How green is my blood?
Global warming and climate change can’t be ignored. As environmentally conscious citizens we need to be aware not only of our individual impact but also that of the organisations we work for or interact with.
Healthcare is a significant contributor to Australia’s greenhouse gas (GHG) emissions, representing around 7% of the annual total. In the year to September 2023 Australia was responsible for 459.7 million tonnes (Mt) CO2 eq of total emissions [1]. When viewed through the lens of environmental sustainability what impact does transfusion have on greenhouse gas emissions?
Blood transfusion is one of the most widely used therapies in medicine and requires a complex and resource intensive chain of processes. In a recent article published in the journal Transfusion, [2] Stephen Hibbs and colleagues describe how they analysed the carbon footprint of transfusion services in England and as a result were able to quantify the GHG emissions associated with red cell transfusion. The authors performed a ‘life cycle assessment’ (LCA) [3] of the whole collection to transfusion process and were able to estimate the relative proportions of GHG emissions at each of seven key stages, namely “donation, transportation, manufacturing, testing, stockholding, hospital transfusion, and disposal”.
The carbon footprint of one unit of red cells was estimated to be 7.56 kg CO2 equivalent (CO2 eq). Annualised, the total carbon footprint for red cell transfusion (1.4 million units annually) is 10.3 million Kg CO2 eq or approximately 0.05% of the 25 Mt CO2 eq total emission from the NHS in England.
The study identified the three biggest contributors to transfusion’s carbon footprint as transport (36%), hospital transfusion activities (26%) largely associated with refrigeration, and donation (17%) from use of plastic blood packs. The basic unit for the study was a standard unit of SAG-M RBC and did not include other products such as plasma, platelets, or specialised components.
The results are only valid for England and the relative proportions for each category and activities contributing most emissions to the overall total will inevitably vary for other services. For example, the article notes that the contributions of greater transport distances and GHGs from generation of electricity will obviously be higher in some countries. In Australia, its sheer size and range of climates creates numerous challenges to the collection, manufacture and distribution of blood and blood products. Transport, especially outside of metropolitan areas, requires movement of materials and people over large distances and using various modes of transport. With Australia’s extremes of climate one would also expect refrigeration and the cold chain and air-conditioning for ambient temperature management to be major sources of carbon emissions.
The study provides an elegant and valuable template for similar analysis by transfusion services elsewhere such as here in Australia. It’s important that blood and blood products are used appropriately, effectively and with minimal wastage. Initiatives such as patient blood management have resulted in fewer red cells (or other products) being used and will undoubtedly translate into in reducing emissions across the healthcare system. Alternative therapies such as iron infusions may similarly reduce red cell use, however the carbon footprint of new therapies need to be quantified and seen to offer a reduction in GHG emissions.
Lifeblood recognises sustainability as a key component of its duty of care to the environment and is committed to net-zero carbon emissions by 2050. While this is an ambitious target, since 2019 emissions generated from sources directly owned or controlled by Lifeblood or those generated by purchased electricity have reduced by 27%. These are well ahead of the 2025 target and on track for the 2030 target of 28% [4].
For its donor centres and processing centres, Lifeblood is focusing on using sustainable materials and incorporating ways to reduce energy usage including use of solar panels, energy efficient technology, purchasing electricity from renewable sources and commencing replacement of ageing heating, ventilation, and air conditioning systems. With transport being a major component of GHG emissions there may be opportunities to introduce electric vehicles. A significant ongoing issue is single-use plastics which are an important and inherent component of the transfusion chain but remain a major source of GHG emissions.
Reduction of GHG emissions can only occur if positive action is taken to act sustainably. The study of Hibbs et al shows how emissions across the transfusion chain can be quantified and in doing so identify opportunities for improvement. It’s important that we engage with our colleagues in the healthcare sector and suppliers to encourage them in minimising their carbon footprint. However, any changes must be made without compromising the quality and safety of patient care.
References
- Australian Government Department of Climate Change, Energy, the Environment and Water. Quarterly Update of Australia’s National Greenhouse Gas Inventory: September 2023.
Accessed at: https://www.dcceew.gov.au/climate-change/publications/national-greenhouse-gas-inventory-quarterly-updates - Hibbs SP, Thomas S, Agarwal N, Andrews C, Eskander S, Abdalla AS, et al. What is the environmental impact of a blood transfusion? A life cycle assessment of transfusion services across England. Transfusion. 2024. https://doi.org/10.1111/trf.17786
- Wikipedia. Life cycle assessment.
Accessed at: https://en.wikipedia.org/wiki/Life-cycle_assessment - Australian Red Cross Lifeblood Annual Report 2022-23.
Accessed at: https://www.lifeblood.com.au/about/our-strategy/annual-reports
Footnote
If you want to understand your own carbon footprint there are many online calculators available like this one from the charity Carbon Positive Australia.
