Erythropoietin (EPO) plays a key role in modulation of erythropoiesis and is required for the survival and proliferation of committed erythroid progenitor cells. 1 EPO has been approved for treatment of anemia in several conditions and for facilitating autologous blood donation. When used as doping agent in sport, EPO increases the ability to exercise as the result of increasing the packed-cell volume (PCV).Case report. A 26-year-old man, a professional cyclist, presented with a 2-month history of headache that had greatly increased in the previous week during a competition. There was no history of head trauma. He was referred to an institution with the diagnosis of idiopathic intracranial hypertension, which was nonresponsive to standard treatment. On admission he was cognitively normal, but reported diffuse headache with nausea, vomiting, and photophobia. Physical examination was unremarkable, except for the presence of a mild left retinal venous engorgement. A lumbar puncture disclosed an increase in CSF pressure, without abnormalities in CSF composition. Blood analysis showed a red blood cell count of 5.4 ϫ 10 12 /L (normal range, 3.5 to 5.0), hemoglobin ϭ 150 g/dL (normal range, 140 to 180), PCV ϭ 0.47 (normal range, 0.39 to 0.49), with normal values for the white cell count and platelet number. The other routine laboratory tests performed in serum and urine were within the normal range. Although the cranial CT scan examination on admission was normal, MRI of the brain revealed occlusion of the superior sagittal and the right transverse sinuses (figure). A diagnosis of cerebral sinus thrombosis was made, and anticoagulation treatment with intravenous sodium heparin infusion was started. A 400-mL phlebotomy also was performed because the PCV spontaneously increased to 0.51. Previously, a coagulation study had been performed with normal values for prothrombin time, activated partial thromboplastin time, fibrinogen, thrombin time, D-dimer, plasminogen, antithrombin III, protein C, protein S, lupus anticoagulant, and anticardiolipin antibodies. A PCR for factor V Leiden also was negative.Because EPO doping was suspected, the patient was questioned about the use of forbidden agents. He admitted to using EPO during the previous 3 months at a dose of 2000 U every 2 days, and growth hormone over the last 15 days of competition to improve his physical exercise capacity. Moreover, he reported habitual, long-lasting consumption of high doses of vitamin A and vitamin E supplements. Anticoagulation resulted in a clinical response and was continued with acenocoumarol for 3 months. A control MRI showed resolution of the thrombosis. When last seen he remained well; currently, he continues to compete.Discussion. The practice of doping to enhance athletic performance is becoming a medical and public health problem because of simplicity of administration and difficulty of detection. 2 The use of forbidden substances in the form of human recombinant peptide hormones with ergogenic action, such as growth hormone and EPO, is curr...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.