Currently blood is a volatile issue. The safety of blood and the
quantification of transfusion risks have been dominant themes that have
stimulated the development of alternative approaches in this rapidly
developing area. In clinical medicine conventional blood and its
components are used in supportive therapies dependent on the choice of
apparent uncritical trigger factors. A compounding factor is depth of
prospective clinical trials for evidence. Such trials in critical care
areas would be of enormous value, not only in recording adverse effects
and under-transfusion, but also indicating the value of decision
analysis and cost-effectiveness in transfusion practice. Alternative
approaches include the use of cytokines, growth factors, humanised
monoclonal antibodies, recombinant plasma factors, and buffy coat
derived natural human interferons. These are being increasingly
implemented in the clinic. Solutions for oxygen transport are being
developed and fibrinogen coated microcapsules are being investigated for
thrombocytopenia. In surgical patients, various crystalloid and colloid
combinations are explored as volume replacements. To avoid allogeneic
transfusions, beneficial blood saving methods include various
strategies, such as autologous deposits, normovolemic haemodilution and
various agents including aprotinin, tranecamic acid, desmopressin and
erythropoietin, but their use in hospital shows considerable variations.
That umbilical cord blood could be a significant source of allogeneic
stem cells in related and unrelated transplantation is illustrated by
the increasing number of cord blood banks in Europe and elsewhere.
Future blood resources are likely to face several challenges: immediate
challenges relate to increased regulatory and political oversights;
intermediate solutions would offer some improvements in public health
and alleviate public fear but probably not address the economic
challenges thrust upon the medical care system.
As we approach the year 2000, the major concerns about transfusion
medicine remain its logistics, safety and effectiveness. This theme is
presented in the proceedings of the 22nd International Symposium on
Blood Transfusion, developed in 21 up-to-date topics, collected and
discussed in four sections.
This book will be of timely value to students, professionals and all
others interested or involved in the field of transfusion medicine,
whether clinical or related.
