Asian Journal of Transfusion Science
Home About Journal Editorial Board Search Current Issue Ahead of print Back Issues Instructions Subscribe Login  Users: 529 Print this page  Email this page Small font sizeDefault font sizeIncrease font size 

Previous Article  Table of Contents  Next Article  
ORIGINAL ARTICLE  
Ahead of print publication
A 5-year cross-sectional retrospective analysis of discard of blood and its components in the blood bank of a tertiary trauma center


1 Department of Pathology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
2 Blood Bank Officer, Sanjay Gandhi Institute of Trauma and Orthopaedics, Bengaluru, Karnataka, India
3 Department of Paediatrics, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India

Click here for correspondence address and email

Date of Submission16-Nov-2020
Date of Decision07-May-2022
Date of Acceptance29-May-2022
Date of Web Publication12-Dec-2022
 

   Abstract 

INTRODUCTION: Blood transfusion is an integral part of health-care system and there is no complete suitable substitute for human blood till date. Thus, every unit of blood and its products is precious and should be used judiciously. There is a steady increase in demand for blood and its components and thus to maintain balance between demand and supply, rational use of blood and its components is the need of the hour. This study was conducted to analyze different reasons for discarding blood and its components in a tertiary trauma center so that proper recommendations can be adopted to minimize the discard rate.
MATERIALS AND METHODS: A retrospective analytical study was carried out in Sanjay Gandhi Institute of Trauma and Orthopaedics, Bengaluru; a Tertiary Trauma Care Centre for 5 years from January 2015 to December 2019. Details of whole blood collected and blood products prepared were collected from donor register. Reasons for discard were retrieved in detail from discard register. Discard rate for each is calculated as ratio between blood and component collected to the total number of collections and it is expressed as percentage.
RESULTS: Out of 22,401 total units of whole blood and its components, 1310 units were discarded accounting for 5.85%. Platelet concentrate (PC) was commonly discarded component (18.3%) followed by whole blood (6.1%), Packed red blood cells (3.64%), and fresh frozen plasma (FFP) (2.92%). The main cause for discarding is expired shelf life (675/1310, 51.53%) followed by transfusion-transmitted infection (12.75%) and suboptimal collection (9.7%). PC was the common component discarded due to the expiry of shelf life (83.21%). FFP was discarded due to damaged blood bags commonly.
CONCLUSION: From our observation, we conclude that strict donor selection criteria, predonation counseling, continuous regular training of technical staff involved in blood collection and processing, and adopting newer techniques such as apheresis and first-in and first-out policy will reduce the overall discard rate.

Keywords: blood components, discard, transfusion-transmitted infections, whole blood


How to cite this URL:
Shankaralingappa A, Jyoti K S, Babu TA. A 5-year cross-sectional retrospective analysis of discard of blood and its components in the blood bank of a tertiary trauma center. Asian J Transfus Sci [Epub ahead of print] [cited 2023 Jan 28]. Available from: https://www.ajts.org/preprintarticle.asp?id=363221



   Introduction Top


Blood transfusion services (BTSs) are an important element of modern health-care system.[1] Blood transfusion includes transfusion of whole blood and its products such as red cell concentrate, fresh frozen plasma (FFP), and platelet concentrate (PC). BTS should aim at providing safe, effective, and adequate supply of blood and its products to meet the patients' demand and need.[2] Blood is a precious liquid connective tissue and there is no complete suitable substitute to human blood till date.[3] Thus, every unit of blood and its products is precious and used judiciously. With advances in medical sciences and increase in life expectancy, the demand for blood and its products is increasing. Thus, to maintain the balance between demand and supply, rational use of blood and its components is the need of the hour.[4] Discard rate of blood has been listed third among 10 quality indicators defined by National Accreditation Board for Hospitals and Health-care Providers.[5] It is defined as the ratio of discarded blood and blood components to the total number of collections done and is expressed as percentage. This study was conducted to analyze the different reasons for discarding blood and its components in a tertiary trauma center so that proper recommendations can be adopted in areas of donor screening and deferral, blood collection, preparation of components, storage, utilization, and continuous training of staff involved.


