Praiseldy Langi Sasongko

29 Past, present, and future of red blood cells 2.1 Introduction “Study the past if you would define the future.” Confucius Studying the past of blood transfusion in the past 25 years alone is a fascinating look into the expected and unexpected. In high-income countries, there have been many general changes, such as greater emphasis on safety and the implementation of various technologies.1–4 Simultaneously, there have been substantial specific changes in blood demand, such as the decline of red blood cells (RBCs). Literature documents this across the United States,5,6 Australia and New Zealand,7–9 and Western Europe.10–12 This decline is attributed to the singular and cumulative effects of patient blood management (PBM), blood-conserving surgical techniques, and alternative treatments for blood transfusion, to name a few.5–7,10,11,13 In the Netherlands, this decline has been especially prominent. Sanquin’s Blood Bank, the sole provider of blood products on a not-for-profit basis, has seen a 43% decrease of RBC demand from 1995 to 2017 (Figure 2.1). Van Hoeven et al.14 studied this decline from 1995 to 2005 and found various trends and suggested underlying reasons. While this study provided a glimpse of the changing blood transfusion landscape in the Netherlands, additional insights are needed to understand the trends and underlying drivers of RBC use in the Netherlands and in comparison to other high-income countries. This is the first step, as the opening quote suggests. Figure 2.1 RBC demand in the Netherlands from 1998 to 2017 showing a 43% decrease 200.000 300.000 400.000 500.000 600.000 700.000 800.000 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Number of units supplied Year

RkJQdWJsaXNoZXIy MTk4NDMw