Patient blood management should not be overlooked in EU’s blood revision, says stakeholder

As the need for blood transfusion is growing worldwide, only roughly a third of patients receive enough of it, Androulla Eleftheriou, Executive Director at Thalassaemia International Federation, told EURACTIV in an interview. [SHUTTERSTOCK/Orawan Pattarawimonchai]

This article is part of our special report Rethinking blood sustainability within the EU.

Patient blood management could be a way to address blood shortages as only a third of world patients receive enough transfusions, according to a health expert who also expressed concern that the forthcoming revision of the EU legislation on the topic will not properly address the issue.

Androulla Eleftheriou is the Executive Director at the Thalassaemia International Federation. She spoke to EURACTIV’s health reporter Giedrė Peseckytė on World Blood Donor Day on 14 June.

How important are blood transfusions for thalassemia patients?

Blood transfusion therapy constitutes the cornerstone of managing these patients, who, in the absence of management, develop multi-order severe complications that lead to early immature death. Therefore, lifelong transfusion of red blood cells is the cornerstone and the major pillar of managing these patients to keep them alive, surviving and improving their quality of life. In addition, a number of other medical protocols and treatments are required. 

As blood transfusion is needed throughout life, do all thalassemia patients get the blood they need in the EU and globally?

We have evidence to demonstrate that less than 30% of the global patient population is actually receiving an adequate amount of blood. And this is a major problem across the world. There are huge challenges in effectively addressing blood transfusion therapy, which is the cornerstone of disease management. 

What could be done to address this issue?

For us, it’s promoting tools and methodologies which would reduce the unnecessary use of blood in other conditions. For example, in anaemia and bleeding disorders, doctors and healthcare professionals could focus on improving the medical conditions before even considering providing blood transfusion. That indirectly benefits our patients because blood is being saved for these patients. Our patients live on blood. They are lifelong dependent on regular monthly blood transfusions to combat severe anaemia. 

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What about programs that address patient blood management?

Programs such as patient blood management, and the clinical use of blood, which have been promoted both by the European Commission and for many years now by the World Health Organisation through declarations, recommendations, and policy briefs, are important.

But what has been the case and what we are evidencing nowadays is that there are considerable gaps in the implementation. There is not enough awareness, not enough sensitisation of the governments, health care professionals, and transfusion services. There is no sharing of the best practices in some countries that have saved considerable resources, including financial, by applying appropriate patient blood management programs, such as in Australia and Italy. Sadly, only very few countries have grasped the idea and value of implementing patient blood management.

Talking about the EU legislation on blood, tissues and cells, what influence does it has on thalassemia patients?

In this directive, although there are a number of issues that relate to the scope of the organisation I represent, they are mostly related to safety and a call for more robust oversight that COVID has brought up. Our kind of concern is that this directive does not give enough attention to the pillar of adequacy in terms of, for example, patient blood management programs.

Although this directive has contributed significantly to improving safety and efficacy across the European countries for many years now, the gaps and some weaknesses have not been revisited for several years. We hope the directive will be finalised shortly. It was meant to be finalised by the end of 2021, but it appears that consultations and reviewing of consultations have probably delayed the finalisation of this directive. 

You mentioned that the directive does not give enough attention to patient blood management. How should this be addressed from your perspective?

Patient blood management is an aspect of adequacy that the directive does not considerably address or touch. It does mention a voluntary donation, but it does not say how we should strengthen this donation or how we should increase the adequacy of blood since many shortages are coming up with the increase of the use of transfusion in other medical disciplines.

And it does not touch those programs that would further contribute to adequacy because reducing unnecessary or inappropriate blood transfusion treatments contributes to the adequacy. Therefore, the pillar of adequacy finds us considerably concerned.

We feel that the Commission has ears in current years – and we are very pleased that there is an interaction, they listen to us, which is very helpful. And we feel that we can do much more.

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[Edited by Gerardo Fortuna]

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