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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 3
| Issue : 2 | Page : 37-43 |
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Availability of blood components and utilization in a teaching hospital blood center
Suneetha Raghu1, Linus Benedicta D Souza2, MN Raghu3, Araveti Yashovardhan4
1 Department of Administration and Quality, RLJH and RC, Kolar, Karnataka, India
2 SUIMC, Mangalore, Karnataka, India
3 Department of Pharmacology, SDUMC, Kolar, Karnataka, India
4 Department of Transfusion Medicine - Blood Center, NMCH, Nellore, Andra Pradesh, India
| Date of Submission | 12-Nov-2022 |
| Date of Decision | 06-Dec-2022 |
| Date of Acceptance | 26-Dec-2022 |
| Date of Web Publication | 13-Feb-2023 |
Correspondence Address:
Mrs. Suneetha Raghu
Department of Administration and Quality, RLJH and RC, Tamaka, Kolar - 563103, Karnataka
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/QAIJ.QAIJ_19_22
Background: The quality of blood centers and transfusion services is judged by the timely availability of blood components and their effective utilization by those in need. Proper utilization of the needed blood components can also prevent the wastage of blood products. Stock management of blood and blood components will increase their maximum availability and utilization. Many studies have shown that a lack of blood and its components increases the risk of severe complications in patients who require blood transfusions on an emergency basis, such as during intraoperative or postpartum hemorrhage, in trauma patients with severe anemia, and so on. All the health-care sectors need supportive facilities to provide on-time services to their customers. Hospital image and the quality of health-care services will be influenced by customer and patient satisfaction. The blood center plays a vital role in that by providing lifesaving blood and its components on an emergency basis as well as to the needy population. Objective: The goals of this research are to examine the stock availability of blood and blood components, to determine the utilization of blood units based on consumer needs, and to discover and analyze blood and blood component waste before use. Methodology: A retrospective study was conducted in a teaching hospital blood center on stock verification and the issuing of blood components. The retrospective record analysis was performed for 18 months. Sampling Method: The availability of stock and the utilization of blood and blood components data were collected from January 2021 to June 2022 from registers maintained and documented in the blood center. Conclusion: Our study provided a clear picture of how to maintain the stock level of blood units and blood components by explicitly stating the percentage of collection, stock level maintained for emergency needs, and percentage of utilized blood and blood components. We were able to determine the number of blood and blood component discards throughout the study and the causes of these discards so that we could implement the best inventory control for blood units in accordance with our analysis of GroupWise blood units' stock level maintenance to satisfy customer needs. Keywords: Blood and blood components, collection, discard, teaching hospital, utilization
How to cite this article:
Raghu S, D Souza LB, Raghu M N, Yashovardhan A. Availability of blood components and utilization in a teaching hospital blood center. QAI J Healthc Qual Patient Saf 2022;3:37-43 |
How to cite this URL:
Raghu S, D Souza LB, Raghu M N, Yashovardhan A. Availability of blood components and utilization in a teaching hospital blood center. QAI J Healthc Qual Patient Saf [serial online] 2022 [cited 2023 Mar 27];3:37-43. Available from: https://www.QAIJ.org/text.asp?2022/3/2/37/369614 |
| Introduction | |  |
The availability of blood components in a timely manner and their effective utilization by those in need are used to judge the quality of blood centers and transfusion services. Proper utilization of the needed blood components can also prevent the wastage of blood products.[1] Stock management of blood and blood components will increase their maximum availability and utilization. Many studies have shown that a lack of blood and its components increases the risk of severe complications in patients who require blood transfusions on an emergency basis, such as during intraoperative or postpartum hemorrhage, or in trauma patients with severe anemia, and so on.[2] All the health-care sectors need supportive facilities to provide on-time services to their customers. Hospital image and quality of health-care services will be influenced by customer and patient satisfaction. The blood center plays a vital role in that by providing lifesaving blood and its components on an emergency basis as well as to the needy population.
