39 Past, present, and future of red blood cells expert mentioned a potentially successful hemoglobin oxygen carrier (Hemopure, HbO2 Therapeutics). One forecasting study created an additive model that predicted future demand would decrease, based on changes such as clinical developments.19 Expectation that future RBC demand will decrease but eventually stabilize Five (12%) experts overall, of which 5% with up to 20 years of experience compared to 17% with 21+ years, expressed their belief that RBC demand will continue decreasing but will eventually stabilize. This is due to one of two factors: the “minimum need” effect (the minimum level at which RBCs are needed for all patient groups) and the influence of demographics (which may buoy the decline): “I think with these other pressures you talked about, with increasing populations, maybe more with communities that might have a greater need for blood if they’ve got inherited blood disorders. I think we may see a bottoming out of the constant fall.” (International Expert 20). One study predicted that RBCs would continue declining until meeting a certain “threshold” and then increase again due to demographics.13 Expectation that RBC demand will stabilize as is Similarly, three (7%) Sanquin and international experts (one with up to 20 years of experience and two with 21+ years of experience) stated that they expect RBC demand to no longer decrease but simply stabilize within the coming years (even as soon as 5-10 years). Experts quoted that this is because the transfusion trigger and rate is already at the “lowest point” and will continue to remain this way. III. Unknown trends with miscellaneous transformational factors However, some experts shared several transformational factors they thought would be significant but were uncertain of the particular effect they would have on blood demand (Table 2.3). These experts, regardless of their years of experience, agreed upon the factors, with the exception of two instances, detailed below. The most cited factor was cultured red blood cells (cRBCs), mentioned by the majority of Sanquin experts (70%) and a sizeable minority of non-Sanquin (38%) and international experts (43%). Regardless of years of experience, more than 50% of both groups mentioned cRBCs, yet 48% of those with 21+ years of experience focused primarily on the barriers hindering cRBCs from becoming clinically viable (such as high cost and limited scalability), compared to 21% of those with less experience. However, a few experts confidently believed it would become successful due to the rapid pace
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