Blood & Beyond is a European initiative funded by Celgene, which is a part of Bristol Myers Squibb (BMS). The project starts from the experience of patients, complemented by insights from numerous experts with expertise in haematology, blood management, nursing, health economics and hospital management. This initiative has now been further developed in Belgium, and aims to raise awareness of the impact of blood transfusion on patients, support networks, healthcare systems and the society at large. The overarching objective is to help advance policies and practices that improve patient outcomes by optimizing blood management and supporting innovation across Europe.

On Wednesday 24th March 2021, the virtual multi-stakeholder event “Blood & Beyond – Rethinking blood use” took place, gathering experts in hematology, patients, relevant medical professional associations, healthcare workers and Belgian policy makers. Jana Vanden Broeck (BeQuinT project coordinator – FPS Public Health) and Luc Crabbé (MDS patient) participated as speakers and Dr. Stef Meers (Hematology AZ Klina), Prof. Dr. Philippe Vandekerckhove (Red Cross Flanders) and Prof. Philippe Van Wilder (Health Economist ULB) as panelists. Federal Member of Parliament Gitta Vanpeborgh (Vooruit), concluded the event with some policy recommendations.

The event discussed the impact of blood transfusions on patients and their quality of life, on the healthcare system and society, as well as solutions to secure and optimize blood supply in Belgium. In addition, topics about how to reduce the dependency on transfusions and innovation were also addressed. The goal of the event was twofold: to provide suggestions and solutions for better blood management with regard to transfusion on the one hand and to make policy recommendations for reducing the impact of blood transfusion on the patient, the healthcare system and society on the other hand.

Patient Blood Management

In optimal blood management, Patient Blood Management (PBM) is an important factor. The Belgian Quality in Transfusion (BeQuinT) platform of the FPS Public Health contributes to this at national level. BeQuinT’s mission is to support Belgian hospitals in their transfusion and hemovigilance policy and thus to pursue an optimal and safe use of blood in Belgium. BeQuinT set up a survey in 2020 to measure and promote the implementation of PBM. This survey revealed that PBM is already on the agenda of transfusion committees (or PBM working groups) in almost ¾ of the Belgian hospitals, however, there is still room for improvement. Recommendations from BeQuinT aim to support hospitals in the implementation of PBM and therefore optimize care for patients who may be eligible for a blood transfusion.

Impact of blood transfusions on patients

The patient’s experience always takes central stage in blood transfusions, but the blood transfusion process also affects the patient. Based on a testimonial, we were told that getting blood transfusions involves various difficulties such as the long procedure, mispuncturing, bruising, pain, etc. In addition, blood transfusions as such also involve some risks. The infectious risks are almost non-existent in Belgium, but the immunological consequences should not be underestimated. Studies have shown that a liberal versus a more restrictive transfusion policy is associated with higher mortality in certain clinical contexts.

The entire panel recommends to limit blood transfusions in case an effective and cost-effïcient alternative exists, for the benefit of the patient. However, there are instances where a patient’s life is saved by receiving a transfusion, and for which there is no valid alternative.

The ultimate goal is to improve the impact of blood transfusions on the patient’s quality of life.

Solutions to secure and optimize blood supply in Belgium

It is an objective to optimize blood consumption. The ageing population and the increasing population currently don’t threaten the blood supply. The number of transfusions (of red blood cells) has already been decreasing by 2% to 3% per year since 1990, thanks to advances in medical technology. Therefore the pressure on the population to donate blood keeps on dropping. There is almost never a shortage of blood products for patients in Belgium.

One panel speaker cited that the cost of certain alternatives can be many times higher than the cost of blood(*,1). . The cost of blood transfusions to the community and to the patient covers several charges that go far beyond just the cost of blood itself. One way to assess the cost-effectiveness of blood transfusions is to conduct an economic analysis. Currently, blood is not evaluated for reimbursement in the same way as medication(*,2).  The economic analysis of medication and other technologies must also take into account other criteria such as the quality of life or impact on the patient, but also the effects and costs borne by the informal caregiver or loved ones assisting the patient, the impact on the patient’s functioning, on possible absenteeism, etc.

(*,1,2) The foregoing contains some generalities that Blood and Beyond will continue to explore with experts in the field. You will be able to follow this and other next steps by Blood and Beyond on the website.

Red blood cell substitutes are currently still not available, despite the fact that 30 years ago, experts predicted that this would be possible. In reality, it is difficult to produce substitutes that are not toxic.

 Call to action

Gitta Vanpeborgh (Vooruit) closed the event by noting that there is clearly a great deal of interest in this topic, which is currently underexposed. Based on information of the various stakeholders, the Commission for Health and Equal Opportunities will be able to look further into this. The solutions discussed will also be submitted to the Federal Minister of Health, Frank Vandenbroucke (Vooruit).

A special thanks to all speakers for their input during the webinar.