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The protocol recognizes that due to the unpredictable requirement for massive transfusions that may exceed participating transfusion services capacity to provide study RBCs in cases with massive bleeding, non-study RBCs may need to be provided

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these changes do not make it a growth-hormone secretagogue, instead they sharply reduce its binding to IGF-binding proteins (IGFBPs), which is what extends its circulating half-life and potency relative to native IGF-1

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