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A study of 15 Swedish athletes by the Stockholm Institute of Gymnastics and Sports found an improvement of nearly 10 percent in aerobic performance."Average" red blood cell volume of the population at sea level is about 45% red blood cells.The increased thickness of the blood (above 70% red blood cells) increases the risk of blood clotting which can block blood vessels causing a heart attack or stroke, especially in the middle of the night when the heart's rate is lowest.

About 5% of the population has less than 40% red blood cell, which is defined as "anemia" and 5% of the population, including many world class athletes, have a natural red blood cells volume of 50%...1% of the population has 54% red blood cell volume.I could have been anyone, and they could have done anything they liked with the bottles." During the 1979 Tour de France, the leader of the mountains classification Giovanni Battaglin tested positive for doping in stage 13.He was penalized by 10 minutes in the general classification, lost the points that he earned in stage 13 and received 10 penalty points in the mountains classification.Systematic blood doping at the 1984 Summer Olympic Games in Los Angeles. The transfusions were to increase red blood cells in riders' blood. They received the blood of others with similar blood types. Steve Hegg, won a gold and a silver; Rebecca Twigg, Pat Mc Donough and Leonard Nitz won silver medals.

The practice, instigated by national coach Eddie Borysewicz, was not against Olympic rules although Games medical guidelines discouraged it. The others were John Beckman, Mark Whitehead and Brent Emery.Recombinant EPO is a bio-manufactured copy of a hormone normally produced in the kidney and was not detectable by any test at the time.EPO stimulates the bone marrow in order to increase red blood cell production and thus the body's ability to carry oxygen.This was included in the 1997 International Olympic Committee study on the Historical Evolution of Doping Phenomenon, and listed as the presumed first death due to doping during a competition.The report did allow that in this period it was common practice, and not illegal.The Wiel's-Groene Leeuw affair – At the stage from Luchon to Carcassonne of the 1962 Tour de France, twelve riders fell ill and said 'bad fish' was the cause.