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Many groups have reported use of mononuclear cells directly enriched with specific growth factors to overcome this issue but a specific protocol is the need of the hour.
If we compare ex vivo with in vivo erythropoiesis, it is regulated by several cytokines and factors.
The process of erythropoiesis is initiated from the primitive pluripotent stem cells, giving rise to mature erythrocyte, which involves various regulatory factors inducing their commitment and further maturation of the cells involved in the red cell lineage.
Fortunately, there are many ex vivo erythropoiesis methodologies being developed by various research groups using stem cells as the major source material for large scale blood production.
Most of these ex vivo protocols use a cocktail of similar growth factors under overlapping growth conditions.
The same group in 2009 reported up to 95% of enucleation of in vitro generated RBCs by the addition of Poloxamer 188 as an RBC survival enhancer.
This enhancer increases the stability of the RBC membrane and decreases the fragility .
There is extreme unavailability of suitable donor due to rare phenotypic blood groups and other related complications like hemoglobinopathies, polytransfusion patients, and polyimmunization.
Looking at the worldwide scarcity of blood, especially in low income countries and the battlefield, mimicking erythropoiesis using ex vivo methods can provide an efficient answer to various problems associated with present donor derived blood supply system.
While differing in initial material and methodology used by different research groups, they all converse at a single point in using EPO as a key regulator in the ex vivo RBC generation measures.
In general, all the methods described so far mimic the marrow microenvironment through the application of cytokines and/or coculture on stromal cells, coupled with substantial amplification of stem cells with 100% terminal differentiation into fully mature, functional RBCs .