How Does Climate Change Affect Hematology Practice? (with Dr Stephen Hibbs)

0:03Greetings 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?

0:40Yeah. 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.

1:15So 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.

1:43So 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.

2:24So 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.

3:14Can 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.

3:42So 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.

4:10So 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?

4:35And 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.

5:21And 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.

5:49So 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.

6:36And 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?

7:11It'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?

7:47I 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.

8:13Now 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.

9:07I 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.

9:37So 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.

10:01I 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.

10:26And 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.

11:18And 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.

11:49If 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.

12:33This 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.