Blood product use for radiological/nuclear trauma: product development and US regulatory considerations

Blood products are likely to be critical components of the medical response to nuclear detonation, as the hematopoietic subsyndrome of acute radiation syndrome (H-ARS) includes depletion of platelets and red blood cells that can lead to lethal hemorrhage and anemia. There is, however, only limited c...

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Bibliographic Details
Published in:	Trauma surgery & acute care open Vol. 9; no. Suppl 1; p. e001123
Main Authors:	Silverman, Toby A, Shadiack, Annette M, Hofmeyer, Kimberly A, Cecere, Ashley E, Eisnor, Derek L, Hoffman, Corey M, Loelius, Shannon G, Patel, Aditiben, Homer, Mary J
Format:	Journal Article
Language:	English
Published:	England BMJ Publishing Group Ltd 01-01-2024 BMJ Publishing Group LTD BMJ Publishing Group
Subjects:	Biological products biomedical research blood FDA approval hemorrhage Manufacturing policy Product development Review United States > US blood biomedical research hemorrhage policy
Online Access:	Get full text
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Summary:	Blood products are likely to be critical components of the medical response to nuclear detonation, as the hematopoietic subsyndrome of acute radiation syndrome (H-ARS) includes depletion of platelets and red blood cells that can lead to lethal hemorrhage and anemia. There is, however, only limited clinical information on the use of blood products to treat H-ARS. As currently configured, the US blood supply cannot meet the predicted surge in blood product demand that is likely to occur short-term and possibly long-term in the event of a large nuclear detonation. As part of the Administration for Strategic Preparedness and Response within the US Department of Health and Human Services, the Biomedical Advanced Research and Development Authority (BARDA) is addressing this preparedness gap by supporting the development of novel blood products and devices with characteristics that improve blood product storage and use in austere operational environments. The US Food and Drug Administration’s Center for Drug Evaluation and Research (CDER) recently issued draft guidance on the development of drugs and biologics regulated by CDER to prevent or treat Acute Radiation Syndrome under the provisions of the “Animal Rule.” The commentary provided here discusses the unique regulatory scheme for transfusion components and blood products regulated as biological drugs by Center for Biologics Evaluation and Research, including the ambiguity surrounding the evidentiary requirements for their approval for H-ARS, and whether, under certain circumstances, a specific H-ARS indication is necessary if relevant commercial indications are approved.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1
ISSN:	2397-5776 2397-5776
DOI:	10.1136/tsaco-2023-001123