Greetings and welcome to EHA Unplugged, the official podcast
channel of the European Hematology Association EHA.
I'm Sarah Deflecker and I'm here today in London with Steven
Hibbs. Steven, would you please
introduce yourself? Yeah, sure.
So I'm up the road in London, in East London.
I'm a hematology registrar and a clinical research fellow, mostly
researching sickle cell disease care, but here to talk about
something different. Yeah.
So we're here to talk really about the environmental impacts
of hematology. But before we get into that, how
do you see that climate change is impacting hematology already?
Yeah. So I think there's probably
often a conversation about climate change that thinks this
is something that's going to happen in the future and it can
be sort of end of the world scenarios.
And those are real, you know, those are real.
But I think what's often missed is that climate change is
happening now and the effects of it are now.
Probably one really important thing to say before I answer
that directly is that the the worst effects of climate change
are felt by those who've contributed least to emissions
and who are least equipped to to deal with those consequences
because they're in parts of the world that have already been
impoverished by the way the global financial system works.
So that's really important just to say to start with.
And so many of our colleagues who listen to this in countries
like the Maldives or Bangladesh or around the Sahara will know
far better than any of us do that climate change is real and
it's happening now. But I think for those of us who
perhaps have felt less of the impact of that so far, we're
going to start seeing it in these big ways.
But perhaps it's just worth pointing out a few ways in which
this is affecting specific parts of hematology practice.
So I'll give a couple of examples.
When we think about blood transfusion, one key part is to
ensure blood safety, thinking about transfusion transmitted
infections. But something that we're seeing
is that as climate changes, the vectors that spread particular
diseases that can be transmitted in infections change.
So West Nile virus is a good is a good example of that.
That's already changing and we'll see more of this in the
years to come. That's perhaps more of an
obvious consequences of things as well, like disruption to
logistical lines or some mass casualty events from severe
weather events. Those are the sort of obvious
things, but I think there's going to be an awful lot of
things that are less predictable as well.
So one really good example of this paper published earlier
this year in Lancet Planetary Health, showed that mothers who
exposed to extreme heat in the first trimester pregnancy, their
children were significantly more likely to go on to develop acute
lymphoblastic leukaemia. Now, I could not have predicted
about that, but that is not, to me, a an obvious link.
And I still don't think anyone fully understands what that is.
But I think it's a good example of how because systems are so
interconnected, all of the planetary health of humans, but
also animals, plants, every part of the planet is deeply
interconnected. And we're going to see many,
many ways in the coming decades in which hematology practices
that we take for granted are going to be affected and
disrupted by climate change. And you've been doing some
research into the impact of hematology on climate change.
Can you maybe sort of tell our audience what you've been
looking into? Yeah.
So just take a bit of brief background.
Healthcare related activities contribute 5% of global
emissions. So of all CO2 emissions from
anything in the world, 5% of it is related to healthcare.
It's quite a big amount and there's a method called life
cycle assessment which is looking at cradle to grade
assessments of a particular practice or a particular item.
So it's originally developed in construction, but it can be
applied to healthcare activities.
So if I start with what kind of inspired the work and then I'll
move on to transfusion. And there's been some really
practice changing work looking at things like anaesthetic gases
and inhalers that showed that you could take an anaesthetic
gas that does exactly the same thing.
So there's one called desflorine does exactly the same thing as
something called Seba fluorine, but the first has 26 times the
environmental impact of the 2nd. And so the first has now been
outlawed, reduced from practice, removed altogether and Seba
fluorine is used instead. And the same with moving from
one type of inhaler to another type.
So we wanted to ask the question, well, what about in
hematology practices? And specifically we were looking
at transfusions. Was there a sort of smoking gun
that we could identify to say there's something about the way
in which we're collecting or processing or giving blood
transfusions that could quickly be changed and lead to a
reduction in its impact? So we wanted to ask the
questions, what is the impact of a blood transfusion on the
environment in terms of its carbon emissions?
And secondly, we wanted to ask the question where along the
cycle are those emissions generated and what can we do
about it? So it's a cut.
Long story short, a lot of work went into it.
We collaborated with some environmental engineers based in
in America, lots of people throughout NHS blood and
transport plant in the UK measured many machines, many
chemicals, many tests, looked at transport surveys, even metered
fridges and how much electricity they were used to come up with
an overall figure. And So what I can tell you is
that one unit of red blood cells in England generates about 7 1/2
kilograms of CO2 equivalent, and most of that is transportation,
refrigeration and the plastic blood bags themselves.
And you said that this is in England.
Do you think that this is, you know, can we extrapolate from
this to other geographies as well?
So I think there's a few factors that are going to change things
in different places. So one is what's the electricity
generation mixes in that country?
So the UK has actually moved a lot to things like wind energy,
renewable energy. And so actually the amount of
carbon that's generate that's that's used to generate
electricity in the UK is quite small compared to a lot of other
countries where it could be two or three times bigger.
So that's one factor we've got to think about.
Another is the distance is involved.
So if you're in a blood system, so your blood provider who's
providing over a huge kind of rural area or area where there's
just big distances, then it's going to go up there and NHS
blood and transplant the UK or sorry, the England's blood
provider, they've already done quite a lot of work to do things
like move to an electrified transport, transport fleet.
