Transfusion in the year 2014
Each year, about 200,000 erythrocyte concentrates are administered to between 50,000 and 60,000 patients in Norwegian hospitals (6, 7). The majority of patients are elderly individuals with anaemia due to neoplastic or other chronic diseases (6). In 2012, a total of 24,508 platelet concentrates were transfused (7), the majority probably in association with myelosuppressive chemotherapy. At Oslo University Hospital, 1,525 patients received 8,871 platelet concentrates in 2012 (unpublished data), and it can therefore be assumed that 4,000 – 5,000 patients received platelet concentrates nationwide. The number of patients who receive plasma products has not been studied, but haemorrhagic conditions and immune disorders probably represent the largest diagnostic groups in need of such treatment.
Based on product prices at the Oslo Blood Bank in 2013, products from Norwegian blood banks are worth an estimated 600 – 700 million NOK per year. The international industry supplying products and services related to transfusion is worth many billions (8). Globally, more than 100 million units of 450 ml whole blood are collected (9) and approximately 40,000 tons of plasma are fractionated (G. Zerlauth, Baxter GmbH, personal communication, 2011). The transfusion service has become an important global player.
Blood banks meet clinician-defined needs, but often the indications for and results of transfusions are not documented in a satisfactory manner (6). This may suggest that the decision to transfuse is not always adequately thought through. This is not new; as early as 1985, Heistø suggested (10) that the clinical use of blood products often occurred on insufficient grounds.
This assumption is supported by the significant differences in transfusion practices seen between comparable countries and hospitals (11) – (13). Among the Nordic countries, Norway has the lowest use of erythrocytes for transfusion in relation to population size, but has long had higher levels of use than, for example, the Netherlands, which has moreover reduced its use by more than 20 % since the turn of the millennium (14). In Norway, a continuous increase in use has now turned into a slight decrease (7), despite an ageing population.
High dose intravenous immunoglobulin (IVIG) can alter, or «modulate», an unwanted immune response, and is attempted as a treatment for many otherwise intractable conditions. While for certain disorders this treatment must now be considered established, the evidence base is often weak (16). In Norway and other Western countries, use of IVIG increased greatly after the start of the millennium. By 2009, use had reached levels beyond what could be achieved with plasma collected domestically. Norway's system of self-sufficiency for plasma products had to be discontinued. Instead, Norwegian plasma is now sold to the European commercial plasma industry, which then delivers desired products back in accordance with contracts with regional health authorities (17). This also includes plasma from paid donors.
Norway has approximately 100,000 volunteer, unpaid blood donors. These individuals satisfy what are probably the world’s most stringent selection criteria, and safety for patients is excellent (18). Voluntary, unpaid blood donation began in the Allied countries during World War II as a way for the civilian population to support the fight for a free society (8). Donating blood voluntarily and without pay is a reflection of socio-ethical values (19). A secondary rationale is that volunteer, unpaid blood donors may be less susceptible to blood-transmissible infections than paid donors (20), although such differences are not always evident (21). International organisations advise member states to remain self-sufficient in blood and plasma products with the help of volunteer, unpaid donors (17), also to prevent the commercialisation of human tissue (22). The Norwegian transfusion service is working to restore the balance between blood donation and blood use with the help of such volunteer, unpaid donors (17).