|Year : 2021 | Volume
| Issue : 3 | Page : 277-281
Analysis on discard of blood and blood components in a tertiary care center: a guide to blood inventory management
Shweta Wasudeo Dhote, Abhiniti Rahul Srivastava, Iqbal Singh
Department of Immunohematology and Blood Transfusion, MGM Medical College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India
|Date of Submission||21-Jun-2021|
|Date of Acceptance||16-Aug-2021|
|Date of Web Publication||03-Sep-2021|
Dr. Shweta Wasudeo Dhote
Department of Immunohematology and Blood Transfusion, MGM Medical College and Hospital, Kamothe, Navi Mumbai 410209, Maharashtra.
Source of Support: None, Conflict of Interest: None
Introduction: In contemporary medicine management, it is evident that transfusion of blood and blood components has become an integral part of the patient. Human blood has no complete substitute to date. Blood is a perishable product and hence proper management of blood inventory is very crucial. Blood being a perishable commodity, efficient management of inventories is pivotal. The challenge that blood centers are facing is to keep sufficient stock to ensure an adequate supply of blood while minimizing losses. Aims and Objectives: The present study is designed to analyze various causes of discard of blood and blood components. Settings and Design: This is an analytical and retrospective type of study, carried out in the Department of Transfusion Medicine, from January 2019 to December 2019. Materials and Methods: Data were collected from blood bank records and confirmed from the master register. Data were then tabulated and analyzed. Statistical analysis used is as follows: Microsoft Excel database sheet was used for analyzing the results for the calculation of percentage and the χ2 test was used. Results: A total of 5,753 units were collected during the study period. A total of 13,913 components were prepared. Out of which, packed red cells (PRCs) were 5691, fresh frozen plasmas (FFPs) 5592, platelet concentrate (PC) 2531, and cryoprecipitate 99. The average discard rate for PRC, FFP, PC, and cryoprecipitate was 4.95%, 2.46%, 19.12%, and 3.03%, respectively. The most common reason for PRC and platelets discard was expiry followed by positivity for transfusion-transmitted infections (TTIs), whereas discard of FFPs was due to breakage in the case. Conclusion: The most common reason for the discard of PRCs and platelets in our study was expiry and positivity for TTI, whereas FFPs were mostly discarded due to breakage/leakage.
Keywords: Discard, expiry, inventory, packed red cell
|How to cite this article:|
Dhote SW, Srivastava AR, Singh I. Analysis on discard of blood and blood components in a tertiary care center: a guide to blood inventory management. MGM J Med Sci 2021;8:277-81
|How to cite this URL:|
Dhote SW, Srivastava AR, Singh I. Analysis on discard of blood and blood components in a tertiary care center: a guide to blood inventory management. MGM J Med Sci [serial online] 2021 [cited 2022 Jan 25];8:277-81. Available from: http://www.mgmjms.com/text.asp?2021/8/3/277/325545
| Introduction|| |
Blood component transfusion has an essential role in patient management in contemporary medicine. To date, there is no absolute replacement for human blood. Nowadays, nearly one-third of critical patients need a blood transfusion. The progression of medical technology calls for increased blood safety for successful patient management. To reduce the gap between demand and supply, the performance of blood transfusion services (BTS) can be increased either by increasing the resources or by using the existent resources more effectively. Blood being a perishable commodity, efficient management of inventories is pivotal. The challenge that blood centers are facing is to keep sufficient stock to make sure an adequate supply of blood while minimizing the losses.
This study focusses on detecting the causes and rate of discard of blood and blood components to make recommendations that will ensure minimal loss and to determine best practices to regulate blood inventory.
Aims and objectives
The present study is aimed at analyzing varied causes which resulted in the discard of blood and blood components to determine best practices that can keep the discard rates at a minimum.
