Transfusion medicine in the era of genomics and proteomics

Viewing recent trends in transfusion medicine (TM), the authors make predictions about possible future developments within this specialty including greater cost-effectiveness and blood safety resulting from increased automation; techniques in genetics replacing serological typing in many standard assays; and TM service playing a major R&D role together with clinical services in the emerging cell-based therapeutics. To achieve this, the TM laboratory of the future will need to have available extensive skills in immunogenetics and database expertise; emerging techniques in genomics and proteomics will need to be integrated with classic immunohematology approaches; and collaborative networks of TM laboratories will need to raise their profiles as a competent partner in the ongoing clinical biotechnology revolution. Blood product safety is profiled to highlight some of these developments. Until recently, avoiding pathogen transmission has focused primarily on excluding at-risk donors and testing donor blood for pathogen markers. Newer trends in pathogen-inactivation procedures could alter the protein composition of the blood product, potentially causing unintended immune reactions that could outweigh their benefits in further reducing a very low current risk of pathogen transmission. By combining proteomics and immunohematology, those manufacturing processes least likely to generate posttranslational protein modifications will need to be identified.