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Preanalytical mixing of whole-blood specimens in the context of the Athlete Passport
  1. Michael Ashenden1,
  2. Anthea Clarke2,
  3. Ken Sharpe3,
  4. Giuseppe d'Onofrio4,
  5. Graeme Allbon2,
  6. Christopher J Gore2,5
  1. 1SIAB Research, Gold Coast, Queensland, Australia
  2. 2Department of Physiology, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia
  3. 3Department of Mathematics and Statistics, University of Melbourne, Melbourne, Victoria, Australia
  4. 4Research Center on Automated Methods in Hematology (ReCAMH), Catholic University of Sacred Heart, Rome, Italy
  5. 5Flinders University, Adelaide, Australia
  1. Correspondence to Dr Michael Ashenden, SIAB Research, PO Box 402, Surfers Paradise, Gold Coast, QLD 4217, Australia; heyasho{at}


Background Full blood counts are now used as evidence that athletes have used banned blood doping. This has led to legal scrutiny of the efficacy of preanalytical procedures such as specimen homogenisation.

Aims To characterise the impact of different mixing strategies on whole-blood homogeneity.

Methods Manual inversion, mechanical mixing and automatic mixing performed by the Sysmex XT-2000i were evaluated.

Results Automated mixing by the instrument, or 1 min of mechanical mixing, thoroughly homogenised specimens even for tubes that had been refrigerated and left undisturbed for 36 h. Manual inversions were almost as effective, provided that specimens were first allowed to equilibrate to ambient temperatures.

Conclusions Current sport guidelines that mandate at least 15 min of mechanical mixing are excessive. Except where specimens are presented to the instrument manually, mechanical mixing is redundant in the context of full blood counts.

  • Homogenisation
  • athlete passport
  • sysmex
  • quality control
  • laboratory tests
  • haematology
  • genetics
  • iron
  • muscle
  • colorectal cancer
  • gall bladder
  • oncogenes
  • P53
  • pancreas
  • leukaemia
  • polycythaemia
  • erythrocyte
  • haematology
  • myeloproliferative disease
  • laboratory tests
  • quality assurance

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  • Correction notice This article has been corrected since it was published Online First. Due to an internal error, an earlier version of this paper was initially published online. The main changes that have been made in this version are: Affiliation 5 was added for Christopher J Gore. Figure 2 has been updated and the caption amended. Take home messages have been added to the paper.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Australian Institute of Sport.

  • Provenance and peer review Not commissioned; externally peer reviewed.