Why Industrial Production of Red Blood Cells From Stem Cells is Essential for Tomorrow’s Blood Transfusion

Keywords: adult stem cells • blood supply • cultured red blood cells • erythrocyte • hematopoietic stem cells • immortalized erythroid progenitor lines • large-scale production • transfusionBlood transfusion remains the only symptomatic treatment for many emergencies and chronic diseases of red blood cells (RBCs), such as sickle cell anemia, myelodysplasias, leukemias and some other cancers.Some patients are transfused all their lives and receive more than 1000 units of packed RBCs (UPR) through their lifetime.However, the more a patient is transfused, the more it increases the risk of immunization against the allogenic RBCs, frequently leading to transfusion-impasses with potentially fatal complications.The requirement for the availability of blood products adapted to the needs of all is a permanent public health challenge.Despite the considerable progress made, transfused patients are still exposed to certain residual risks which justify, in our countries today, important expenditure for the safety of each donation.Public health costs are enormous which include the prescription of UPR, repeated hospitalizations in special care units and the social cost of disability.Present & future challenges of blood transfusion Of the 112.5 million blood donations collected globally each year, approximately half of these are collected in high-income countries, home to 19% of the world's population [1].Of course, the requirements vary considerably between different countries.In developed countries, the problem is both that of transfusion impasses due to secondary hyperimmunization with polytransfusion, and the aging of the population which has two important consequences [2].First, it leads to a considerable development of blood cancers whose incidence increases with age and which have important transfusion needs.By 2050, their incidence will increase by 60% in France and by 100% in the USA.Second, the number of individuals within the age range able to donate blood will become much less than is required to meet the need of blood products.While the general population will increase by 16% in France and 49% in the USA, the population of blood-giving age is only 6 and 35%, respectively [3].In developing countries, the problem is not only that of supply but also of infectious security by inadequate biological detection of pathogens.In all countries, health crisis situations may impair the collection of blood, such as outbreaks of Ebola in Africa and Chikungunya or Dengue in the Caribbean/Guyana. Rethinking the blood supply modelAn ideal transfusion would allow: quantitative self-sufficiency on a global scale; qualitative self-sufficiency by producing 100% compatible receiver blood and thus avoid any risk of immunization; protection against infectious health risks, freeing themselves from the donor source; and eliminating metabolic complications, including iron overload as a result of post-transfusion hemolysis.