Alternatives to Human Blood and Blood Resources

Biotechnology is increasingly providing alternatives to established transfusion products, with the promise of freedom from infectivity and unlimited supply. Such products must demonstrate a safety and efficacy at least as great as current products, and thereafter an improved cost‐benefit ratio. Alternatives to established products may be categorised as: • Alternatives made from blood donations. • Substitutes (acting by distinct mechanisms). • Recombinant analogs. • Cellular therapies (including gene therapy). This overview covers the current status in each of these categories, and likely trends in the near future. Recombinant therapeutic proteins are already established in certain indications, and are likely to be extended to a wider range of applications as the methods for bulk production are improved. Alternative products from donated blood should find niche indications, especially for acute therapy, but cellular therapy is unlikely to be widely implemented on this timescale, except as an adjunct in life‐threatening indications. Substitutes are perhaps the most interesting category and are expected to have a major impact, particularly through the use of “poietins” to stimulate endogenous production of circulating cell populations.