Management of blood supply and demand includes continuous monitoring of blood supply and demand along with appropriate steps to prevent unanticipated blood shortages, particularly for blood and other body fluids with a short shelf life, such as platelets. In addition to taking lives, health problems and the collapse of medical systems are one of the greatest dangers to the country's security and economy. The World Health Organization (WHO) defines international health security as the proactive and reactive activities and actions required to reduce the occurrence and impact of any health change affecting people's health on a national or international scale.[3] Institutions have to use more creative thinking to engage consumers by endorsing products that meet their greatest needs and requirements. The quality revolution is a movement that has a huge impact on an institution's management system. A successful management team uses the continued provision of good service in order to compete in this field, and furthermore, one of the sectors that drive income activity is the service sector. In the health sector, the blood center plays a vital role in fulfilling the consumer's needs during their emergencies.[4],[5] The Drugs and Cosmetics Provision specifies that not everyone who visits a blood bank or donation center to donate blood is a donor. By definition, a donor is a person whose been approved by a doctor to donate blood following a comprehensive medical examination. Several safety measures are implemented by the blood transfusion community to make blood donation safe and boost public confidence in voluntary blood donation. Donor selection is the most important precautionary measure. Strong, careful, and serious donor screening is required to protect blood donors and recipients. There have not been enough healthy, dependable blood donors. The lack of genuine, safe blood donors has always been a big problem for blood centers all over the world. While it is essential to have an adequate supply of blood, it is also essential that the practice of collecting blood and transfusing it really does not harm either the donor or the recipient.[6] As a result, a vital part of ensuring the quality of transfusion services is ensuring the effective utilization of blood products. Keeping a decent balance between elevated blood demand and supply is especially difficult. Interventions should attempt to improve transfusion practices, so regular evaluation of existing guidelines is designed to improve transfusion practices. As a response, this study aims to evaluate blood and blood component usage patterns in a teaching hospital facility.
Objective
- To analyze the stock availability of blood and blood components
- To determine the utilization of blood units based on consumer needs
- To find out and analyze the wastage of blood and blood components prior to their use.
| Methods | | |
A retrospective study was conducted in a teaching hospital blood center on stock verification and blood component distribution. The retrospective record analysis was performed over a period of 18 months.
Sampling method
The availability of stock and the use of blood and blood component data were collected from January 2021 to June 2022 from registers maintained and documented in the blood center. As a result, our blood center is regarded as a “tiny blood center” because our annual total collection is <5000.
Inclusion criteria
- The analysis of stock availability included the blood collected from voluntary donors as well as replacement donors
- Utilization of blood and blood components was included only for inpatient and emergency patients at the teaching hospital where the study was being conducted.
Exclusion criteria
- Blood and blood components obtained from outside sources and temporarily stored.
- Outside recipients of blood and blood components.
| Data Analysis and Results | | |
During the 18-month research period, 3059 blood units were collected.
[Graph 1] depicts replacement and volunteer donors. Seven percent of the 3059 collections were male, while 4% were female. Even though male donors outnumber female donors by 0.68%, female donors account for 0.68% of replacement donors. This graph shows that the number of voluntary donors is quite low, implying that blood donation awareness is not at the level recommended by health guidelines. The WHO/BTS, for example, has published recommendations based on the World Health Assembly Resolution 28.72 of 1975, which calls on Member States to create national blood transfusion programs based on voluntary, uncompensated blood donation. It also provides technical assistance and collaboration to Member States in the development of national blood programs.[7]
[Graph 2] depicts the number of postponed donors, with a higher proportion of female donors (73.86%) than male donors (lower side) (26.13%). Thus, we discovered low hemoglobin, a medication history, underweight, low blood pressure, and menstruation, a history of vaccinations due to a current pandemic, prior hospitalization, surgery, an alcoholic history, comorbidity, and weakness as a result of a history of periodic fasting for religious rituals as deferral causes.
