The US Food and Drug Administration (USFDA) approved recombinant human erythropoietin (rhEPO) in June 1989 for the treatment of anemia in association with chronic kidney disease. This is because rhEPO promotes red blood cell production. Even though rhEPO is used for therapeutic purposes, it can also be abused, such as in the case of blood doping in sporting events.
Erythropoietin can stimulate red blood cell production and thus increase oxygen delivery to tissue. This is because hemoglobin resides in red blood cells, its primary role being to bind oxygen and transport it to areas where oxygen is needed. The level of oxygen plays a critical role in athletic performance, where higher oxygen levels lead to a higher aerobic metabolism that can generate higher energy (ATP), putting the athlete who is doped at a competitive advantage.
The International Olympic Committee prohibits the administration of erythropoietin, and its use is classified as doping.