ALTERNATIVES TO HUMAN BLOOD AND BLOOD RESOURCES

Biotechnology is increasingly providing alternatives to established tr ansfusion products, with the promise of freedom from infectivity and u nlimited 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 categorise d as: Alternatives made from blood donations. Substitutes (acting by d istinct mechanisms). Recombinant analogs. Cellular therapies (includin g gene therapy). This overview covers the current status in each of th ese categories, and likely trends in the near future. Recombinant ther apeutic proteins are already established in certain indications, and a re likely to be extended to a wider range of applications as the metho ds for bulk production are improved. Alternative products from donated blood should find niche indications, especially for acute therapy, bu t cellular therapy is unlikely to be widely implemented on this timesc ale, 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 stimulat e endogenous production of circulating cell populations.