Anaemia is the world’s most prevalent disorder with more than 2.4 billion people affected. Evidence is mounting that anaemia has a negative impact on medical and surgical outcomes contributing to increased rates of morbidity, mortality and hospital length of stay. Therefore, timely diagnosis and more effective treatment of chronic anaemia will help both to improve overall patient outcomes and to relieve the pressure on Europe’s blood supply. The crisis caused by the COVID-19 pandemic underscores the importance of promoting and adopting innovative solutions and policy measures to make change happen, write Dr Androulla Eleftheriou, Dr Axel Hofmann and Prof Norbert Gattermann.
Dr Androulla Eleftheriou is the Executive Director of the Thalassaemia International Federation. Dr Axel Hofmann is visiting Professor at the Institute of Anaesthesiology at the University Hospital Zürich and Adjunct Associate Professor at the School of Medicine at the University of Western Australia. Prof Norbert Gattermann is Senior Consultant in the Department of Hematology, Oncology and Clinical Immunology and Managing Director of the University Cancer Centre at the Heinrich Heine University in Düsseldorf.
The majority of blood transfusions in Europe are used in chronic anaemia care
About 25 million blood transfusions are administered to patients every year throughout the European Union. What may come to mind to most people when thinking about blood transfusion is acute or emergency care. However, in reality around 2/3 of red blood cell transfusions are used in the medical care of anaemia related to chronic diseases such as blood, cancer, kidney and cardiovascular diseases.
For decades, clinicians almost exclusively relied on transfusions to save, extend and improve the lives of anaemic patients. However, and mainly on account of different levels of quality in transfusion practices for certain indications, transfusions may bring along negative effects for patients, healthcare systems and the society at large, including impaired quality of life, risks (acute or delayed) and potential complications (such as iron overload), threats of varying magnitudes to blood supplies (such as those seen during the pandemic) jeopardizing the health and quality of life of mainly transfusion-dependent patients, and substantial costs. Consequent to better medical care and improved public health services, the numbers of patients ageing is increasing and so is age-related anaemia, augmenting as a result the demand for blood, further stretching the blood supplies.
The COVID-19 pandemic is amplifying existing challenges in the blood ecosystem and medical care, and the need to rethink blood use, how to manage the patient’s own blood in an effort to improve patients’ outcomes, rather than resorting to donor blood in the first place
The pandemic has put severe strain on a blood supply system that is already under pressure. On the supply side, social distancing measures have significantly impaired blood donation drives, although blood donations are still possible and encouraged in many countries. Indeed, Stella Kyriakides, European Commissioner for Health and Food Safety, took the opportunity of the World Blood Donor Day on 14th June 2020 to stress the need and the value of blood donation.
Meanwhile, patients in need of regular blood transfusions have experienced limited or no access to transfusion care and specialists centres in many European countries due to the disruption caused by the pandemic and which has negatively affected basic standards of care for many chronic disease patients. Ongoing coping strategies, such as the postponement of non-urgent interventions and measures taken by blood establishments in most EU countries, seem to have ensured – temporarily – that supply has met demand. However these are not viable options in the long run and there is a clear need for long-term solutions.
The COVID-19 pandemic has brought to the surface the need to strengthen public health programmes and develop innovative approaches and tools to effectively address these challenges and support the sustainability of the European blood systems. One important step would be the development of harmonised, evidence-based, European clinical guidelines for Patient Blood Management (PBM), including elements for chronic diseases. These, complemented with relevant education of healthcare professionals, will contribute significantly to a more effective implementation of PBM guidance. There is clearly an unmet need for PBM roll out and for treatment options that may reduce the need for regular lifelong blood transfusions.
How EU legislation can support blood sustainability on the long-term
The political outlook is encouraging. The ongoing revision of the EU Blood Directive brings a timely opportunity to improve the landscape. The European Commission has already concluded that further measures are needed to ensure sufficiency and sustainability in blood supplies, that the existing legislation is outdated and that gaps and divergences exist at national level. The inclusion of PBM programmes to ensure a more appropriate blood demand/utilization is also clearly indicated. The revision of the Directive should now take a long-term approach to tackling these challenges further highlighted by the crisis.
An EU action plan on blood would provide a more effective coordination which is a key element in supporting the sustainability of the blood supply at the national and European levels, strengthening member states’ collaboration, supporting research into unmet needs and gaps while appropriately addressing emergency situations.
The recent report published by the multi-stakeholder initiative “Blood and Beyond” provides recommendations aiming to contribute to shaping future EU policy in this direction.
Finding a way forward: Learning from experience
Healthcare systems are more stretched than ever and optimising finite resources is crucial. Suddenly, the COVID-19 pandemic has added even more urgency, exemplifying the need for revisiting and strengthening relevant programmes and importantly for innovative approaches in all spheres of healthcare – including the management of both patients’ and donors’ blood.
Rethinking ways to optimise blood management in chronic diseases can contribute significantly to addressing sustainability and broader challenges, especially in times of infectious disease outbreaks and beyond.
Implementing learnings from this extraordinary situation resulting from COVID-19 will support systems to become more resilient and prepared for upcoming challenges, while putting patients’ interests at the heart of policies and actions.
Blood and Beyond is a multi-stakeholder initiative developed and funded by Celgene, now part of Bristol Myers Squibb, involving experts from the fields of haematology and blood management, nursing, patient advocacy, health economics and hospital management.