Praiseldy Langi Sasongko

40 Chapter 2 of technology. For those who saw its potential, several echoed that cRBCs would be most appropriate for the rare patient groups than the masses. For oxygen-carrying or biologic substitutes and the universal RBC, experts shared both the potential and the problems of these products. (Of note, in the former group, there were more experts who spoke about this with less experience [21%] compared to those with more experience [4%]). Finally, RBCs as drug carriers were seen as a promising alternative function for RBCs, and two experts spoke about future practices regarding hemoglobin measurement. Dutch Expert 23 stated that markers other than hemoglobin for oxygen demand will become “the future,” while International Expert 33 spoke about measuring hemoglobin within the tissues accompanied by non-invasive technology. This technology was perceived to “totally disrupt the blood bank industry,” although it was not specified to what effect. Table 2.3 Transformational factors for future trends in RBC demand with unspecified/uncertain effect on trend per expert group Transformational factors with unspecified/uncertain effect upon trend Sanquin, n (%) Total, 20 Non-Sanquin, n (%) Total, 8 International, n (%) Total, 14 Overall, n (%) Total 42 Universal RBCs 2 (10) 2 (25) 3 (21) 7 (17) Challenges 1 (5) 1 (12) … 2 (5) RBCs as drug carriers 2 (10) … 1 (7) 3 (7) Other markers for oxygen demand and the tools to measure it … 1 (13) 1 (7) 2 (5) Cultured RBCs 14 (70) 3 (38) 6 (43) 23 (55) Advantages 1 (5) 1 (7) 2 (5) Challenges 9 (45) 6 (43) 15 (36) Oxygen-carrying substitutes or biologic substitutes 2 (10) 2 (25) 1 (7) 5 (12) Challenges 1 (5) … 1 (7) 2 (5) Within the literature review, seven groups of transformational factors were found (Table 2.4). The majority of the studies were focused on the RBC substitutes and modifications, ranging from cRBCs to oxygen carriers and universal RBCs. These studies described the great potential for these innovations to reduce dependency on human donors and overcome shortage and matching issues but clearly outlined the great challenges that remain for any of these options to be viable transfusion alternatives. Second, immune/gene therapy studies outlined several promising ways of editing genetic markers or tumors that contribute to genetic diseases and cancers, with implications toward a reduction of transfusions needed, with challenges

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