Genetically-engineered, recombinant blood products are expected to have an increasing role in transfusion medicine.
Clinical experts in various fields of practice should assess their clinical application.
|Haemopoietic growth factors
|Recombinant Human Erythropoietin (EPO)
- Administration of EPO can increase the rate of red cell production.
- Use of EPO in patients with chronic renal failure shows improvement in quality of life and a significant reduction in the requirement for repeated transfusion of red cells.
- There is increasing evidence of the efficacy of EPO to decrease transfusion requirements in the management of a number of clinical conditions, such as:
- premature neonates
- rheumatoid arthritis
- in cancer chemotherapy
- myelodysplastic syndromes and
- in HIV-positive patients.
|Granulocyte Colony Stimulating Factor (G-CSF)
- This is an accepted therapy:
- in management of patients with severe neutropenia associated with chemotherapy and bone marrow failure, or
- to increase the level of haematopoietic progenitor cells in the circulation prior to apheresis collection for autologous and allogenic stem cell transplantation.
||Not available for clinical use.
|Recombinant factor VIII
- Similar efficacy to plasma-derived factor VIII in the management of bleeding, and the rate of developing inhibitors to factor VIII.
- Some products use human albumin to stabilise the factor VIII, so theoretically these could transmit infection.
- There are other risks associated with the culture of the product in mammalian cell lines.
- This does not contain von Willebrand factor (vWF) and is not appropriate for use in von Willebrand Disease (vWD) patients.
|Recombinant factor IX
- Similar to plasma-derived Factor IX in the management of bleeding, and the rate of developing inhibitors to factor IX.
- Some products use human albumin to stabilise the factor IX, so theoretically these could transmit infection.
- There are other risks associated with the culture of product in mammalian cell lines.
|Recombinant factor VIIa
- This is used for the treatment of bleeding in patients with haemophilia A and B, who have a circulating inhibitor of the coagulation factor.
- This is being studied in the management of various other disorders of haemostasis, in particular, bleeding associated with disorders of platelet function and liver disease.
- Increasing interest has been shown in the use of this product in the massive transfusion setting.