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| "Spin" | |
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| House episode | |
| Episode no. | Season 2 Episode 6 |
| Directed by | Fred Gerber |
| Written by | Sara Hess |
| Featured music | Solomon Burke - None of Us Are Free |
| Original air date | November 15, 2005 |
| Guest appearances | |
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"Spin" is the sixth episode of the second season of House , which premiered on Fox on November 15, 2005.
Jeff, a well-known cyclist, is cycling in a non-profit charity race, when he is unable to breathe and taken to the hospital. House finds it surprising that Jeff admitted he is taking illegal enhancement drugs. He agreed to blood doping, which is common among cyclists, to better one's athletic performance. Because red blood cells carry oxygen between the lungs and the muscles, a higher number of red blood cells can increase an athlete's endurance. While trying to figure out what cause of Jeff's respiratory distress, they find an air embolus in his chest. While Dr. Chase works to remove the air bubble, Jeff begins to feel numbness in his legs, but is told that it might be due to the sedation. While his manager talks to the press, Jeff loses feeling in his legs. Dr. Cameron informs House that Jeff's red blood count is continually dropping, revealing that his body is no longer able to produce red blood cells on its own. House becomes convinced that Jeff lied about a specific drug that could be the cause of all of his symptoms, erythropoietin (EPO), a hormone produced in the kidney that promotes the formation of red blood cells by the bone marrow. Adding more red blood cells increases the oxygen level in the blood, thus presumably causing all of Jeff's symptoms as he fails to produce red blood cells on his own. This explains him also having anemia, caused by chronic Acquired Pure Red Cell Aplasia (PRCA), probably resulting from blood doping. After responding to prednisone, Jeff begins losing more red blood cells, to the point of requiring a transfusion. House scans Jeff's neck and a thymoma is discovered; an extremely rare tumor on the thymus, confirming that he wasn't taking EPO, but did have Chronic Acquired Pure Red Cell Aplasia. Due to the diagnosis he can legally blood dope or get a thymectomy, which could only bring a temporary remission, after which he would have to be on medical steroids.
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Darbepoetin alfa (INN) is a re-engineered form of erythropoietin containing 5 amino acid changes resulting in the creation of 2 new sites for N-linked carbohydrate addition. It has a 3-fold longer serum half-life compared to epoetin alpha and epoetin beta. It stimulates erythropoiesis by the same mechanism as rHuEpo and is used to treat anemia, commonly associated with chronic kidney failure and cancer chemotherapy. Darbepoetin is marketed by Amgen under the trade name Aranesp.
Anemia or anaemia is a blood disorder in which the blood has a reduced ability to carry oxygen. This can be due to a lower than normal number of red blood cells, a reduction in the amount of hemoglobin available for oxygen transport, or abnormalities in hemoglobin that impair its function.
Aplastic anemia (AA) is a severe hematologic condition in which the body fails to make blood cells in sufficient numbers. Blood cells are produced in the bone marrow by stem cells that reside there. Aplastic anemia causes a deficiency of all blood cell types: red blood cells, white blood cells, and platelets.
Erythropoietin, also known as erythropoetin, haematopoietin, or haemopoietin, is a glycoprotein cytokine secreted mainly by the kidneys in response to cellular hypoxia; it stimulates red blood cell production (erythropoiesis) in the bone marrow. Low levels of EPO are constantly secreted in sufficient quantities to compensate for normal red blood cell turnover. Common causes of cellular hypoxia resulting in elevated levels of EPO include any anemia, and hypoxemia due to chronic lung disease and mouth disease.
Methemoglobinemia, or methaemoglobinaemia, is a condition of elevated methemoglobin in the blood. Symptoms may include headache, dizziness, shortness of breath, nausea, poor muscle coordination, and blue-colored skin (cyanosis). Complications may include seizures and heart arrhythmias.
