I don't doubt your clinical expertise but xc skiers are some of the most notorious EPO/ blood dopers in all of sport
Sorry, I have worked in a Haematology lab, haematocrit can be over 50% in healthy people who aren't doping.
I had iron deficient anaemia a few years ago and would test my own blood to monitor my recovery, a friend of mine donated blood for an experiment and had well over 50% HCT.
I think the highest naturally recorded adult HCT level is about 60% in a cross country skiier. Just looking online shows normal value ranges up at, or near to, 50% for men, when dehydrated that would rise.
That 60% seems way out of line and indicative of doping.
UCI cycling had and I think still has a 50% "health and safety" cut off limit for hematocrit. Most believe that this is 1 or 2 % above the level a properly hydrated/ altitude trained/ well conditioned athlete can maintain naturally. Combining EPO with plasma transfusions can also help keep athletes below the 50% level while retaining and actually maximizing doping advantage. Thus, levels below 50% may not necessarily clear an athlete of doping but levels significantly above 50% point to either a medical abnormality or doping.
In practice, the blood profile testing system seems designed to weed out the most egregious dopers and serve as a health precaution rather than a stringent anti-doping tool.
Like other have pointed out, the blood profile in question was not only abnormal as compared to other athletes, it was abnormal compared to the own athlete's baseline tests even after factoring possible effects of training and altitude. That is what is so damning about the profile and why the athlete has fought so hard to keep it from being released.