Red cells, platelets and plasma all have important roles in medical care, high efficacy for their primary indications, and no obvious replacements in the foreseeable future. They represent about 1% of the overall cost of healthcare, and about 2% of the cost of tertiary care centres. Blood collection centres and hospital transfusion services will remain largely as they are in the immediate future. There are no alternatives.

Efforts are being made to grow red cells from stem cells. At this time, a peripheral blood stem cell collection can be treated with growth factors and turned into about 3 mL of red blood cells. This is an important demonstration of principle, but not a useful production technology. More red cells than that are lost in the lines of the apheresis device used to collect the stem cells. Even when cloned “universal donor” red cells are industrially produced, they will still be need to be in units managed in blood banks, and there will be a fraction of individuals, such as those of the Bombay phenotype, who will not be able to receive them.

Platelets for transfusion are even less likely to come from alternative sources of production, but donor-derived apheresis platelets already make up almost three-quarters of the national supply. Apheresis devices with higher yields and gentler handling can improve the number and quality of platelets in the supply. Better storage systems can make them last longer and be safer, but here, the needs of trauma patients for the plasma in platelet units compared to needs of highly transfused cancer patients to have the plasma removed, compete. Changes in the carrier solution for platelets will require alternative formulations of plasma.

Frozen FFP and FP will remain standards, but their dilute nature remains a problem for trauma patients and field medical care situations. Freeze-dried plasma which can be reconstituted in less then normal volumes of water to make concentrated solutions offer a potential alternative. Mixtures of bioengineered proteins are further off, have high developmental costs, and difficult regulatory paths to licensure.

Conventional blood products appear to be with us for the foreseeable future. It is important that we learn more about them. Such knowledge will help us manage them better now, and make better versions available