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

• 0:03
  Greetings and welcome to EHA Unplugged, the official podcast
• 0:07
  channel of the European Hematology Association EHA.
• 0:12
  I'm Sarah Deflecker and I'm here today in London with Steven
• 0:15
  Hibbs. Steven, would you please
• 0:17
  introduce yourself? Yeah, sure.
• 0:19
  So I'm up the road in London, in East London.
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  I'm a hematology registrar and a clinical research fellow, mostly
• 0:26
  researching sickle cell disease care, but here to talk about
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  something different. Yeah.
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  So we're here to talk really about the environmental impacts
• 0:34
  of hematology. But before we get into that, how
• 0:37
  do you see that climate change is impacting hematology already?
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  Yeah. So I think there's probably
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  often a conversation about climate change that thinks this
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  is something that's going to happen in the future and it can
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  be sort of end of the world scenarios.
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  And those are real, you know, those are real.
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  But I think what's often missed is that climate change is
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  happening now and the effects of it are now.
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  Probably one really important thing to say before I answer
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  that directly is that the the worst effects of climate change
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  are felt by those who've contributed least to emissions
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  and who are least equipped to to deal with those consequences
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  because they're in parts of the world that have already been
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  impoverished by the way the global financial system works.
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  So that's really important just to say to start with.
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  And so many of our colleagues who listen to this in countries
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  like the Maldives or Bangladesh or around the Sahara will know
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  far better than any of us do that climate change is real and
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  it's happening now. But I think for those of us who
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  perhaps have felt less of the impact of that so far, we're
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  going to start seeing it in these big ways.
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  But perhaps it's just worth pointing out a few ways in which
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  this is affecting specific parts of hematology practice.
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  So I'll give a couple of examples.
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  When we think about blood transfusion, one key part is to
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  ensure blood safety, thinking about transfusion transmitted
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  infections. But something that we're seeing
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  is that as climate changes, the vectors that spread particular
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  diseases that can be transmitted in infections change.
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  So West Nile virus is a good is a good example of that.
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  That's already changing and we'll see more of this in the
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  years to come. That's perhaps more of an
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  obvious consequences of things as well, like disruption to
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  logistical lines or some mass casualty events from severe
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  weather events. Those are the sort of obvious
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  things, but I think there's going to be an awful lot of
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  things that are less predictable as well.
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  So one really good example of this paper published earlier
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  this year in Lancet Planetary Health, showed that mothers who
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  exposed to extreme heat in the first trimester pregnancy, their
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  children were significantly more likely to go on to develop acute
• 2:38
  lymphoblastic leukaemia. Now, I could not have predicted
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  about that, but that is not, to me, a an obvious link.
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  And I still don't think anyone fully understands what that is.
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  But I think it's a good example of how because systems are so
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  interconnected, all of the planetary health of humans, but
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  also animals, plants, every part of the planet is deeply
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  interconnected. And we're going to see many,
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  many ways in the coming decades in which hematology practices
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  that we take for granted are going to be affected and
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  disrupted by climate change. And you've been doing some
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  research into the impact of hematology on climate change.
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  Can you maybe sort of tell our audience what you've been
• 3:17
  looking into? Yeah.
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  So just take a bit of brief background.
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  Healthcare related activities contribute 5% of global
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  emissions. So of all CO2 emissions from
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  anything in the world, 5% of it is related to healthcare.
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  It's quite a big amount and there's a method called life
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  cycle assessment which is looking at cradle to grade
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  assessments of a particular practice or a particular item.
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  So it's originally developed in construction, but it can be
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  applied to healthcare activities.
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  So if I start with what kind of inspired the work and then I'll
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  move on to transfusion. And there's been some really
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  practice changing work looking at things like anaesthetic gases
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  and inhalers that showed that you could take an anaesthetic
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  gas that does exactly the same thing.
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  So there's one called desflorine does exactly the same thing as
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  something called Seba fluorine, but the first has 26 times the
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  environmental impact of the 2nd. And so the first has now been
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  outlawed, reduced from practice, removed altogether and Seba
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  fluorine is used instead. And the same with moving from
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  one type of inhaler to another type.
