Abstract
Our ability to meet patient needs for blood product replacement falls short of our expectations in some instances. Fortunately, recent scientific developments suggest ways in which these problems can be addressed. The application of this research can assure an adequate supply of safe blood and blood-related products, and can improve the effectiveness of this important medical therapy.
While there are now good methods to sterilize plasma derivatives, much more work is needed to assure comparable freedom from transmission of disease by whole plasma, red cells, and platelet concentrates. Plasma treated by the solvent-detergent method is expected to be a significantly safer product, but the treatment of cellular blood products remains a difficult problem for which there are no immediate solutions. We need to better understand the interaction of viruses and bacteria with red cells and platelets if there is to be progress in addressing this concern.
A second important safety concern is the apparent immunosuppression produced by some blood products. The magnitude of this problem needs to be determined and the role of leukocytes needs to be examined more carefully.
The effectiveness of some transfused blood products is now limited by the development of alloimmune reactions. This can be a serious complication, especially for platelet transfusion. A better understanding of alloimmunization and the identification of ways to prevent this problem will markedly improve the practice of transfusion medicine. At the same time it is important to develop improved blood product storage conditions and to develop new blood products.
Fortunately, progress in biomedical research is providing the necessary tools to address these needs. For example, it is likely that conditions will be identified that support the production of cellular blood products in tissue culture. In addition, recombinant technology may permit production of essential proteins for therapy even though they are difficult to prepare from plasma because of low concentration or instability. Scientists will also seek to develop modified “second generation” products that avoid limitations inherent in some natural proteins. Finally, recombinant growth factors have already had an important effect in transfusion medicine, and additional products are anticipated.
