Choice of factor concentrates for haemophilia: a developing world perspective

Provision of factor concentrates continues to be the single greatest challenge in providing effective haemophilia care in the developing world. While concerns for ultimate safety and very high purity dominate the selection of factor concentrates in developed countries, availability and cost are the pressing issues in developing countries. There certainly is concern for reasonable safety but purity is often considered an unaffordable luxury. Cost-effective protocols need to be designed for factor replacement in these countries where liberal on-demand therapy and prophylaxis are not possible. It is also essential to establish a good transfusion service for collecting adequate quantities of safe plasma. Support from government and health insurance is required to allow access to at least modest quantities of virus-inactivated factor concentrates. Depending on the situation in each country, factor concentrates may be imported, contract-fractionated or locally produced. Paradigms of effective management of this problem exist within the developing world. Until such time as these examples are widely emulated, less safe products will continue to be used in situations where a distinction frequent needs to be made between what is ideal and what is practical.