The Future

Abstract

If we were to look through a crystal ball and project what might happen in the future, we have to first look to see from where we came. Comprehensive care had become a key health care programme for haemophiliacs in many parts of the world. Home care, or self-infusion had become the ultimate goal of our patients, so they could be emancipated from emergency rooms and hospitals. By the 1970s, research and technology had transformed a generation of plasma dependent patients, to those capable of infusing cryoprecipitate or concentrated materials. The plasma industry grew enormously and could supply the world’s needs by 1975. Plasmapheresis had become an established method of donor procurement and thousands of donors could be recruited for factor materials, such that by the 1980s, the average number of donors was 5000 for a single lot of material which reached approximately 100 recipients. In 1975, post-transfusion complications for chronically transfused haemophiliacs included hepatitis and liver disease, immune haemolysis, and inhibitors (Fratantoni and Aronson, 1976). Shortly thereafter, hepatitis B virus was identified and in rapid fashion, donor screening was initiated. Unfortunately, despite the great sensitivity and specificity of the test, hepatitis B continued to be transmitted by the factors. Not until a vaccine was available was there hope of total eradication of transfusion-induced hepatitis B.