The total number of reactive and nonreactive blood units calculated from the collected units is shown in [Graph 3]. According to the screening system, 3% of blood units were reactive and 97% were nonreactive, which may be used to avoid future problems and increase the supply of safe blood. A nonreactive result of 97 parts per thousand implies that the units are infection-free, whereas 3% of blood units are reactive for illnesses such as HIV, HBV, HCV, syphilis, and others. We were able to identify and report any infections to the proper authorities, as well as the ICTC for HIV, in order to promote good health.
[Graph 4] shows the collection of blood units and the availability of stockpiles for consumers in need throughout 18 months. According to this study, blood unit collections were highest on November 2021 and February 2022, and lowest on May 2021. As a result, the graph reveals that February has the highest stock availability, while January 2021 and October 2021 have the lowest stock availability. The fact that stock was more available (5.39%) while collection was much lower (0.25%) on May 21 shows that demand for blood units or blood unit use was significantly lower on May 21. In this regard, when we completed our research, we observed that patient inflow was lower that month.
We attempted to depict the percentage of blood units used at the teaching hospital in [Graph 5] by removing blood units supplied from outside sources. In this case, we discovered that the consumption rate is larger than the discard rate. Blood units are frequently discarded at a higher rate than they are used, particularly during the months of June 21, July 21, August 21, September 21, March 22, April 22, and June 22. Because demand was low, more blood units were discarded during the preceding months. The blood unit expiration dates were caused by faulty storage, broken bags from long-term return, and a subsequent first in, first out (FIFO) system. This study aided us in improving bloodstock management to eliminate avoidable unnecessary discards.
Examination of the relationship between the use of emergency and elective blood units Concerns about external blood components, inpatients, and outpatients are included in this category. According to the same graph, 95.09% of blood units were delivered on an elective basis, while 1.91% were provided on an emergency basis, but no blood components were provided on either an elective or emergency basis for outpatients or inpatients. Because no outside blood components were delivered as an emergency, the elective basis was 2.98%. Because this study on the consumer need-based blood recipient screening system was done in a teaching hospital, blood unit issuance is more common according to the [Graph 6].
[Graph 7] depicts the various types of blood component collections, the amount of unused old stock still in stock, and the number of discarded blood component collections. These data show that blood components were collected and used in more than 95% of cases, with the exception of platelets, which were used at a slightly lower rate than normal throughout the course of 18 months (January 2021–June 2022). As indicated in [Graph 5], discarded percentages of packed cells were 3.97%, platelets were 14.45%, and fresh frozen plasma (FFP) was 4.82% due to expiration dates and other considerations; single donor platelet discards were nil. There were 0.23% of packed cells, 0.46% of platelets, 2.96% of FFP, and 0.92% of single cells left in the inventory.
[Graph 8] depicts the availability of packed cells based on blood group availability throughout an 18-month period (January 2021–June 2022). As a result, [Graph 8] reveals that O+ had a larger percentage (41.7%). All packed cell groups maintained some level of stock, while AB− had the lowest level of stock, along with the negative group's stock, and AB+ had the lowest level of stock relative to other positive packed cell groups.
[Graph 9] demonstrates that a certain percentage of platelet and FFP supply levels were maintained from January 2021 to June 2022. Over the course of 18 months, the O group kept stock levels nearly identical to those of the above – 41% group, the B group kept stock levels nearly identical to those of the above – 33% group, the A group kept stock levels slightly lower than those of the above – 17% group, but the AB group kept the lowest levels of stock – platelets at 4.99 and 5.69% – over that time. This graph also reveals that no zero stock was retained from January 2021 to June 2022 during the study period.
| Discussion | | |
Modern health care includes a blood transfusion service as a crucial component. The Food and Drug Control Authority classifies blood and blood components as medicines. Multiple patients can benefit from component treatment since the components made from a single unit of whole blood (WB) can be used to meet a variety of transfusion demands. Due to the burden of chronic diseases on the senior population and the rise in blood-demanding surgical operations, the usage of blood components has expanded recently.[1] This study illustrates how blood and blood components are available, how they are used, and where the discarded blood units are located in order to prevent needless wasting of any blood and blood components during the course of an 18-month period from January 2021 to June 2022. This study assisted us in putting into practice a new policy that will sustain the supply of blood units for customers who truly need them.
