial blood loss. However, the blood was drawn after a race and Mrs. Pechstein won the silver medal of that world championship. I think It is difficult to become vice champion of the world after a double blood donation. The second option is a problem with the blood that had to be analyzed and that the result of the analysis was wrong. Option No. 3 is a particularly heavy loss of fluids beforehand by, for example, gastrointestinal infection or training without drinking. 15

16 Details of No. 5 Details of No. 6 Conclusion Case No. 5 is a borderline one. However, the increase was observed at a world championship and is particularly suspect because of this. Unfortunately, the next control was done only after three months. The "starting value" of case No.6 was particularly low, a week before he had a haemoglobin value of 14.8 g/dl, which is nearly identical to the incriminated higher concentration of 15,0 g/dl. Two suspicious looking haemoglobin increases have been observed in the observation period from 2000 to 2009: the increases number 4 and 5. 16

17 5 What happens after high reticulocyte counts above 2.4%? If ESA-Epo-doping was the reason for the elevated reticulocytes above the ISU limits, the hemoglobin should increase about 1 g/dl or more. That was never the case. In fact, the mean hemoglobin within the next four weeks after suspicious reticulocytes is lower (14.3 g/dl) than in all other occurrences (14.6 g/dl). The same applies for hematocrit. If the hemoglobin tends to be lower within one month after high reticulocyte values, this it doesn t apply to the doping theory. On the contrary, this situation looks more like subclinical hemolytic constellation, which usually isn t noticed. Hemoglobin values at the time of high reticulocytes and during the next 2-4 weeks. No hemoglobin determinations evailable after episodes 2, 3, 5, and 9 Hb at high retics Hb 2-4 weeks thereafter Hemoglobin g/dl Number of episode 17

18 Table: Episodes of high reticulocyte counts above the limit of 2.4% as defined by the ISU Episode Reticulocytes % Haemoglobin g/dl No No No counts No No counts No No No counts No No No No No counts No

19 6 What about the reticulocyte counts one to three weeks before the highest haemoglobin values? The next question was: What were the reticulocyte counts one to three weeks before the highest haemoglobin values? If the highest haemoglobin values of the Athlete were a sign of ESAepo doping, high reticulocytes before this time might show this. This, of course, is not mandatory. A low-dosed constant therapy with epo wouldn t necessairily lead to high reticulocytes (see also Prof. Dr. Jelkmann). Before high hemoglobin values the reticulocytes were always between 1.3 and 2.3%, the mean value is 1.8%. This is below the mean value in other situations (2.0%). 4 Reticulocyte counts 1-3 weeks prior to 12 episodes of relatively high hemoglobin levels above 15 g/dl - no reticulocyte counts available prior to episodes 1,3, 6, 7, and 8 Reticulocytes % Episode nr 19

20 Table: Episodes with haemoglobin concentrations above 15 g/dl (ISU-limit 16.5 gdl). Reticulocyte counts are are lower prior to high haemoglobin concentrations over 15 g/dl. Episode Reticulocytes % Haemoglobin g/dl No prior blood test available No No No prior blood test available No No No No prior blood test available No No prior blood test available No No prior blood test available No No No No No

21 7 World Championship in Hamar 2009 Prior to Hamar Hamar After Hamar Mrs. Pechstein had five doping controls including determination of the blood counts in January 2009, the month prior to the World Championship of Hamar. The first three controls were performed at the European Championships in Heerenveen during the second week of January. Further checks were done at a world cup event on January 30 th and 31 st. The first doping test at the Hamar championship was done on February 6 th and showed a very high reticulocyte count of 3.5%. This count was confirmed at the following day immediately after a 3000m race. A few days later, on February 18 th, another blood test was done showing a reticulocyte count of 1.37% without a rise of haemoglobin concentration. The following table and the corresponding figure show that there was no increase of haemoglobin concentration and of haematocrit during January In addition, they show no haematology profile of ESA doping aiming at good blood counts for the Hamar championship. Optimizing blood volume and haemoglobin concentration for Hamar would have required high reticulocytes one (and two) weeks prior to that event. Normal ranges according to the text book Labor und Medizin of Prof. Dr. Lothar Thomas 7. Auflage 2008 Haemo- Haemato- Reticuloglobin crit cytes g/dl % % Normal ,5-1,4 range Normal for athletes Limits ,4 Limits of the ISU Europ. Championship Europ. Championship Europ. Championship World Championship World Championship World Championship

22 50 Blood counts December 2008 bis Februar 2009 Haemoglobin (g/dl), Haematocrit (%), Retics (per erys) Hb Hct Reti Prof. Dr. med. Winfried Gassmann. 22

23 Annex 1: Blood counts of the top event season 2006: Olympic Games in Turino, World Championship in Calgary (very few doping tests in the years before prior to top events making analyses like the following impossible). Hb Hct Haematocrit % Reti

24 Annex 2: Blood counts of the top event season 2008: World Championships in Berlin and Nagano (no participation in a top event in 2007) Hb 16,0 14,0 12, Hkt Hkt Reti 4,0 3,0 2,0 1,0 0,

25 Annex 3 Official blood counts of the ISU doping control system Hb Hct Retics MCHC Medals g/dl % % Normal Text book of Lothar Thomas Labor und Medizin range Normal range ofrathletes Limits of ISU ,4 0,6-2,2 Pentra 120 0,6-1,8 Gen-S 0,4-1,6 SE ,6-2,4 CD ,5-1,4 Advia / WC Milwaukee (Combined) WC Milwaukee (Combined) WC Milwaukee (Combined) WC Nagano (Einzel) WC Nagano (Einzel) WC Nagano (Einzel) * } 1x Gold } 2x Gold, 1x Silver WC Salt Lake City (Einzel) 1x Silver, 1x Bronce Olympic Games Salt Lake City Olympic Games Salt Lake City Olympic Games Salt Lake City Olympic Games Salt Lake City } 2x Gold EC Heerenveen (Combined) EC Heerenveen (Combined) } 1x Silver Training WC Göteburg (Combined) WC Göteburg (Combined) } 1x Silver WC Göteburg (Combined) Training 25

26 Training Training EC Heerenveen (Combined) 1x Silver WC Hamar (Combined) WC Hamar (Combined) } 1x Silver Training Training Training Training EC Heerenveen (Combined) EC Heerenveen (Combined) } 1x Bronce WC Inzell (Einzel) 2x Silver Training Training Training EC Hamar (Combined) EC Hamar (Combined) } 1x Gold Olympic Games Turin Olympic Games Turin 1x Gold, } 1x Silver WC Calgary (Combined) WC Calgary (Combined) } 1x Silver Training EC Collabo (Combined) Training Training Training WC Berlin (Combined) WC Nagano (Einzel) Training Training Training 26

27 EC Heerenveen (Combined) EC Heerenveen (Combined) EC Heerenveen (Combined) WC Hamar (Combined) WC Hamar (Combined) WC Hamar (Combined) Training } 1x Gold } Mittelwerte * no text: Results obtained at world cup events 27