Hey Dr. I've got this friend who will be doing his first triathelon soon. He's totally jazzed about this because this dude used to be a 90 pound weakling and now looks like an ironman. He's been using loads of steroids and got ahold of some erythropoeitin as well. I just saw his latest lab tests and noted his hemoglobin was 18.5 (high). He's reluctant to cut back on his "roids" and erythro. until after the event. I'm just a bit concerned, am i at any significant risk? Concerned

Hello Ironman,

"Theoretically speaking," it's a hard question to answer. Physicians will sometimes perform phlebotomy (taking blood out) in folks with polycythemia vera (a condition that causes an abnormally high hemoglobin and red blood cell count) when the hemoglobin gets up into the 18-19 g/dL range in order to reduce the risk of getting blood clots! However, this disease is associated with an inherent thrombotic (blood clotting) tendency independent of the level of hemoglobin. As far as I know, there is no increased blood-clotting tendency associated with drug-induced elevated red blood cell counts. For example, endurance athletes sometimes blood dope with erythropoietin to hemoglobin levels of 20 g/dL or more to achieve greater performance. I'm not aware that they are at any particular risk for blood clots. I certainly don't recommend pushing hemoglobin levels above the normal range. So I don't think your theoretical "roid-raging" and "Procrit-happy" friend is in any immediate danger, but I would strongly recommend he let his hemoglobin fall back into the normal range soon, and certainly not allow it to get above 20 g/dL. So just when is YOUR (I mean your friend's) triathlon event?

P.S. It was a dead giveaway when you asked "Am I at any significant risk?"

Good luck to you (and your "friend," too).

Dr. Bob