   Materials and Methods Top


A retrospective analytical study was carried out in Sanjay Gandhi Institute of Trauma and Orthopaedics, Bengaluru; a Tertiary Trauma Care Centre for 5 years from January 2015 to December 2019. The details of whole blood collected and blood components prepared were collected from donor register. The details about their discard were collected from discard register. Blood and its components were collected from healthy suitable donors according to donor selection criteria put forth by the Drugs and Cosmetics Act, 1940 and Rules, 1945.[6] Blood components such as Packed red blood cells (PRBC), FFP, and PC were prepared with all aseptic precautions according to the Food and Drug Administration guidelines.[7] Discarding of blood and its components was carried out according to the standard operating procedure recommended by the National AIDS control organization.[8]

The reasons for discard of blood and blood components were retrieved in detail from the discard register. Discard rate for each is calculated as ratio between the blood and component collected to the total number of collections and it is expressed as percentage. Graphical representation is done wherever necessary.


   Results Top


In the present study, for 5 years from January 2015 to December 2019; 11,689 units of whole blood were collected. Out of these, 7358 (62.95%) units were processed to obtain 18,070 units of different blood components such as PRBC, FFP, and PC. [Table 1] shows the details of units of whole blood and its components collected from 2015 to 2019.

Out of 22,401 total units of whole blood and its components collected over 5 years, 1310 units were discarded which accounted for 5.85%. PC was the most commonly discarded components (18.3%) followed by whole blood (6.1%), PRBC (3.64%), and FFP (2.92%) [Table 2].

Out of 1310 discarded units, the main cause for discarding is expired shelf life (675/1310, 51.53%) of the units followed by transfusion-transmitted infection (TTI) (12.75%) and suboptimal collection (9.7%). PC was the common component discarded due to expiry of shelf life (83.21%). [Table 3] and [Figure 1] show the detailed analysis of reasons for discard of the blood and its components. Seropositivity for TTI was the reason for discard of 167 units. Among TTIs, hepatitis B (157/167, 94.01%) was the common reason, followed by human immunodeficiency virus (08/167, 4.8%) and hepatitis C (02/167, 1.2%).
Figure 1: Bar graph showing reasons for discard

Click here to view



   Discussion Top


Blood transfusion is an essential and vital component of the current modern health-care system.[9] The demand for blood and its components is on steady rise and it is a challenge for BTS to achieve a balance between the demand and supply of blood and its components. In view of this, majority of developed countries have implemented patient blood management initiatives and have adopted retrospective status quo analysis of the supply of blood components.[10] An internal audit regarding discard of blood and blood products throws light on preventable causes of discard and thus guides to adopt suitable measures to reduce the avoidable wastage of blood and blood products.[11]

In our present study, the overall discard rate was 5.85% over 5 years which was slightly higher than the studies by Thakare et al. and[12] Morish et al.,[13] whose discard rates were 3.58% and 2.3%, respectively. It was less compared to studies by Bobde et al.,[14] Suresh et al.,[15] Sharma et al.,[4] Ghaflez et al.,[16] and Deb et al.[17] Overall most of the units that were discarded were expired units (675/1310, 51.53%) constituted predominantly by PC which was similar to the study by Dogra and Gosai[18] followed by TTI (12.75%).

PC was the most commonly discarded component accounting for 18.3% which was in concordance with a study done by Veihola et al.[19] which included 17 blood centers over 10 European countries and whose mean platelet discard rate varied between 6.7% and 25%. This was similar to the observation made by Sharma et al.,[4] Ghaflez et al.,[16] and Bobde et al.,[14] The main reason for discard of PC was expired units accounting for 83.21% (461/554) which was similar to other studies by Patil et.al.(56.62%),[1] Sharma et al.,[4] Ghaflez et al.,[16] and Bobde et al.,[14] This is due to short shelf life of 5 days for PC[18] and this could be minimized by preparing PC on demand, first-in and first-out (FIFO) policy and using contemporary method such as apheresis.[1]

The second common reason for overall discard was seropositivity for TTI, accounting for 12.75% which was comparable to studies by Dogra and Gosai[18] and Arora et al.[20] who noted 13.06% and 14.28%, respectively. Among TTIs, hepatitis B (94.01%) was the common reason, followed by human immunodeficiency virus (4.8%) and hepatitis C (02/167, 1.2%) which was similar to Lakum et al.[21] and Kumar.[3] We did not report a single case of malaria or syphilis over 5 years. Discard due to TTI can be significantly reduced by strict adherence to donor selection criteria, predonation counseling, predonation screening of donors using rapid, cost-effective kits, and permanent deferral of TTI-positive donors.[1],[15]

The next cause for overall discard of blood and its products was suboptimal collection (9.7%) which was less compared to the study by Arora et al,[20] Morish et al,[13] and Kanani et al.[22] under collection may be due to under-skilled staff involved in phlebotomy or due to donor adverse reactions. This can be reduced by predonation counseling and proper selection of donors along with continuous, regular training, and monitoring of technical staff involved in blood collection. Calibration and maintenance of weighing balance should be done regularly to avoid under or over the collection of blood.

