33 Past, present, and future of red blood cells (effectiveness). Ultimately, this resulted in shifting public and medical perspectives, as reflected in experts’ phrases, from “blood is always lifesaving” so that it is “given like lemonade” to “blood is bad!” Forty-one articles (41/107; 38%) mentioned or thoroughly described this historical decline and its subsequent effects. Within these 41 articles, safety and cost were common drivers, with 27 articles mentioning safety, 18 mentioning cost, and 15 articles mentioning both cost and safety. Experts further outlined other drivers, which were grouped under three categories: 1) lowered transfusion thresholds, 2) surgical techniques and pharmacologic agents, and 3) organizational changes. These categories were often interlinked. Table 2.1 Characteristics of interviewed experts Respondent characteristics From the Netherlands International (%) Total (% of total) Sanquin (%) Non-Sanquin (%) Total number (% of total) 20 (48) 8 (19) 14 (33) 42 (100) Female (% within subgroup) 11 (55) 3 (38) 5 (36) 19 (45) Functions Researcher only 1 0 0 1 (2) Researcher-clinician/clinical background 5 2 2 9 (21) Management only 4 0 0 4 (10) Researcher-management 8 0 3 11 (26) Researcher-clinician-management 3 5 9 17 (40) Years of experience 0-10 4 2 0 6 (14) 11-20 7 4 2 13 (31) 21-30 7 0 6 13 (31) 30+ 3 1 6 10 (24) Clinical specialties represented Anesthesiology, cardiothoracic surgery, hematology, intensive care, obstetrics and gynecology, neonatology, pediatric hematology Countries Australia, Canada, Denmark, France, Germany, Netherlands, Singapore, United Kingdom, United States In the first category, the majority of experts stated that the decline was due to the lowered transfusion thresholds, linked to evidence and awareness of transfusion’s adverse reactions. Overall, 74% of experts with up to 20 years of experience in blood transfusion, compared to 52% who had 21+ years of experience, attested to the lowered transfusion thresholds. More specifically, nearly all (90%) Dutch experts stated the Dutch national guidelines on transfusion thresholds (4:5:6 mmol/L as measured
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