Focus on optimal use is key to not waste blood in ‘vein’, say experts

In the EU, France is not the only country hit by a decline in blood supplies due to the Covid-19 pandemic. Most of the countries are.  [iPreech Studio/Shutterstock]

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

Health experts and European lawmakers suggest that new approaches to blood use could have ‘healing’ effects on the EU’s blood supply recently put under additional pressure due to the COVID pandemic.

Blood reserves in some EU countries are at their lowest, such as France, where the national blood establishment (EFS) called in December for donations from citizens to replenish stocks ahead of the winter season.

“Due to the particularly deteriorated health context [of COVID-19] today, 115,000 are needed”, the EFS warned in a press release on 6 December.

This is a consequence of blood donors being forced to stay home because of restrictions – something only partially compensated by decreased blood demand as surgical procedures declined during the pandemic.

But some health experts have chosen to search for new perspectives in blood use that could help reduce the pressure on the blood supply.

The new approaches start from shifting the focus away from blood supply toward optimal blood use. “We have to really think in terms of ‘Is it really needed?’ Need and demand are two different things,” said Axel Hofmann, a professor at University Hospital Zurich, during an online event.

During the panel, stakeholders and policymakers discussed solutions to current challenges in patient blood management (PBM), starting from the lessons learnt from the COVID crisis.

“COVID-19 is, of course, a threat, but on the other hand, it is a once in a lifetime chance to use the insights we have gained so far to build up a good Patient Blood Management (PBM) programme and implement this into daily clinical practice”, said Jens Meier, an anesthesiologist in intensive care.

This is a view shared by Portuguese socialist MEP Manuel Pizarro who sees the revision of the EU Blood directive as “a unique opportunity to initiate a broader reflection on how to improve blood sustainability and use in Europe, beyond the issues of availability, quality and safety of blood and components.”

A window of opportunity

Scientists who intervened in the event proposed the inclusion of the concept of Patient Blood Management (PBM) – a standard of care defined by the World Health Organisation (WHO) to optimise medical and surgical patients outcome – in the future revision of the EU Blood directive.

The Commission is currently overhauling blood, tissue, and cells legislation. The first step involved the publication of a roadmap describing the initiative and collecting first feedback from stakeholders, authorities and citizens.

Then, the Commission opened a stakeholder consultation, which closed last April, that received more than 370 submissions.

“The WHO expects that the revised EU Blood Directive will state the need and importance of PBM as an effort to ensure patient safety and availability of blood for transfusions”, said Yuyun Maryuningsih, a transfusion medicine expert.

Although the WHO and the Commission have developed standard guidelines to support health authorities in developing PBM, a gap among member states persists.

According to Croatian Christian-democrat MEP Tomislav Sokol, the new European Health Union framework can offer the opportunity to include blood management as “a key component of healthcare systems” into the forthcoming health legislation.

In this context, many pointed out that the EU must strengthen its role in ensuring blood sustainability, with Romanian centre-right MEP Cristian Bușoi stressing the importance of data collection and an updated registry to answer blood demands for patients better and avoid shortages.

“There is a need for EU funding to support the adaptation of healthcare systems to evidence-based clinal practice, including PBM, while at the same time help improve standards of transfusion care uniformly across Europe”, he added.

Education for patient (and professionals)

Apart from exchanging good practices and pooling expertise in optimal blood use, the EU can also have a role in promoting education efforts.

“I think what the Commission and all the bodies within the public health sector could help with really promoting the education of the patients,” explained Hofmann.

He added that sometimes patients do not know that other options exist and are less attentive regarding bleeding events.

“[Health] education should go even beyond the healthcare professionals; it should be something like a more general public awareness on how important it is that everyone looks after his own or her own,” he said.

According to Androulla Eleftheriou from the Thalassemia International Federation, awareness and education are the only way to have knowledgeable patients who understand complex concepts such as PBM to be the best advocates and the best supporters of these programs.

She added that education is also needed for healthcare professionals as they need to align with the patient community to find innovative programs to serve them better.

[Edited by Alice Taylor]

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