And so I think all of those things mean that I expect the
other, the other blood providers might find that their red blood
cells generate even more carbon. I guess another question here
is, well, what is 7 1/2 kilograms of CO2 equivalent,
right? Because we're not used to
dealing with this particular unit.
And I find it really hard to answer that question because
depending on the answer I give you, it really sounds more or
less significant. So I could tell you that it's
about the equivalent of 100 COVID tests.
Sounds quite a lot, You know, you think, well, that's, that's,
that's a decent amount. I could also tell you that it's
an 8 oz beef steak in a higher welfare cow or that you'd for
one person going to an international hematology
conference. So flying out to ASH or AABB or
whatever. The amount of emissions
generated by that trip is the same as 150 red blood cell
transfusions. So what do you say?
It's significant, but modest compared to some other things.
I read somewhere that it's equivalent to about driving 40
kilometers in a, you know, in a petrol car.
So what would you say to people who say, well, you know, what's
the harm in that? It's it, you know, it's a life
saving procedure in many cases, yeah.
Yeah. I mean, in no way is anything
we're trying to say we should use less blood on the basis of
its environmental impact. I guess it's more saying are
there are there clear ways in which we can reduce the we can
reduce now the impact that it does generate?
I think when we, when we think about the scale of one blood
transfusion, it's not very much. But when we, when we sort of
scaled it up to 1.3 million units transfused each year, it
really does start to become a significant amount.
And so any saving that can be made across that is significant.
I think that some of the things actually might be quite
practical, like modernizing fridges or consolidating things
into one larger fridge rather than several smaller fridges is
1 quite practical thing that can be done.
Now we need to look at some of the plastic that's used in the
blood bags that could improve things as well.
But I think that the other thing here is that actually what this
method shows us is that there's many other practices in
hematology, transfusion and elsewhere where we might also
apply such a method. Is there any indication on, you
know where that might lie within hematology at this point?
So it's not been done very much so far.
A colleague of mine in in Harvard, Andrew Hantel, has
looked a bit at doing remote or local consultations for cancer
follow up rather than bringing people into centres some of the
far away from their homes. There's a little bit of work
looking at things like for blood counts and basic other
hematology tests, but I think there's some really important
work to be done looking at things like anticoagulation
strategies. There really might be quite
significant carbon footprint there that we've not seen.
I think when we think about transfusion, some of the frozen
products we use, So if you put plasma in a freezer for two
years, there's a huge amount of electricity generation and also
refrigerant leakage there. Where now we've got
possibilities of things like freeze dried products that don't
need to be kept in a freezer that whole time.
There really might be a significant saving there to
make. So I think quoting Antonio
Guterres, who's the UN secretary general, he says when we think
about the climate, when we think about climate change, it needs
to be Everything, Everywhere, all at once.
So are there any things that like an individual hematologist
can do in order to reduce their impact?
I think probably some of the stuff that makes sense already
in when we think about economic and just patient care, things
like challenging tests that don't make sense.
I think reducing waste is going to be a big one.
I think probably thinking about some of our professional
practices as well. I mentioned things like
international conferences and meetings.
I think there's, there's been some good suggestions about
maybe using hub and spoke models rather than bringing everyone in
the world to 1 central place. Could we have a few smaller
local gatherings that then link in in different ways that that
could be big? I think also just looking up at
some of the things like our organisations we work for, I can
say because I've already spoken to people on the E Hard board
that E Hard does not have any investments in fossil fuels, but
actually a lot of organisations might.
And so looking at the organisations that you're part
of to see the impact they have. So I think the final thing I'd
say is that if it's if there's someone who's listening to this
and who is interested in the research aspect of this, there
is a huge amount of work to be done to understand what our
footprint even is and to look for some strategies how we might
reduce that. You're obviously very passionate
about this. Why should other hematologists
get passionate about this? For those who haven't looked at
the sort of wider conversation on climate change, it might seem
quite a niche issue. I think for those who have
looked at the sort of wide issues about climate change, it
can be overwhelming. We're really looking at, you
know, possibilities of millions of people dying within the next
couple of decades of man made climate change.
And for me, I can often feel a bit overwhelmed by that and feel
a bit paralyzed. Just it's too big, it's
happening. What what can we do?
I think what's not talked about enough are some of the good news
stories and a question that I really like that one of my
favorite podcasts about climate change often says is what would
it look like for this to go right?
What if, what if this goes right?
And I think leading on from that question, if we look at some of
the good news, like I think last week, the last ever coal power
generation in the UK was shut down after 142 years of coal
power. That's happened.
If we look at the last three years in the UK, we've gone from
15% of electricity as wind power to 35%.
I mean, there's incredible upscale and there's incredible
good news stories around the world.
I mentioned about anesthetic gases, I mentioned about
inhalers. I think that it is possible it
might not happen. We might fail, we might face
human extinction in the next decade, in the next century.
That that is a possibility. But I think part of the reason
about being about really trying to think about what we can do
with as hematologists is both about feeling like we've got
some agency, some power in this, but also about as, as Antonio
Gutierrez says, being part of that, Everything Everywhere all
at once. OK, thank you very much.
This is a very interesting conversation and I implore our
listeners to have a look into this in their own time and look
up some of the research and the position papers that have
already been published on this. Thank you, Steven for being here
with us today and TuneIn for the next episode of EHA Unplugged.