Analysis of reasons for discarding blood and blood components in a blood bank of tertiary care hospital in central India : A prospective study

Today, many modern surgical procedures could not be carried out without the use of blood and there is no substitutes for human blood.[1,2] It has been estimated that one-third of all patients admitted to intensive care units in the developed world receive a blood transfusion.[3] So each unit of blood is precious and utilized judiciously with minimal wasting. By analyzing the data and the reason for the discards, the blood transfusion services can develop plans to improve performance through education and training of staff and introducing new measures in order to minimize the number of discarded blood to a reasonable rate.[4] The aim of this study was to fi nd out the reasons for discarding blood bags so that they could be utilized judiciously with minimal wasting.


Data analysis
Blood bags included during this period, were screened for transfusion transmissible infections (TTIs).The blood bags, which were seroreactive (seropositive) were discarded.The blood bags, which were expired because of non-utilization, were discarded.Less amount of blood collected from the donors because of any reasons, including donor's reactions was discarded.Blood showing any changes of either hemolysis or turbidity were also discarded.

RESULTS
Among total donors in the blood bank, 97.05% were male and 2.95% were female.Almost 78% were voluntary donors and 22% were replacement donors.Among voluntary donors 96.24% were male and 3.76% were female donors as shown in Table 1.
Out of total 10,582 blood bags which were collected from donors during the study period, 346 (3.25%) of whole blood bags were discarded.Out of these 346 bags, approximately 74.30% were discarded because of seropositivity for TTIs.Among infectious diseases, hepatitis B infection was the most common cause for discarding as shown in [Table 2].
Amongst whole blood bags discarded, seropositivity for TTIs were the most common cause followed by expiry of date due to nonutilization (11.84%), others cause include yellowish discoloration of plasma, signs of hemolysis noted in blood bags, issued blood bags to the patients but not used as shown in Table 3.
A total of 542 blood components were discarded against 3702 blood components prepared during the study period.The most common blood components were discarded were platelets followed by fresh frozen plasma (FFP)-as mentioned in Table 4.
A total of 542 blood components were discarded in which the most common cause was expiry of blood components, constituted 87.00% followed by seropositive for transfusion transmitted diseases, constituted 8.00% as shown in Table 5.

DISCUSSION
In a study done by Thakare et al. [5] it was observed that 3.58% of blood bags were discarded.The main reason of the discarding these blood bags was the positivity for different transmissible diseases (TTIs) constituting 68.86% followed by other reasons (31.13%).Among the units discarded, 49.82% were positive for hepatitis B surface antigen (HBs Ag), 10% for human immunodefi ciency virus (HIV) and 8.97% for hepatitis C virus (HCV) while no unit was positive for Venereal Disease Research Laboratory.
In a study done by Deb et al. [6] it was observed that an average 292 (14.61%) bags from the total collection were discarded.Of the 292 units discarded, 242 units were due to non-utilization.
In another study done at Choithram Hospital and Research Center, Indore, India by Chitnis et al. [7] it was observed that approximately    TTIs = Transfusion transmissible infections (8.9-10%) of blood bags were discarded (approximately 80 blood bags were discarded monthly against a total of 800-900 units collection) as reactive for HIV/HBs Ag/HCV or contamination/ reactions to recipients and expired units.
In a study done by Gauravi et al. [8] in Saurashtra region of Gujarat, it was found that in 2008, 226 blood bags were discarded against 7882 blood bags collected due to seropositive for TTIs diseases.In 2009, 178 blood bags were discarded due to seropositive for infectious diseases against total 8141 blood bags collected and in 2010, 212 blood bags were discarded against 9441 blood bags collected due to seropositive for TTIs diseases.In a study done by Morish et al. [4] in National blood center, Kuala Lumpur, a total of 390,634 whole blood and blood components units were prepared in 2007 in National Blood Center.Of these 8968 (2.3%) units were discarded.Platelet concentrate scored the highest at 6% when compared with the other blood components.The discarded rates of whole blood and packed red blood cells (RBCs) were 3.7% and 0.6%, respectively.The reasons behind the discard of whole blood can be attributed to procedures carried out during the collection process.The leakage was the second cause of discarded blood and its components, which represented 26% of discarded blood.
The frozen blood components that consist of 43% and 27% of discarded FFP and cryoprecipitate, respectively, were due to the leakage.25% (2208) of discarded blood were wasted because of gross lipemic blood components.
A large-scale study conducted in 17 blood centers in 10 European countries from 2000 to 2002 reported that the mean platelet discard rates for the 3 years were between 6.7% and 25%.However, the annual mean discard rates from 2000 to 2004 remains at 13%.The discarded platelets included all platelet units, which were damaged during processing regardless of the preparation method as well as those that expired. [9] the same European centers, the mean for packed RBC discard rate was 4.5%, varying annually from 0.2% to 7.7%. [10]e current study showed that the FFP and RBC discard rates were comparable with the Novis et al. study in USA, which reported that the discard rates of FFP ranged from 2% to 2.5% and RBC ranged from 0.1% to 0.7% in 1639 hospitals. [9,11]

CONCLUSION
As compared with these studies, it was observed that lesser number of blood bags was discarded in our blood bank.It was mostly because of positivity for different transmissible diseases (TTIs).Among blood components discarded, most commonly units were platelets.The most common cause of discarding the blood components was expiry of date due to non-utilization.
A properly conducted donor interview, notifi cation of permanently deferred donors will help in discarding less number of bags from collected units.
Similarly, properly implemented blood transfusion policies will also help in discarding less number of blood bags due to expiry.These discarded bags, because they are unutilized are both fi nancially as well as socially harmful to the blood bank.
International Journal of Medicine and Public Health | Jan-Mar 2014 | Vol 4 | Issue 1 International Journal of Medicine and Public Health | Jan-Mar 2014 | Vol 4 | Issue 1