Damaged blood bags was the other reason for discard accounting for 8.17% of overall discard and 27.23% discard rate of FFP which was akin to studies by Kumar et al.[23] The blood bags were damaged due to improper handling of bags while storing and during centrifugation. During centrifugation, the bag may be damaged as it is forced to the sharp interior bottom. This can be curtailed by placing FFP bags in protective cardboard or polystyrene containers during handling, storage, or transportation.[24]

The other causes for overall discard of blood and its components included red cell contamination, clotted blood, lipemia, hemolysis, and polycythemia which together accounted for 9.7% (127/1310). These can be reduced drastically by training the technical staff involved in blood collection and processing. Predonation questionnaire should include questions regarding food consumed a day before donation and the donor who has consumed fatty meals has to be deferred to reduce the wastage. For quality assurance, 107 (8.17%) units were utilized over 5 years.


   Conclusion Top


In our study, the overall discard rate is 5.85% and the most common component discarded was PC accounting for 18.3%. The main reason for overall discard was expired units followed by TTI, under collection, damaged blood bags, and others. Discard of blood and its components poses an economic burden and it's the need of the hour to reduce such wastage. In this regard, the blood bank should frame its policies prudently and a regular internal audit will help to arrive at the deficiencies in implementing those policies. From our observation, we conclude that strict donor selection criteria, predonation counseling, continuous regular training of technical staff involved in blood collection and processing, and adopting newer techniques such as apheresis and FIFO policy will reduce the overall discard rate.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Patil P, Bhake A, Hiwale K. Analysis of discard of whole blood and its components with suggested possible strategies to reduce it. Int J Res Med Sci 2016;4:477-81.  Back to cited text no. 1
    
2.
Newman B. Blood donor suitability and donation complications. In: Handbook of Blood Banking and Transfusion Medicine. India: Jaypee Brothers Medical Publishers (P) Ltd; 2006. p. 27-35.  Back to cited text no. 2
    
3.
Kumar R, Prakash S, Chhabra V, Lokhande T, Kumar K, Dhakar P, et al. A prospective study of analysis of reasons for discarding blood and it's components in (M.B.G.H. Blood bank), department of transfusion medicine and immunohematology, R. N. T. Medical College, Udaipur (Rajasthan). Int J Curr Adv Res 2018;7:12089-93.  Back to cited text no. 3
    
4.
Sharma N, Kaushik S, Kumar R, Azad S, Acharya S, Kudesia S, et al. Causes of wastage of blood and blood components: A retrospective analysis. IOSR J Dent Med Sci 2014;13:59-61.  Back to cited text no. 4
    
5.
Accreditation Standards on Blood Banks/Blood Centers and Transfusion Services. National Accreditation Board for Hospitals and Healthcare Providers. 2nd ed. New Delhi: Quality Council of India; 2013. p. 51-2.  Back to cited text no. 5
    
6.
Malik V. Law Relating to Drugs and Cosmetics. 22nd ed. Lucknow: Eastern Book Company; 2011.  Back to cited text no. 6
    
7.
Saran RK. Transfusion Medicine Technical Manual. 2nd ed. Drugs Controller General, India. Directorate General of Health Services, Government of India; 2003.  Back to cited text no. 7
    
8.
National AIDS Control Organization. Standards for Blood Banks and Blood Transfusion Services. New Delhi: Ministry of Health and Family Welfare, Government of India; 2007.  Back to cited text no. 8
    
9.
Alcantara TY, Alresheid AA, Shammary SA. A comparative study on blood components utilization in selected hospital-blood banks in Hail, K.S.A. IOSR J Nurs Health Sci 2015;4:28-33.  Back to cited text no. 9
    
10.
Mathew AS, Kurian SS, Sundaresan NP, Jayalekshami B, Roderigues FP, John A, et al. Pattern of blood component utilization in a teaching hospital in South Kerala. Acad J India 2014;2:28-31.  Back to cited text no. 10
    