Tyler Hamilton is an American former professional road bicycle racer. He is the only American rider to win one of the five Monuments of cycling, taking Liège–Bastogne–Liège in 2003. Hamilton became a professional cyclist in 1995 with the US Postal Service cycling team. He was a teammate of Lance Armstrong during the 1999, 2000 and 2001 Tours de France, where Armstrong won the general classification. He was a key asset for Armstrong, being a very good climber as well as time-trialist. Hamilton appeared at the 2000 and 2004 Summer Olympics. In 2004, he won a gold medal at the individual time trial. The first doping test after his Olympic victory gave a positive result, but because the backup sample was frozen, no doping offence could be proven. After he failed further doping tests at the 2004 Vuelta a España, Hamilton was suspended for two years from the sport.
Polycythemia is a laboratory finding in which the hematocrit and/or hemoglobin concentration are increased in the blood. Polycythemia is sometimes called erythrocytosis, and there is significant overlap in the two findings, but the terms are not the same: polycythemia describes any increase in hematocrit and/or hemoglobin, while erythrocytosis describes an increase specifically in the number of red blood cells in the blood.
Blood doping is a form of doping in which the number of red blood cells in the bloodstream is boosted in order to enhance athletic performance. Because such blood cells carry oxygen from the lungs to the muscles, a higher concentration in the blood can improve an athlete's aerobic capacity (VO2 max) and endurance. Blood doping can be achieved by making the body produce more red blood cells itself using drugs, giving blood transfusions either from another person or back to the same individual, or by using blood substitutes.
Pure red cell aplasia (PRCA) or erythroblastopenia refers to a type of aplastic anemia affecting the precursors to red blood cells but usually not to white blood cells. In PRCA, the bone marrow ceases to produce red blood cells. There are multiple etiologies that can cause PRCA. The condition has been first described by Paul Kaznelson in 1922.
Aplasia is a birth defect where an organ or tissue is wholly or largely absent. It is caused by a defect in a developmental process.
There have been allegations of doping in the Tour de France since the race began in 1903. Early Tour riders consumed alcohol and used ether, among other substances, as a means of dulling the pain of competing in endurance cycling. Riders began using substances as a means of increasing performance rather than dulling the senses, and organizing bodies such as the Tour and the International Cycling Union (UCI), as well as government bodies, enacted policies to combat the practice.
Operación Puerto is the code name of a still unfinished Spanish Police operation against the pro sports doping network of Doctor Eufemiano Fuentes. It started in May 2006, which resulted in a scandal that involved several of the world's most famous cyclists and teams at the time.
5-Aminoimidazole-4-carboxamide ribonucleotide (AICAR) is an intermediate in the generation of inosine monophosphate. AICAR is an analog of adenosine monophosphate (AMP) that is capable of stimulating AMP-dependent protein kinase (AMPK) activity. The drug has also been shown as a potential treatment for diabetes by increasing the metabolic activity of tissues by changing the physical composition of muscle.
Erythropoiesis-stimulating agents (ESA) are medications which stimulate the bone marrow to make red blood cells. They are used to treat anemia due to end stage kidney disease, chemotherapy, major surgery, or certain treatments in HIV/AIDS. In these situations they decrease the need for blood transfusions. The different agents are more or less equivalent. They are given by injection.
Hematologic diseases are disorders which primarily affect the blood and blood-forming organs. Hematologic diseases include rare genetic disorders, anemia, HIV, sickle cell disease and complications from chemotherapy or transfusions.
Non-sideropenic hypochromic anemia also known as Normochromic Normocytic Anemia is a kind of anemia in which the red blood cells in circulation have a normal red color (normochromic) and the same size (normocytic). Normocytic normochromic anemia is most commonly caused by a variety of chronic infections and systemic diseases.
Eugene Goldwasser was an American biochemist at the University of Chicago who identified erythropoietin, a hormone that plays a vital role in the synthesis of red blood cells. After sharing the minute quantities that he had been able to isolate with researchers at the biotechnology firm Amgen, that company was able to use genetic engineering technology to produce useful amounts of erythropoietin as a drug to treat anemia that has achieved substantial financial success, but that has also been used by athletes as a performance-enhancing drug.
Daprodustat, sold under the brand name Duvroq among others, is a medication that is used for the treatment of anemia due to chronic kidney disease. It is a hypoxia-inducible factor prolyl hydroxylase inhibitor. It is taken by mouth.
