PLATELET TRANSFUSIONS are being administered at an ever-increasing rate at medical centers in North America, Western Europe, and Japan. 1 An important cause of this increased demand is the relatively cavalier attitude that many physicians have toward this modality of therapy. However, indiscriminate usage can only account for a fraction of this seemingly unquenchable demand. Undoubtedly, these explosive needs are in large part due to advances in medical technology and greater access to such technologies as cardiac surgery and bone marrow, heart, and liver transplantation. Adaption of the concept of dose intensification as a means of delivering curative therapy to cancer patients, and the human immunodeficiency type 1 (HIV-1) epidemic have also contributed to this platelet supply crisis. Repeated platelet usage, although frequently life-saving, results unfortunately in the inevitable transmission of the many blood-borne infectious diseases as well as alloimmunization. 1 In addition, the financial burden of this blood product usage is not trivial and likely contributes significantly to the burgeoning of medical costs in our society.

Development of alternative strategies to deal with this crisis verges on being a national medical priority. Reversal of these trends will require education of the medical community on the indications for and use of platelet products, and enforcement of these criteria at the local institutional level. All efforts should obviously be directed at expansion of the donor pool, an effort that requires education of members of our society. An alternative approach to meet these needs, which likely will be realized during this decade, is the use of hematopoietic growth factors (HGFs) to promote platelet production and accelerate recovery of platelets after viral, radiation or chemotherapeutic assault upon the marrow. Such a strategy could potentially diminish our need for these blood banking resources. Two reports dealing with interleukin-6 (IL-6), an HGF that potentially will be used for these purposes, appear in this issue of Blood. 2., 3. At present, an HGF with this therapeutic potential is not available to practicing physicians. In addition, several other novel HGFs, including c-kit ligand (KL), IL-1, IL-3, IL-11, and leukemia inhibitory factor (LIF) are also being similarly evaluated.