IBMS Congress

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Something old, something new, something borrowed, something blue: A brief history and outlook on current and future options in the correction of congenital and acquired defects of coagulation

Session 4

Transfusion Science

Martin Besser, Consultant Haematologist

Patients have successfully treated with plasma products for various indications for less than a hundred years. This presentation gives a brief overview of the challenges overcome in this time period and those yet to be resolved.

The idea of using plasma in place of whole blood originated in the last year of the great war and did not really enter clinical practice until almost two decades later. The second world war proved to be the catalyst to advance the technique of whole blood fractionation to plasma fractionation on an industrial scale which was one of the many factors that helped win the war.

Despite a paradigm shift in the indications for the use of plasma have from a preservable blood replacement fluid to correction of coagulopathy, many of the great challenges we face today originated from the introduction of these two techniques and strangely have not advanced significantly until very recently despite many scientific discoveries.

Despite a 70 year history of access to FFP, its efficacy was never proven by a randomized controlled trial in coagulopathy which is the main indication we use FFP for today and in fact the evidence there is mostly shows little to no advantage. The production, purification and pasteurisation of the other plasma derivatives has made great advances in the past 50 years but the main challenges remain in the sustainable acquisition of uncontaminated plasma suitable for transfusion.

The introduction of an increasing repertoire of recombinant blood products and more recently genetically engineered blood products with improved clinical characteristics will usher in a new era for the treatment of coagulopathy.