Questions and Answers - Workshop on Mobilizing Support for Haemophilia Care (Workshop II)
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Module
Workshop on Mobilizing
Institution
Workshop On Mobilizing
Question: Should third world countries strive to
become self-sufficient for plasma products?
Answer: Definitely ‘yes’. Cryoprecipitate produc
tion is encouraged as a high priority. The development
of national blood transfusion services is important and
urgent, and provides a source of...
Haemostasis /0(Suppl. 1): 79 (1981)
Questions and Answers - Workshop on Mobilizing Support for Haemophilia Care (Workshop II)
Question: Should third world countries strive to become self-sufficient for plasma products?
Answer: Definitely ‘yes’. Cryoprecipitate produc
tion is encouraged as a high priority. The development of national blood transfusion services is important and urgent, and provides a source of plasma.
Question: Is there a problem using concentrated red cells for transfusion when plasma has been removed from the whole blood?
Answer: This is a matter of physician education and development of proper transfusion practices. Experi
ence in major blood centers indicates that 80% conver
sion of whole blood into concentrated red blood cells is practical and acceptable.
Question: Is plasmapheresis possible with non- remunerated donors?
Answer: There are examples of successful programs in Finland, Belgium and a number of other countries. The problems are more with organization than with motivation of the donors. Whether nonremunerated donors can effectively provide the world’s plasma needs is unanswered and controversial.
Question: At this time there is a clear need for remunerated as well as nonremunerated donors for plasmapheresis. Should small or developing countries produce high-potency concentrates?
Answer: The technology is complex and costly. Expert and experienced personnel are required, as is enormous capital investment. The minimum volume to consider for production is 50,000 liters/year, equivalent to a population of 4 million of medical treatment is fully developed. It is more practical to think in terms of much larger facilities (0.5-1.5 million liters) equivalentto a population base of 40-120 million. Existing frac
tionation facilities are not fully utilized and the estab
lishment of new facilities is not a high priority.
Question: What is the cost of cryoprecipitate and of concentrates in different areas?
Answer: The cost of cryoprecipitate depends primarily upon the cost of the container and of the personnel who do the work. Generally 5-10 US cents per factor VIII unit. The cost of concentrates are often higher, and are affected by ability to market other plasma products (particularly albumin). Cost should not be confused with price. Price is a decision by the vendor. It is affected by what the market will bear. Higher prices in Europe reflect higher production and marketing costs, devaluation of the US dollar, different technology and a different marketing structure for other plasma fractions.
Question: Why is there a dosage difference of 50,000 factor VIII units per patient per year in USA; compared to 200,000 factor VIII units per patient per year in one center of the Federal Republic of Germany.
Answer: Each group is convinced that its results are satisfactory. The data necessary to resolve this question are not available so. At this time, there is no answer. In Bonn, Federal Republic of Germany, the objective of treatment is to prevent all bleedings; in USA the objec
tive is to prevent all damage caused by bleeding, but minor bleeding promptly treated is not considered to be a problem. A collaborative study will be undertaken, with agreed objectives and study criteria, to compare results over the next 5 years. Hopefully the answers will emerge from this study.
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