As many as 21 athletes from five sports might have been part of a doping ring stretching around the world, German prosecutors said on Wednesday.
Austrian police arrested five competitors at the Nordic skiing world championships last month and the case has since spread to cycling.
Munich prosecutor Kai Graeber said that the scandal could spread further.
Blood doping has occurred in at least 10 countries since late 2011 and “there is believed to have been a three-figure number of cases of blood withdrawal and retransfusion around the world,” Graeber said.
The athletes come from eight countries, Graeber said.
Authorities have not named suspects or the sports affected, but Graeber said that three of the five sports are winter events.
Doping allegedly took place in European countries such as Italy, Sweden and Croatia, along with Hawaii and last year’s Winter Olympics host, South Korea, Graeber added.
The US Anti-Doping Agency confirmed that it was investigating the Hawaii connection.
“We can confirm that we are cooperating with officials in Germany and Austria, and have offered all assistance in this case,” the agency said in a statement.
The International Olympic Committee did not immediately respond when asked whether it feared blood doping could have compromised last year’s Pyeongchang Games.
Since the five skiers were arrested last month shortly before a world championship race, an Estonian skier has admitted to doping and two Austrian cyclists who raced in the Tour de France have been suspended.
Five nonathletes have also been arrested in Germany and Austria, including a doctor, Mark Schmidt, who used to work in professional cycling.
The most recent arrest was on Monday in Erfurt, Germany, of a person who is suspected of transporting blood for athletes and carrying out blood transfusions, Graeber said.
That person had no medical training and “instead learned to inject on the principle of learning by doing,” Graeber said.
Austrian police earlier opened an investigation after a video was posted online by media apparently showing skier Max Hauke in the middle of a blood transfusion.
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