55 Past, present, and future of red blood cells Historical RBC trends Trend/Theme Drivers/Factors Definition Example quote Decreased demand of RBCs This code encompasses respondents who specified that red cells have declined in the past 20-25 years in a variety of specialties and settings. Although some of these respondents were not from the NL, their responses is also applicable to the Dutch situation (i.e. global statements). So red cells, I think, throughout the world, is decreasing. National guideline changes to reduced triggers This sub-code describes how national guidelines were changed to a lower transfusion trigger, which changed clinical practice, and reduced RBC demand. I think the guidelines have been changed. In the past, the doctors gave blood transfusion to people who got a little bit anemic. After the delivery, they gave, “Oh, your hemoglobin level is lower. It’s nice for you to have more blood.”. That is totally being changed, so the changing the guidelines, based on evidenced-based guidelines. PBM This sub-code describes Patient Blood Management, described as a set of principles, a movement, that caused growing awareness amongst physicians, amongst other things, to be careful with the amount of RBCs they use. I think a growing awareness of the concept of PBM but also--linked with that, but not the only thing—awareness of the risks of transfusion, that it’s not just infectious, but only the sense of stewardship that we have a sense of responsibility in looking after these products. Evidence: scientific This sub-code describes the scientific evidence that led to the change in transfusion triggers and guidelines, and ultimately led to a decrease in RBC demand. I think that’s due to trials showing that you can go much lower, and safely lower and lower Hb concentrations-- and maybe [even] better if you don’t transfuse in some settings.
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