|Year : 2020 | Volume
| Issue : 1 | Page : 39-44
Analysis of blood and blood components wastage in a tertiary care hospital in South India
Kingsley Simon1, Marie Moses Ambroise2, Anita Ramdas2
1 Department of Transfusion Medicine, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India
2 Department of Pathology, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India
|Date of Submission||27-Feb-2020|
|Date of Decision||31-Mar-2020|
|Date of Acceptance||16-Apr-2020|
|Date of Web Publication||20-Jul-2020|
No. 83, Vaigai Street, Vasantham Nagar, Arumparthapuram 605 110, Puducherry
Source of Support: None, Conflict of Interest: None
Objectives: The aim of the study is to determine the rate and reasons for blood and blood components wastage in the blood bank of a tertiary care hospital.
Background: A major challenge facing the blood bank is to supply a sufficient amount of safe blood whenever required. India fell short of 1.9 million units of blood in 2016–2017. To overcome the shortage of blood supply, performance of blood bank can be increased either by increasing the level of resources from voluntary donors and/or by reducing the wastage of blood and blood components.
Materials and Methods: This is a retrospective analysis of discarded blood components data in Pondicherry Institute of Medical Sciences from January 1, 2014, to December 31, 2018. The study analyzed the various factors responsible for discarding of whole blood, red cells, platelets, fresh frozen plasma (FFP), and cryoprecipitate units. Wastage rate was calculated with a percentage of total number wastage against the total number of collection.
Results: A total of 36,631 blood components were prepared from 12,615 whole blood donations during this study period. Of the total, 7,103 (19.3%) components were discarded. The most common blood component discarded were platelets 5,980 (84%) followed by FFP 669 (9.4%) and packed red cells 451 (6.3%). Blood component expiry was the common reason for discarding.
Conclusion: Implementation of proper blood transfusion policy, donor screening, and training of technical staff will help to reduce the discard rate and solve the shortage of these precious elements.
Keywords: Blood components, discarding reasons, training, transfusion policy, wastage percentage
|How to cite this article:|
Simon K, Ambroise MM, Ramdas A. Analysis of blood and blood components wastage in a tertiary care hospital in South India. J Curr Res Sci Med 2020;6:39-44
|How to cite this URL:|
Simon K, Ambroise MM, Ramdas A. Analysis of blood and blood components wastage in a tertiary care hospital in South India. J Curr Res Sci Med [serial online] 2020 [cited 2020 Aug 3];6:39-44. Available from: http://www.jcrsmed.org/text.asp?2020/6/1/39/290255
| Introduction|| |
The main aim of blood centers worldwide is the provision of safe and sufficient blood and blood components. Blood and blood component transfusion plays a vital role in patient management in modern medicine. Blood transfusion services (BTS) is an integral part of blood transfusion therapy and is responsible for ensuring adequate and safe blood supply. Usage of blood components is more than the whole blood usage in surgical and medical cases in this era. One whole blood donation can be separated into three components and thereby save three lives. In 2016–2017, 1.18 million units of blood and blood components are discarded by the blood bank across the country. The figures are alarming because blood shortage is a chronic problem in our country. It exists everywhere, right from the interior parts of the country to metropolitian cities. Lack of synergy between donors, blood bankers, hospitals, and receivers is leading to the wastage of blood. Blood is a valuable resource, and blood wastage can have a negative impact on BTS.
Many factors lead to the wastage of blood products such as broken bag, broken seal, expired units, serology positive units, broken cold chain, clotted blood, or miscellaneous reasons, which is most importantly due to lack of proper knowledge, training, and awareness. Wastage of blood components will continue to be an issue at all hospitals, therefore, inexpensive and easy interventions such as educational outreach, print and digital messaging, and improved transportation and component identification modalities can have a prompt and dramatic impact on reducing blood wastage, with regards to both cost and resource savings. Because blood products have a limited half-life, accurate strategies should be enforced for blood reserves to prevent loss and reduce wastes as much as possible.