The objective is to identify various causes of discard of blood and blood components, i.e., packed red cells (PRCs), fresh frozen plasma (FFP), platelet concentrate (PC), cryoprecipitate, and target these to lessen the wastage of blood and blood components to the minimum.
| Subjects and methods|| |
The retrospective study was accomplished in the Department of Transfusion Medicine. The period of study was 1 year, i.e., from January 2019 to December 2019. Data were collected after obtaining ethical clearance from the institute. Microsoft Excel database sheet was used for analyzing the results for the calculation of percentage and χ2 test.
All the blood units were collected from donors meeting the specified donor criteria.
Platelets collected by apheresis procedure (single donor platelets) are not included in the study.
Therapeutic phlebotomy blood bags are not included in the study.
Data were retrieved from blood bank records and confirmed from the master register and discard register.
Discard rate was calculated as: The total number of blood or blood component discarded / The total number of blood or blood components prepared X 100. The whole blood and blood component’s quality were assessed as per the National Accreditation Board for Hospitals and Healthcare Providers (NABH) Guidelines.
Parameters under which the discarded blood and blood components were categorized are as follows: suboptimal volume, expiry, non-utilization after issue, red cell contamination, lipemia, hemolysis, breakage, and leakage. After classifying each component under these categories, data were tabulated and analyzed.
| Results|| |
A total of 5,753 units were collected during the study period from various blood donation camps and in-house collections. About 5,219 (90.72%) units were collected from male donors, whereas 534 units were collected from (9.28%) female donors. In addition, 5727 (99.54%) were voluntary blood donors, whereas only 26 (0.45%) were related donors [Table 1].
Out of 5,753, only 5,691 units were subjected to component preparation. Rest of the units were not included as they were low volume and not suitable for component preparation. In our setup, only components are issued and not whole blood. It was observed that the average discard rate was 6.51% for blood components, out of which discard rates for PRCs, FFP, PC, and cryoprecipitate (CRYO) were 4.95%, 2.46%, 19.12%, and 3.03, respectively [Table 2].
In blood components, the total PRCs prepared were 5,691. Out of a total of 282 PRCs discarded, 215 PRCs (76.24%) were discarded due to the expiry of the product. The second most common reason for discard was due to seropositivity for transfusion-transmitted infections (TTIs) [5 (19.50%)]. Other reasons for the discard of PRCs were non-utilization after issue 07 (2.4%), leakage 04 (1.4%), and hemolyzed bag 01 (0.3%) [Table 3].
The total number of FFP units prepared was 5592, and 138 FFP units were discarded. Most units of FFP were discarded because of breakage/leakage. It constitutes 80 units (57.9%). The second most common reason for discard was due to positivity for TTI [55 units (39.8%)]. It was observed that 02 units (1.4%) of FFP were discarded due to expiry and 01 unit (0.72%) was discarded due to RBC contamination [Table 3].
Random donor platelets (RDPs) were discarded the most. A total of 2,531 platelet concentrates were prepared. Out of which, 484 units of platelets were discarded; 459 units (94.8%) of PC were discarded due to expiry. Twenty-four units (4.9%) were discarded due to positivity for TTIs and only one unit (0.2%) was discarded due to RBC contamination [Table 3].
A total of 99 units of cryoprecipitate were prepared, out of which 3 were discarded. Two units (66.7%) were discarded due to breakage and one unit (33.3%) was discarded due to expiry [Table 3].
In our study, TTI positivity was the second most common reason for discard. [Table 4] shows that due to this, a total of 134 units were discarded. Out of 134, 110 units were discarded due to positivity for HbsAg. The average discard rate for units of various components discarded due to HbsAg is 82.08%. The second most common TTI-positive units were that of human immunodeficiency virus (HIV). Nine units (6.71%) were discarded due to the positivity for HIV. Eight units (5.9%) were discarded due to positivity for hepatitis C virus (HCV) and seven (5.22%) units were discarded due to positivity for Venereal Disease Research Laboratory. No positivity was found for malarial parasite.
| Discussion|| |
Blood transfusion has become an integral part of patient management in modern medicine. As each unit is precious, it should be utilized judiciously with minimum wastage. The BTS can be increased effectively through proper blood inventory management. Analysis of wastage of blood and blood components is a key to determine reasons which are specific to the blood center.
