Vox Sanguinis (2011) 100, 10–21 ª 2010 The Author(s) Vox Sanguinis ª 2010 International Society of Blood Transfusion DOI: 10.1111/j.1423-0410.2010.01446.x
REVIEW
How much blood is needed? E. Seifried,1 H. Klueter,2 C. Weidmann,3 T. Staudenmaier,4 H. Schrezenmeier,4 R. Henschler,1 A. Greinacher5 & M. M. Mueller1 1
Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden-Wuerttemberg-Hessen and Clinics of the Johann Wolfgang Goethe University Frankfurt ⁄ Main, Frankfurt ⁄ Main, Germany 2 Institute for Transfusion Medicine and Immunology, German Red Cross Blood Donor Service Baden-Wuerttemberg-Hessen and Medical Faculty Mannheim, Heidelberg University, Germany 3 Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany 4 Institute for Clinical Transfusion Medicine, German Red Cross Blood Donor Service Baden-Wuerttemberg-Hessen and Ulm University Hospital, Ulm ⁄ Donau, Germany 5 Institute for Immunology and Transfusion Medicine, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany
Received: 21 July 2010, revised 22 October 2010, accepted 25 October 2010
Demographic changes in developed countries as their populations age lead to a steady increase in the consumption of standard blood components. Complex therapeutic procedures like haematopoietic stem cell transplantation, cardiovascular surgery and solid organ transplantation are options for an increasing proportion of older patients nowadays. This trend is likely to continue in coming years. On the other hand, novel aspects in transplant regimens, therapies for malignant diseases, surgical procedures and perioperative patient management have led to a moderate decrease in blood product consumption per individual procedure. The ageing of populations in developed countries, intra-society changes in the attitude towards blood donation as an important altruistic behaviour and the overall alterations in our societies will lead to a decline in regular blood donations over the next decades in many developed countries. Artificial blood substitutes or in vitro stem cellderived blood components might also become alternatives in the future. However, such substitutes are still in early stages of development and will therefore probably not alleviate this problem within the next few years. Taken together, a declining donation rate and an increase in the consumption of blood components require novel approaches on both sides of the blood supply chain. Different blood donor groups require specific approaches and, for example, inactive or deferred donors must be re-activated. Optimal use of blood components requires even more attention. Key words: adequate use of blood components, ageing of population, blood donors, consumption of blood products, population demographics.
Introduction Haemotherapy is an integral part of contemporary medicine. High-dose chemotherapy regimens for haematological Correspondence: Erhard Seifried, MD, Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden-Wuerttemberg-Hessen and Clinics of the Johann Wolfgang Goethe University Frankfurt ⁄ Main, Sandhofstrasse 1, 60528 Frankfurt ⁄ Main, Germany E-mail:
[email protected]
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and solid malignancies, haematopoietic stem cell (HSC) and solid organ transplantation as well as major surgery and modern trauma management would not be possible without supportive care including red blood cell (RBC) and platelet concentrate transfusion. Fresh frozen plasma (FFP) and plasma-derived pharmaceuticals are additional cornerstones in the therapy of bleeding disorders complicating surgical procedures as well as the clinical course in severe trauma or diseases. Since only few plasma-derived drugs can be manufactured using modern biotechnology, most of the standard
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blood components used today still fully rely on altruistic blood donation by healthy volunteers. Barriers to blood component supply and the timely provision of blood products are not topics for discussion in this article. However, logistics remains a relevant part of the work of today’s blood banks. More important for ensuring a sufficient supply of blood products is maintaining a stable balance between the blood donor population and patients needing transfusions. Demand for blood donation is driven by the consumption of standard blood components. While we discuss the current situation in developed countries only as well as potential changes in the future, we are aware that the rapidly developing and transitional countries with their major share of today’s global population and their tremendous economic growth will also face major challenges in blood supply as their medical systems develop on a fast track. However, the demographic characteristics and cultural frameworks in these countries differ considerably from those in the Western World. These topics require a separate discussion, which is not covered in this article.
Current status: Consumption of blood components in developed countries The World Health Organization (WHO) stated in 2009 [1] that more than 81 million units of blood are collected globally per year and an estimated maximum of 80 million units of RBC were transfused [1, 2]. Of all RBC transfused, 30 million units are consumed annually in Europe and Northern America. This is also reflected by the rate of blood donations per 1000 of the population per year in Europe and the USA. In 2006, the median rate in Europe was 43 blood donations per 1000 of the population with a first quartile of 37 and a third quartile of 55. Similar rates were observed for the USA. Within the group of developed countries, differences in annual RBC consumption per 1000 of the population can be detected. Ranging from