Wastage of blood in hospitals is a universal issue and should be addressed with easy and inexpensive interventions that can reduce the wastage of blood and blood components.
The aim of our study is to determine rates of discard of blood and blood components units and identify the various reasons for discarding blood units in the hospital blood bank and explain the strategies to reduce the discarding rate in blood banks. This can help us in formulating the proper guidelines for donor screening, component preparation, storage, optimized usage, and also training of staff.
| Materials and Methods|| |
This is a retrospective study involving the analyses of discarded blood and blood components data in Pondicherry Institute of Medical Sciences from January 1, 2014, to December 31, 2018, which measured the outcome-based quality of discarded blood and its components. The study included the discarding of whole blood, red cells, platelets, fresh frozen plasma (FFP), and cryoprecipitate units. Reasons for discarding of blood products included were expiry, serology positive, red blood cells (RBCs) contamination of platelets, leakages, clots, and lipemic appearances of FFP.
Registration forms are filled by blood donors who carried important informations such as personal details, demographic details, occupational, and medical history. The donors are then screened according to the standard guidelines and finally examined by medical officers. Only the donors found to be physically fit according to blood donor selection criteria and medical examination are allowed to donate blood. Whole blood was collected, and components were separated according to the Drugs and Cosmetics Act 1940 and Rules 1945. We used citrate phosphate dextrose (CPD) as an anticoagulant and saline adenine glucose and mannitol as a preservative for RBCs. Components were separated by platelet-rich plasma method. The quality of whole blood and components was assessed as per the Drugs and Cosmetics Act 1940 and Rules 1945.
The discard policy was followed as per the norms mentioned in the standard operating procedures made by the blood bank under the NACO guidelines.
Discard rate = Number of blood and blood components units wasted/total number of blood or components stored × 100.
Blood components procedure
Collected blood units are separated into components by different centrifugation methods. RBCs are stored for 42 days, platelets for 5 days, and FFP stored for 1 year. All units that were discarded due to various reasons are documented in the discarding register, which has all relevant informations such as donor number, reason for discard, blood group, method of discard, and then total discarded units at the end of the year.
Collected data were analyzed using Microsoft Excel.
| Results|| |
A total of 12,615 units of blood were collected at PIMS blood bank from January 2014 to December 2018.
Among the total donors, 12,522 (99%) were males and 93 (1%) were females. 10,566 (83.7%) were voluntary donations, and 2049 (16.3%) were from replacement donations [Table 1].
Of the 12,615 whole blood donations, 12,574 (99.7%) whole blood were separated into components, and remaining 41 (0.3%) were used as whole blood, of which 3 (0.02%) whole blood bags were discarded due to expiry.
A total of 36,631 blood components were prepared from 12,615 whole blood donations during this study period. Of which 7,103 (19.3%) components were discarded [Table 2].
Among the total discarded components, platelet concentrates (PCs) were discarded 84.5% (5980/7103), of which 95.6% (5719/5980) was due to expiry, 1.3% (79/5980) due to packed red cells contamination, and 3.1% (182/5980) due to seropositivity.
About 9.4% (669/7103) FFP were discarded, most of them due to damage during storage and shifting 322 (48.2%), followed by turbidity 159 (23.7%), seropositivity 183 (27.3%), and green plasma 5 (0.8%). 6% (451/7103) of packed RBCs (PRBCs) were discarded, of which 59% (267/451) was due to expiry and 183 (41%) due to seropositivity.
