Blood Testing for Prohibited Substances in Sport

Welcome to the restored Drug Free Sport Blog, Perspectives! 

After a three-year hiatus, we are eager to begin sharing our expertise, stories, and trending news related to sport drug testing and athlete health. We hope to reengage our followers and expand our reach to new audiences to provide valuable “perspectives” about our company, staff, and the sport drug testing industry. Thank you for reading and sharing!

To kick-off our reentry into the blogosphere, we explore blood testing for prohibited substances in sport, current trends related to phlebotomy testing, and other fun facts from the industry.

To gain insight into the use of blood for drug testing athletes we sat down for a Q&A with our own Ben Mosier, Director of Professional Sports Drug Testing, Ryan Willis, Director of NFL PED Drug Testing, and Sarah Ziegelmann, Phlebotomy Services Program Manager.

Q: Drug Free Sport has been conducting blood drug testing in professional sports since 2004. Has anything significant changed in this area of drug testing?

A: Blood testing continues to expand in professional sports through the continuous addition of certified phlebotomists and an increased understanding of the process and specificity of testing. Currently, there is increasing interest in blood biomarkers and the athlete’s biological passport. Biomarker testing serves to monitor variables over time that may reveal the effect of doping, and the biological passport uses longitudinal profiling to test an athlete’s blood for initial testosterone levels. These levels are held on a file and reviewed in the future to determine if the athlete has used testosterone boosting substances. The World Anti-Doping Agency (WADA) will begin biomarker testing in the near future.

Q: So instead of testing for testosterone at a single test, you’re comparing the athlete’s own blood levels of testosterone from one sample to another over a period of time?

A:  Exactly. That would be an example of using the Athlete Biological Passport. The Athlete Biological Passport (ABP) provides a longitudinal study that monitors a panel of biomarkers within the athlete’s blood that will indirectly show the effects of doping over a period of time. Instead of searching for a specific performance-enhancing substance, a positive test can result from inconsistencies measured in the athlete’s biomarker levels. This is called a Non-Analytical Positive. Blood testing in sport can also identify and accurately detect two other categories of performance enhancement that other matrices cannot: Blood Doping and Human Growth Hormone (hGH).  

Q: Tell us about these other categories. What makes them different?

A:  There are several substances or methods used for blood doping in sports. Erythropoiesis Stimulating Agents (ESA), also known as recombinant erythropoietin (rEPO),work by stimulating the production of more red blood cells. Hemoglobin-based Oxygen Carriers (HBOC) and Homologous Blood Transfusions (HBT) are other blood doping methods. All three methods are used in various manners to increase an athlete’s red blood cell count, resulting in an increase of stamina and performance. Blood passport testing is used to target and identify these different doping methodologies. 

Human growth hormone (hGH) is a naturally occurring substance in the body produced by the pituitary gland. hGH is most often attributed to blood drug testing in sports. Synthetic hGH is used as a Performance Enhancing Drug (PED) to enhance the growth of bone, muscle and organ tissues within the body.  The Isoforms Test and Biomarkers Test can be used to determine whether the hGH levels in an athlete are naturally occurring or synthetically altered.

Q: How accurate are the results of these blood tests?

A: When conducted according to the specified collection procedures and protocols, blood testing provides less than a 0.01% error—higher accuracy than provided by urine drug tests.

Q: Are blood test results produced quicker than urine tests?

A: The speed of receiving results from a blood test is primarily dependent on the drug-testing laboratories’ volume at the time. The average timeframe for a result is 10 – 14 days, but for an additional fee the process can be expedited. A benefit of blood testing is the ability to test 20 samples at a time which can speed the process compared to urine testing. Urine testing has a 14 day result turn around.  

Q: How do athletes feel about blood testing compared to urine testing?

A: The average blood draw takes about 10 minutes, which most athletes prefer due to the quickness of the test and the ability to perform a test on demand as opposed to waiting to produce and validate a urine sample. On the other hand, some athletes have a fear of needles, making this type of testing less desirable. Under most circumstances, trained phlebotomists administering the tests are skilled at calming the athlete and successfully collecting a sample.

Q: What would be good information for athletes to know about what to expect from a blood test?

The average blood draw takes 10 minutes, 
and collects 10mL of blood.

10mL is one-third of a standard shot of espresso. 
Photo credit: by Sandstein (Own work) [CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons 

A: Well, the notification of a blood test to an athlete is dependent on if the sport is in-season or off-season. Also, to ensure accuracy, blood tests require specific amounts of time between when an athlete last engaged in physical activity/exercise and the blood collection. When being tested for hGH, the athlete must wait at least 30 minutes after exercise to produce a blood sample. For ESA blood testing, the athlete has to wait a minimum of two hours after engaging in physical activity.

Similar to urine-based drug tests, the athletes are able to select their testing devices and custody and control forms for testing. Trained phlebotomists ensure that clients have a full scope of knowledge in regards to the blood collection process; this also protects the health and safety of the athletes. Prior to testing, the phlebotomist will ask about the athlete’s history with providing blood samples along with potential complications. Once athlete identification and demographic information is confirmed, the blood draw begins. Blood tests are administered using a small needle and collect 10 milliliters (mL) of blood in a test tube. (Consider: The human body has approximately 5,500 mL of blood and a standard shot of espressoholds 30 mL of fluid.) The collection tube is then secured into transport kits, stored, and shipped in temperature controlled containers. Both the athlete and collector confirm the validity of the procedure with affidavits and if feeling well, the athlete is dismissed.

Blood testing collections continue to expand in professional sports and new scientific advancements and innovations further protect the integrity and landscape of the sport drug testing industry. Drug Free Sport oversees the collection of 5,000 blood tests annually. Our experts are here to answer questions and assist you through the process. Feel free to leave comments or reach out to us directly with any questions.