Out of the various quality indicators of NABH, discard rate is one of them. Blood products are discarded as per the standard guidelines as the quality of the product is prime in blood transfusion practices. To keep the discard rate at the lowest, multifaceted efforts are needed. It is essential to determine the various causes and focus on these causes particular to that blood center. It helps us to formulate and develop certain guidelines targeting these causes.
Blood component wastage
The average discard rate in our study was 6.51%. The studies conducted by Patil et al., Gahflez et al., and Deb et al. showed an average discard rate of 22.45%, 12%, and 14.6%, respectively. The discard rate in the present study was found to be much lower.
Packed red cells
The discard rate of packed red cells (PRC) in our setup was found out to be 4.95%. The most common reason for discard of PRC was due to expiry (76.24%), followed by TTI (19.5%). In TTI, the most common reason was positivity for HbsAg (81.81%). The discard rate for PRC in studies conducted by Suresh et al. (3.3%), Sharma et al. (3.2%), and Bobde et al. (2.0%) was slightly lower than that of our study.
The most common reason for PRC discard was expiry. In our setup, a large number of thalassemia children are registered with the institute, and fresh PRCs are issued in such cases. In this scenario, it is not feasible to implement a first-in first-out (FIFO) policy. In these cases, we had to follow the last-in first-out policy. This has resulted in the discard of PRCs due to expiry.
The other reasons for discard were non-utilization after issue 2.48%, leakage (1.41%), and hemolysis (0.35%). The reasons for non-utilization after the issue were patient’s death, patient’s discharge against medical advice, excess and wrong product requested, and return of PRCs after 30 min. Proper coordination between clinicians and blood bank personnel is essential and can minimize wastage due to non-utilization after issue. Doctors were sensitized for the indication and utilization of blood products as non-utilization after issuing the product was another common cause. Blood bags were taken back to stock when returned within 30 min in case of non-utilization. PRCs which were received back after 30 min of the issue were discarded.
Fresh frozen plasma
It was observed that the discard rate for fresh frozen plasma (FFP) was 2.46% in our study. The commonest reason for discard was breakage (57.9%), followed by positivity for TTI (39.85%). The least bags were discarded due to expiry (1.44%) and RBC contamination (0.72%). A total of three cryoprecipitate units were discarded, out of which 2 (66.67%) units were discarded due to breakage and one unit (33.3%) was expired.
Studies conducted by Bobde et al., Sharma et al., and Kumar et al. showed that the average discard rate for FFP was 7.6%, 6.2%, and 5.36%, respectively. The present study showed a significantly lower rate of discard of FFP when compared with these studies. FFP was also sent for fractionation which also contributed to the low discard rate.
Breakage and leakage were found to be the most common causes for the discard of FFP in our study. This wastage can be minimized by using cardboard or polystyrene protective containers during storage, proper handling, and transportation. The second most prevalent reason was TTI positivity. Absolute adherence to the donor selection standards is necessary along with pre-donation history and donor counseling to identify that high-risk donors could minimize the wastage due to TTI positivity.
Platelet concentrate (PC) was the component with the highest discard rate. The discard rate for PC was found out to be 19.12%. The most common reason for discard of PC was due to expiry (94.83%). In another study conducted by Veihola et al. in 17 different blood centers in European countries, the mean discard rate varied from 6.7% to 25%.
The studies carried out by Saluja et al. (20.83%), Bodbe et al. (26.2%), and Kumar et al. (37.11%) showed a slightly higher discard rate than the present study. As platelets are short-lived, the discard rate is very high. This discard can be reduced by platelet production to be determined as per the stock availability. Recently, the apheresis technique can be utilized, and single donor platelets can be prepared as per the demand.