Among the 267 expired packed red cells, 53% (142/267) were positive blood groups and 47% (125/267) were negative blood groups, and the most common blood group discarded was O positive followed by O negative [Table 3].
| Discussion|| |
This study attempts to analyze blood collection and wastage at PIMS hospital during the period of 2014–2018. Proper blood management, self-audit of blood and blood components discarded rate, and reasons for discarding in blood bank will reduce the unnecessary wastage of blood and blood components. A close view on the distribution of blood would help to focus on the areas of frequent wastage and to understand the main cause/causes of blood wastage. This would further help to design intervention programs or measures to prevent such wastage and also to increase awareness of the wastage. Wastage of blood components will continue to be an issue at all hospitals, therefore, inexpensive and easy interventions such as educational outreach, print and digital messaging, and improved transportation and component identification modalities can have a prompt and dramatic impact on reducing blood wastage, with regard to both cost and resource savings.
During our study period, 12,615 whole blood units were collected, of which 99% were from male donors and 1% from female donors. There were 16% from replacement donors and 84% voluntary donors.
In our blood bank, packed red cells concentrate were most frequently collected components followed by FFP, platelet, cryoprecipitate, and whole blood. Whole blood was the least collected blood component, and this could be because whole blood is not frequently administered to patients unless ≥75% of blood was lost.
Among the 12,615 whole blood collected from the donors, 99.7% (12,574/12,615) was separated into blood components. Of which packed red cells concentrate was 12,574 (99.7%), platelets 11,465 (91.6%), FFP 11,987 (95%), cryoprecipitate 564 (4.55%), and whole blood 41 (0.3%).
In our study, totally 36,631 blood components were separated from 12,574 whole blood, of which 7103 (19.6%) units were discarded. Platelets concentrated was the highest discarded component 5980/36,631 (16.5%) followed by FFP 669/36,631 (1.8%), red cells concentrate 451/36,631 (1.2%), and whole blood 3/36,631 (0.1%).
The discard rate of blood components in central India was 14.6%, which was 5% lower than our study. In ten European countries, the wastage level was reported to range between 0.2 and 7.7%, with an average of 4.5% (Veihola et al., 2006). This was much lower than the wastage rate in the present study.
Discard rate for packed red cells concentrate in the present study was 3.5% (451/12,574). This matches with a study by Arora et al. 3.5% and Thakare et al. 3.58% and higher than quoted by Morish et al. 2.3%, Suresh et al. 3.3%, and Sharma et al. 3.2%. The most common reason for discard of red cells concentrate was expiry 59% (267/451), followed by transfusion transmitted infection (TTI) positive 41% (182/451). One of the reasons for expiry was collecting whole blood for making random donor platelets. In our study, maximum red cells concentrates was discarded in 2014 and 2017 during the dengue epidemics. Using apheresis platelet in the dengue epidemic can help minimize the wastage.
In our study, predominant blood group of discarded packed red cells was O positive followed by O negative [Table 4]. Creating awareness about compatible blood transfusions among the clinicians will reduce the wastage of O positive and O negative blood groups. Clinicians have to be made aware that O positive transfusion can be done to all the positive blood groups and AB positive patient can be transfused with other positive blood groups. Transfusion of negative blood to corresponding positive blood group individuals can also be done and O negative blood can be used for universal transfusion. Expiry of the PRBC can be minimized by proper inventory management and recruitment of blood donors with required blood groups.
The discard rate of FFP in our study was 5.5% (669/11,987), which is lower than Bobde et al. (7.6%) and Sharma et al. (6.2%). Similar to Kanani, the most common reason for discard of FFP was leakage 48% (322/669), followed by TTI positive units 27% (183/609), lipemic 24% (159/609), and green plasma 1% (5/609). Leakage was the most common cause of wastage of FFP, which can be minimized using appropriate size freezers, putting FFP units in cardboard, or polystyrene protective container that minimizes the risk of breakage of product during storage, handling, and transportation. Excess FFP can be given to fractionating and this will further minimize the expiry rate of FFP. The lipemic discards can be minimized by proper donor questioning regarding their interval between donation and time of the last meal.
