Blood doping: Then and now. A narrative review of the history, science and efficacy of blood doping in elite sport.

As the line between excellent and exceptional athletic performance narrows and as the financial remuneration for exceptional performance increases, unscrupulous athletes and their trainers will strive to enhance performance regardless of cost. One method of performance enhancement is by the augmentation of the oxygen-carrying capacity of the blood through blood doping. We discuss the science behind erythropoiesis and means by which these processes can be exploited to the potential advantage of the athlete. These include pre-sport transfusion practices as well as supplemental recombinant human erythropoietin (rHuEpo) and the use of newer erythropoietic agents, many of which have not received FDA approval. Finally, we discuss the data behind the efficacy of blood doping in an attempt to discern whether or not the practice actually works to improve athletic and competitive performance.