[Transfusion medicine: debate, field of application, the stakes]

Transfusion medicine has aroused much controversy as to the definition of its field of application, as the Etablissement Français du Sang (EFS) is being set up. One argument put forward by supporters of transfusion medicine in hospital--including nominal attribution and clinical immunohematology--is the possible influence of blood component producers on the decisions of prescribers. The EFS considers transfusion medicine as the rationale underlying a therapeutic chain applied to blood products and possibly to cell therapy products, within a coherent structure. Any disruption in the chain would result in reduced visibility at each stage of the chain, diluted responsibilities, and less efficient communication between blood collection and actual needs. It is, however, extremely important to clearly distinguish between the activities related to the production of biological products for therapeutic use from the activities of evaluation, in the setting of clinical protocols, which are the clinicians' responsibility. The EFS views the production of blood components as one of the various aspects of its missions as a transfusion medicine operator. The involvement of blood transfusion centers in the development of biotechnologies is a historical reality which justifies EFS's ambition to integrate cell therapy activities within its field of competence. The EFS, with its 18 blood transfusion centers, will have to play a part in health care, research and teaching networks, at the regional or inter-regional level. Irrespective of the progress achieved in substitution products and the evolution to be expected in transfusion-related jobs, transfusion as a discipline must maintain its coherence to be able to better assume its responsibilities.