PC was the most common component discarded during the study. The discard rate of PC was 52% (5980/11,465) which was higher than that of Bobde et al. (26.2%), Kanani (28.39%), and Sharma et al. (43.6%) and lower than that of Ghaflez et al. (58.1%). The most common reason for discard of PC was expiry 95.6% (5719/5980), followed by TTI positive 3.1% (182/5980) and red cells contamination 1.3% (79/5980). High discard rate of PC was because of 5-day storage period. Studies conducted by Kumar et al. and Deb et al. concluded that the most common components discarded were platelets, and the most common reason was expiry. Using platelet additive solutions, special type of storage bag and cryopreservation techniques can minimize the expiry of PC. Red cells contamination can be reduced by continuous training and monitoring on component separation and using automated cell separator. Red cells contaminated platelet can be used to same blood group individuals within 24 h of separation. Various studies have been conducted to manage PC inventory (De Kort et al., 2011). Van Dijk et al. designed a model to reduce PLT wastage from 15%–20% to less than 0.1%, with regards to the fact that PLT units have short expiry dates. The model aimed to balance between PLT production and hospital demands, prevent PLT expiration, and prevent the inventory shortage. However, a certain amount of PLT wastage is unavoidable to ensure its availability when it is needed.
The discard rate for whole blood in the present study was 7% (3/41), which was higher than the rates quoted by Suresh et al. (5.7%), Bobde et al. (6.63%), and Sharma et al. (4.46%). All the three units were discarded due to expiry.
Our study found expiry/outdated units to be the most common reason for discarding 84.3% (5989/7103). This is similar to the study done by Jariwala et al. and Kurup et al. (87.7%–96.6%), who also showed outdating to be the most common cause of discarding.
TTI positivity is the second most common reason for discarding which is 7.8% (516/6607). This is lower than that of Arora et al. (14.8%).
Cryoprecipitate was prepared according to demands, so there was no wastage of cryoprecipitates.
The role of blood bank staffs to minimize the wastage of blood and blood components.
- Strict adherence to donor selection criteria based on SOP, taking proper predonation history and counselling, identifying transfusion transmitted positive donors, deferring suspected professional donors who have been screened previously, appropriate usage of antiseptics solutions and proper serological testing reduces the wastage of blood and blood components due to TTI and lipemic plasma.
- Wastage due to expiry and outdated can be reduced by proper inventory management and know the day to week basis of blood requirement
- Proper method of storage of FFP inside the freezers and careful handling of FFP during thawing and transport reduce the wastage due to damage
- Maintain the stock register with collection date and expiry date will help to issue the blood and blood components in first in, first out (FIFO) policy.
Blood bank medical officer
- Blood donor recruitment and blood collection and component separation can be adjusted on the basis of demand from the hospital. The optimal inventory level for RBCs, platelets, and FFP can be evaluated every day such that the inventory is adjusted to hospital requirement
- Continual educational programs to improve the performance of staff to minimize technical faults leading to wastage of blood components. These training courses included standard methods of blood collection, processing, proper storage, shifting, and transportation based on the standard operational procedures
- Using blood bag with CPD with the additive solution can extend the storage period of red cells
- Continued medical education for technical staff, issuing blood/components based on FIFO policy, and regular audit by hospital transfusion committee will help to reduce the wastage
- Good communication with the clinician and compatible blood units transfusion reduces the O negative and O positive blood group wastage
- Calibrated and validated equipment should be used for the storage of blood components. The storage unit should also be equipped with electronic temperature monitoring and alarm system which is linked to the monitoring audible alarm. This monitoring system should have automatic SMS text warning to blood bank medical officer or technical supervisor. This will prevent the wastage of blood due to storage problems
- Implementation of blood transfusion policies and coordinate with clinicians
- Platelet has only 5-day storage period. Using a platelet additive solution, storage period can be extend up to 7 days and using cryopreservation techniques the platelets can be stored for a longer term. Preparing platelet on demand reduces the wastage
- Dispatching surplus blood components to other licenced blood centers and surplus FFP for fractionation also reduces wastage.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
We would like to acknowledge Mr. Pradeep Kumar L, technical supervisor, blood bank, for helping us with the data acquisition.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]