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  So we wanted to ask the question, well, what about in
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  hematology practices? And specifically we were looking
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  at transfusions. Was there a sort of smoking gun
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  that we could identify to say there's something about the way
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  in which we're collecting or processing or giving blood
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  transfusions that could quickly be changed and lead to a
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  reduction in its impact? So we wanted to ask the
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  questions, what is the impact of a blood transfusion on the
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  environment in terms of its carbon emissions?
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  And secondly, we wanted to ask the question where along the
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  cycle are those emissions generated and what can we do
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  about it? So it's a cut.
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  Long story short, a lot of work went into it.
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  We collaborated with some environmental engineers based in
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  in America, lots of people throughout NHS blood and
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  transport plant in the UK measured many machines, many
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  chemicals, many tests, looked at transport surveys, even metered
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  fridges and how much electricity they were used to come up with
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  an overall figure. And So what I can tell you is
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  that one unit of red blood cells in England generates about 7 1/2
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  kilograms of CO2 equivalent, and most of that is transportation,
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  refrigeration and the plastic blood bags themselves.
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  And you said that this is in England.
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  Do you think that this is, you know, can we extrapolate from
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  this to other geographies as well?
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  So I think there's a few factors that are going to change things
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  in different places. So one is what's the electricity
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  generation mixes in that country?
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  So the UK has actually moved a lot to things like wind energy,
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  renewable energy. And so actually the amount of
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  carbon that's generate that's that's used to generate
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  electricity in the UK is quite small compared to a lot of other
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  countries where it could be two or three times bigger.
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  So that's one factor we've got to think about.
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  Another is the distance is involved.
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  So if you're in a blood system, so your blood provider who's
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  providing over a huge kind of rural area or area where there's
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  just big distances, then it's going to go up there and NHS
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  blood and transplant the UK or sorry, the England's blood
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  provider, they've already done quite a lot of work to do things
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  like move to an electrified transport, transport fleet.
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  And so I think all of those things mean that I expect the
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  other, the other blood providers might find that their red blood
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  cells generate even more carbon. I guess another question here
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  is, well, what is 7 1/2 kilograms of CO2 equivalent,
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  right? Because we're not used to
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  dealing with this particular unit.
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  And I find it really hard to answer that question because
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  depending on the answer I give you, it really sounds more or
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  less significant. So I could tell you that it's
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  about the equivalent of 100 COVID tests.
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  Sounds quite a lot, You know, you think, well, that's, that's,
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  that's a decent amount. I could also tell you that it's
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  an 8 oz beef steak in a higher welfare cow or that you'd for
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  one person going to an international hematology
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  conference. So flying out to ASH or AABB or
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  whatever. The amount of emissions
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  generated by that trip is the same as 150 red blood cell
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  transfusions. So what do you say?
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  It's significant, but modest compared to some other things.
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  I read somewhere that it's equivalent to about driving 40
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  kilometers in a, you know, in a petrol car.
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  So what would you say to people who say, well, you know, what's
• 7:27
  the harm in that? It's it, you know, it's a life
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  saving procedure in many cases, yeah.
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  Yeah. I mean, in no way is anything
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  we're trying to say we should use less blood on the basis of
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  its environmental impact. I guess it's more saying are
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  there are there clear ways in which we can reduce the we can
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  reduce now the impact that it does generate?
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  I think when we, when we think about the scale of one blood
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  transfusion, it's not very much. But when we, when we sort of
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  scaled it up to 1.3 million units transfused each year, it
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  really does start to become a significant amount.
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  And so any saving that can be made across that is significant.
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  I think that some of the things actually might be quite
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  practical, like modernizing fridges or consolidating things
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  into one larger fridge rather than several smaller fridges is
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  1 quite practical thing that can be done.
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  Now we need to look at some of the plastic that's used in the
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  blood bags that could improve things as well.
