ASTUTE · Advanced Studies in Transfusion Epidemiology: Using ‘Big Data’ to safeguard the blood supply of the future

The lifetime risk of receiving a transfusion is almost 20%, meaning that close to 100 million EU citizens will receive a transfusion at some point in their lives. Consequently, the issue of blood transfusion safety—in a wide sense—are highly relevant for population health. It is therefore disconcerting that blood safety is often narrowly defined, focusing almost exclusively on the elimination of known transfusion-transmitted disease, ignoring donor health and failing to consider unconventional pathogens. In this comprehensive research program, proposing a series of Advanced Studies in Transfusion Epidemiology, I will lead research within four distinct work packages, first creating a nationwide vein-to-vein database, with detailed data on blood donors and transfused patients in Sweden between 1968 and 2023, linked to detailed outcomes registers, and then making a version of this database publicly available through anonymization. We will then exploit this database in a series of applied studies divided into three work packages. In the first of these, we will conduct a careful, hypothesis-based investigation where we follow-up a previous publication from my research group, showing possible transfusion transmission of an agent causing intracerebral hemorrhage, seeking to establish the etiology of these hemorrhages, and testing whether it might have been driven by transmission of amyloid β. In the second work package we will perform a series of studies of blood donor health, investigating aspects on donor health behavior, short term risks of donating blood, and the risks of negative intergenerational effects from the iron-depletion suffered by many female blood donors. Lastly, we will perform a comprehensive, phenome-wide study where we search for unknown transfusion-transmitted disease using both traditional epidemiological and state-of-the-art machine learning methods. Together, these tasks have the potential of making important gains for transfusion safety in Europe.