11.
Kaur P, Kaur R, Masih V, Jindal A. Incidence and causes of wastage of blood and blood components in a blood bank of tertiary care hospital: A retrospective study. IOSR J Dent Med Sci 2016;15:108-10.  Back to cited text no. 11
    
12.
Thakare MM, Dixit JV, Goel NK. Reasons for discarding blood from blood bank of government medical college, Aurangabad. Asian J Transfus Sci 2011;5:59-60.  Back to cited text no. 12
[PUBMED]  [Full text]  
13.
Morish M, Ayob Y, Naim N, Salman H, Muhamad NA, Yusoff NM. Quality indicators for discarding blood in the National Blood Center, Kuala Lumpur. Asian J Transfus Sci 2012;6:19-23.  Back to cited text no. 13
  [Full text]  
14.
Bobde V, Parate S, Kumbhalkar D. Analysis of discard of whole blood and blood components in government hospital blood bank in central India. J Evid Based Med Healthc 2015;2:1215-9.  Back to cited text no. 14
    
15.
Suresh B, Sreedhar Babu KV, Arun R, Chandramouli P, Jothibai DS. Reasons for discarding whole blood and its components in a tertiary care teaching hospital blood bank in South India. J Clin Sci Res 2015;4:213-9.  Back to cited text no. 15
  [Full text]  
16.
Ghaflez MB, Omeir KH, Far JM, Saki N, Maatoghi TJ, Naderpour M. Study of rate and causes of blood components discard among Ahwaz's hospital. Sci J Iran Blood Transfus Organ 2014;11:197-206.  Back to cited text no. 16
    
17.
Deb P, Swarup D, Singh MM. Two corps blood supply unit, 56 APO audit of blood requisition. Med J Armed Forces India 2001;57:35-8.  Back to cited text no. 17
    
18.
Dogra, Devanshi Gosai, Ashu. An Analytical Study of Discarded Units of Whole Blood and its Components in a Blood Bank at a Tertiary Care Hospital in Vadodara. Global Journal of Medical Research, [S.l.], apr. 2020. ISSN 2249-4618. Available from: https://medicalresearchjournal.org/index.php/GJMR/article/view/2020. [Last accessed on 2022 Aug 29].  Back to cited text no. 18
    
19.
Veihola M, Aroviita P, Linna M, Sintonen H, Kekomaki R. Variation of platelet production and discard rates in 17 blood centers representing 10 European countries from 2000 to 2002. Transfusion 2006;46:991-5.  Back to cited text no. 19
    
20.
Arora I, Singh S, Singh S. Donor blood wastage: A study from blood bank Chamba (H.P). Int J Community Med Public Health 2018;5:3016-9.  Back to cited text no. 20
    
21.
Lakum NR, Makwana H, Agnihotri A. An analytical study of discarded units of whole blood and its components in a blood bank at a tertiary-care hospital in Zalawad region of Saurashtra. Int J Med Sci Public Health 2016;5:318-21.  Back to cited text no. 21
    
22.
Kanani AN, Vachhani JH, Dholakiya SK, Upadhyay SB. Analysis on discard of blood and its products with suggested possible strategies to reduce its occurrence in a blood bank of tertiary care hospital in Western India. Glob J Transfus Med 2017;2:130-6.  Back to cited text no. 22
  [Full text]  
23.
Kumar A, Sharma MS, Ingole NS, Gangane N. Analysis of reasons for discarding blood and blood components in a blood bank of tertiary care hospital in central India: A prospective study. IJMPH 2014;4:72-4.  Back to cited text no. 23
    
24.
World Health Organization. Quality Systems for Blood Safety: Introductory Module Guidelines and Principles for Safe Blood Transfusion Practice. Geneva: World Health Organization; 2002. p. 65-75.  Back to cited text no. 24
    

Top
Correspondence Address:
Arundhathi Shankaralingappa,
All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajts.AJTS_181_20



    Figures

  [Figure 1]



 

Top
[PREVo] Next Article
 
  Search

  
     Search Pubmed for
 
    -  Shankaralingappa A
    -  Jyoti K S
    -  Babu TA
   Article in PDF


    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
   Conclusion
    References
    Article Figures

 Article Access Statistics
    Viewed128    
    PDF Downloaded4    

Recommend this journal

Association Contact us | Sitemap | Advertise | What's New | Copyright and Disclaimer | Privacy Notice


2006 - Asian Journal of Transfusion Science | Published by Wolters Kluwer - Medknow
Online since 10th November, 2006