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  But I think that the other thing here is that actually what this
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  method shows us is that there's many other practices in
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  hematology, transfusion and elsewhere where we might also
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  apply such a method. Is there any indication on, you
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  know where that might lie within hematology at this point?
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  So it's not been done very much so far.
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  A colleague of mine in in Harvard, Andrew Hantel, has
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  looked a bit at doing remote or local consultations for cancer
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  follow up rather than bringing people into centres some of the
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  far away from their homes. There's a little bit of work
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  looking at things like for blood counts and basic other
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  hematology tests, but I think there's some really important
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  work to be done looking at things like anticoagulation
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  strategies. There really might be quite
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  significant carbon footprint there that we've not seen.
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  I think when we think about transfusion, some of the frozen
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  products we use, So if you put plasma in a freezer for two
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  years, there's a huge amount of electricity generation and also
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  refrigerant leakage there. Where now we've got
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  possibilities of things like freeze dried products that don't
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  need to be kept in a freezer that whole time.
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  There really might be a significant saving there to
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  make. So I think quoting Antonio
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  Guterres, who's the UN secretary general, he says when we think
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  about the climate, when we think about climate change, it needs
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  to be Everything, Everywhere, all at once.
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  So are there any things that like an individual hematologist
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  can do in order to reduce their impact?
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  I think probably some of the stuff that makes sense already
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  in when we think about economic and just patient care, things
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  like challenging tests that don't make sense.
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  I think reducing waste is going to be a big one.
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  I think probably thinking about some of our professional
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  practices as well. I mentioned things like
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  international conferences and meetings.
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  I think there's, there's been some good suggestions about
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  maybe using hub and spoke models rather than bringing everyone in
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  the world to 1 central place. Could we have a few smaller
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  local gatherings that then link in in different ways that that
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  could be big? I think also just looking up at
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  some of the things like our organisations we work for, I can
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  say because I've already spoken to people on the E Hard board
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  that E Hard does not have any investments in fossil fuels, but
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  actually a lot of organisations might.
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  And so looking at the organisations that you're part
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  of to see the impact they have. So I think the final thing I'd
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  say is that if it's if there's someone who's listening to this
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  and who is interested in the research aspect of this, there
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  is a huge amount of work to be done to understand what our
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  footprint even is and to look for some strategies how we might
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  reduce that. You're obviously very passionate
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  about this. Why should other hematologists
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  get passionate about this? For those who haven't looked at
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  the sort of wider conversation on climate change, it might seem
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  quite a niche issue. I think for those who have
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  looked at the sort of wide issues about climate change, it
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  can be overwhelming. We're really looking at, you
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  know, possibilities of millions of people dying within the next
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  couple of decades of man made climate change.
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  And for me, I can often feel a bit overwhelmed by that and feel
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  a bit paralyzed. Just it's too big, it's
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  happening. What what can we do?
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  I think what's not talked about enough are some of the good news
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  stories and a question that I really like that one of my
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  favorite podcasts about climate change often says is what would
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  it look like for this to go right?
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  What if, what if this goes right?
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  And I think leading on from that question, if we look at some of
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  the good news, like I think last week, the last ever coal power
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  generation in the UK was shut down after 142 years of coal
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  power. That's happened.
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  If we look at the last three years in the UK, we've gone from
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  15% of electricity as wind power to 35%.
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  I mean, there's incredible upscale and there's incredible
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  good news stories around the world.
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  I mentioned about anesthetic gases, I mentioned about
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  inhalers. I think that it is possible it
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  might not happen. We might fail, we might face
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  human extinction in the next decade, in the next century.
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  That that is a possibility. But I think part of the reason
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  about being about really trying to think about what we can do
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  with as hematologists is both about feeling like we've got
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  some agency, some power in this, but also about as, as Antonio
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  Gutierrez says, being part of that, Everything Everywhere all
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  at once. OK, thank you very much.
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  This is a very interesting conversation and I implore our
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  listeners to have a look into this in their own time and look
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  up some of the research and the position papers that have
• 12:42
  already been published on this. Thank you, Steven for being here
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  with us today and TuneIn for the next episode of EHA Unplugged.