What is the environmental impact of a blood transfusion? A life cycle assessment of transfusion services across England

Abstract Background Healthcare activities significantly contribute to greenhouse gas (GHG) emissions. Blood transfusions require complex, interlinked processes to collect, manufacture, and supply. Their contribution to healthcare emissions and avenues for mitigation is unknown. Study Design and Methods We performed a life cycle assessment (LCA) for red blood cell (RBC) transfusions across England where 1.36 million units are transfused annually. We defined the process flow with seven categories: donation, transportation, manufacturing, testing, stockholding, hospital transfusion, and disposal. We used direct measurements, manufacturer data, bioengineering databases, and surveys to assess electrical power usage, embodied carbon in disposable materials and reagents, and direct emissions through transportation, refrigerant leakage, and disposal. Results The central estimate of carbon footprint per unit of RBC transfused was 7.56 kg CO 2 equivalent (CO 2 eq). The largest contribution was from transportation (2.8 kg CO 2 eq, 36% of total). The second largest was from hospital transfusion processes (1.9 kg CO 2 eq, 26%), driven mostly by refrigeration. The third largest was donation (1.3 kg CO 2 eq, 17%) due to the plastic blood packs. Total emissions from RBC transfusion are ~10.3 million kg CO 2 eq/year. Discussion This is the first study to estimate GHG emissions attributable to RBC transfusion, quantifying the contributions of each stage of the process. Primary areas for mitigation may include electric vehicles for the blood service fleet, improving the energy efficiency of refrigeration, using renewable sources of electricity, changing the plastic of blood packs, and using methods of disposal other than incineration.