To control platelet inventory, some studies have been conducted. A model has been designed by van Dijk et al. and De Kort et al. to reduce the discard from 15% to 20% to less than 0.1% because platelet has the shortest shelf life. The study design was aimed at balancing between platelet preparation and in order to thus prevent platelets discard due to expiry and to prevent stock insufficiency.
However, a certain number of platelets concentrate wastage is inevitable as demands are unpredictable. The other reasons for PC discard were TTI positivity (4.96%) and RBC contamination (0.2%). This discard can be effectively reduced by proper selection of donors, constant personnel training, and proficiency testing involved in component separation.
| Conclusion|| |
The most common reason for the discard of PRCs and platelets in our study was expiry and positivity for TTI, whereas FFPs were mostly discarded due to breakage/leakage.
To minimize discard, arrangement of blood donation camps at proper intervals, strict adherence to the donor selection criteria, regular conduct of training program of the staff for up-gradation, and safe handling of blood products would help in minimizing losses with optimum utilization and implementation of FIFO policy.
The competent authority should be notified, and proper counseling of permanently deferred donors can help reduce the discard due to TTI. Hospital policy has to be revised yearly and executed prudently. Since blood products have a limited shelf life, good management of blood inventory is very essential. Also, discard rate is one of the quality indicators. A lower discard rate is a sign of good practice. If the above norms are followed, we can bring the discard rate to a minimum and maximize the utilization of this precious resource. At the same time, we can minimize the monetary load by enhancing the usage of blood and blood components. It is essential to carry out the root cause analysis of discard, focussing on these challenges to reduce the wastage of blood and blood components. Excess bloodstock can be shared with licensed blood centers, and surplus FFPs sent for fractionation could help in reducing the waste. A considerable reduction can be achieved by the execution of all these measures.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
The Institutional Ethics Committee has reviewed and approved the research study entitled: Analysis on discard of blood and blood components in a tertiary care centre: A guide to blood inventory management in its meeting held on August 31, 2020 communicated vide letter no. N-EC/2020/08/59 dated September 10, 2020.
| References|| |
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 Sci2012;6:19-23. [Full text]
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.
Saxena S, Weiner JM, Rabinowitz A, Fridey J, Shulman IA, Carmel R. Transfusion practice in medical patients. Arch Intern Med 1993;153:2575-80.
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 Med2017;2:130-6. [Full text]
Pitocco C, Sexton TR. Alleviating blood shortages in a resource-constrained environment. Transfusion 2005;45:1118-26.
Smita M, Binay B, Gopal K, Debasish M, Rashmita P, Pankaj P. Discard of blood and blood components with the study of causes—A good manufacture practice. World J Pharm Med Res 2017;3:172-5.
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;4:21321-9.
Kumar A, Sharma SM, 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. Int J Med Public Health 2014;4:72-4. [Full text]
Collins RA, Wisniewski MK, Waters JH, Triulzi DJ, Yazer MH. Effectiveness of multiple initiatives to reduce blood component wastage. Am J Clin Pathol 2015;143:329-35.
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.
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.
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.
Sharma N, Kaushik S, Kumar R, Azad S, Acharya S, Kudesia S. Causes of wastage of blood and blood components: A retrospective analysis. IOSR J Dent Med Sci 2015:13:59-61.
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.
Veihola M, Aroviita P, Linna M, Sintonen H, Kekomäki 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.
Saluja K, Thakral B, Marwaha N, Sharma RR. Platelet audit: Assessment and utilization of this precious resource from a tertiary care hospital. Asian J Transfus Sci 2007;1:8-11.
] [Full text]
van Dijk N, Haijema R, van der Wal J, Sibinga CS. Blood platelet production: A novel approach for practical optimization. Transfusion 2009;49:411-20.
[Table 1], [Table 2], [Table 3], [Table 4]