36 Chapter 2 Literature also attests that this subgroup are indeed the dominant recipients of blood transfusions.14,16–18,31,42,43 Further, Dutch experts (3/42; 7%, all with up to 20 years of experience) shared that another reason is the increasing migrant population (including first- and second-generation migrants) with diseases of hemoglobinopathy and/or thalassemia. Studies on sickle cell patients record this increased demand due to increasing indications,44–46 while others state that optimal treatment for this patient group may be to increase transfusion usage.20,29 Furthermore, in the Netherlands, due to the TAPS (Transfusion Alternatives Preoperatively in Sickle Cell Disease) study,47 all Dutch patients with sickle cell disease having surgery under general anesthesia now are administered a preoperative transfusion, warranting more transfusion. Finally, two Dutch and international experts had observed a small rise in women undergoing a cesarean section and experiencing postpartum hemorrhage (PPH), although it seemed to be more prominent in the United States than in the Netherlands. Three studies on PPH highlight how this seems to be growing in high-income countries.48–50 II. Medium-term trends and contributing transformational factors When experts were asked to hypothesize trends in the medium-term future, four trends emerged: RBCs would increase, RBCs would decrease, RBCs would decrease but eventually stabilize, and RBCs will stabilize as is. For each trend, various transformational factors were given that would contribute to that trend. These are listed in Table 2.2.
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