Over the course of the 18-month research period, 3059 blood units were total collected for the current study. For the purpose of identifying donors' knowledge and understanding of the advantages of blood donation, we divided donors into volunteer and replacement donors, although our study revealed that replacement donors were more numerous than voluntary donors. This shows that replacement donors only provide blood units when they urgently need them, and that during the study period, fewer blood camps were organized because of the pandemic problem to prevent overcrowding. This shows that there are extremely few donors who give blood voluntarily and walk to a blood bank, indicating that blood donation awareness is not at the level recommended by health guidelines. The World Health Assembly Resolution 28.72 of 1975, for instance, calls on Member States to set up national blood transfusion facilities based on unpaid, voluntary blood donation. The WHO/BTS has published recommendations based on this resolution. In addition, it provides Member States with technical support and participation in the development of national blood programs.[8] Our study also found that there are more male donors than female donors. According to Rajendra and Madapura research, voluntary donors make up a small portion of the donor pool (7.7%), whereas replacement donors make up a large portion (92.2%) of the donor pool. In addition, male donors make up a larger portion of the donor pool (83.7%) than female donors (16.2%).[9] 95.13% of donors were male, and 4.8% were female. 95.13% of donors were male, and 4.8% were female, according to Unnikrishnan et al. The low number of female donors can be attributed to females' lack of knowledge, fear, awareness, and drive.[10]
Numerous factors for delaying blood donation have been examined in this study.[10] In our study, deferral donors were divided into male and female deferral donors. When compared to female deferral donors, men made up the majority (86.23% of replacement and 7% of voluntary donors) (4% were voluntary and 0.68% replacement donors). This result was consistent with a number of previous researches. In comparison, there were 73.86% of female deferral donors and 26.13% of male donors. Due to a variety of factors, female deferral donors predominate in our study over male donors. Deferral rates for male donors were 19.85%, according to Sareen et al. Deferral rates across the board were 22.36%. Anemia 764 (39.42%) was the main reason for delay in both males and females. The additional factors in descending order of low body weight 277 (14.29%), youth 151 (7.79%), drug/medication history 118 (6.01%), recent blood donation 75 (3.87%), icterus 49 (2.53%), and monthly bleeding 45 (2.32%) were all frequent cardiac issues and hypertension accounted for the majority of permanent deferral causes, making up 208 (10.73%) of all causes. Asthma in 27 (1.39%) cases and diabetes mellitus requiring insulin therapy are uncommon causes.[11] Although the focus of our study was only on the common factors that led to donors being rejected, such as low haemoglobin, a medication history, being underweight, low blood pressure, menstruation, prior hospitalization, surgery, an alcohol history, comorbidity, and weakness brought on by a history of intermittent fasting for religious rituals.
The screening system in this study indicated that just 3% of blood units were reactive and 97% were not reactive. Infections such as HIV, HBV, HCV, and syphilis are reactive in 3% of blood units. Blood donors were found to have a significantly higher seroprevalence of syphilis than the general population, which was reported to be 2.1%, according to Arshad et al.[12]
Our study examined the overall amount of blood units collected as well as the blood units that were available. For 18 months, the month of November 21 saw the highest number of collections, and the month of May 21 saw the lowest number of collections. While January 2021 had the lowest degree of stock maintenance and September 2021 experienced the highest level of stock availability. Our research demonstrates that no nil stock level was kept in order to meet consumer demand. As per their study, Bedi et al. conducted a similar investigation. A total of 20,517 units of blood were collected throughout the course of the 1½-year study period, with outdoor voluntary blood donation camps accounting for 90% of the blood collection.[2] Rajendra and Madapura conducted one more investigation to examine the blood units collected over a 5-year period. Total blood units for consumer needs were donated by 92.2% of replacement and 7.7% of volunteer donors.[9]
In order to reduce wasteful waste and incorrect management during our study period, we also sought to determine the use and discard rates of blood units. The highest percentages of blood units used were between the months of December 2021 (9.02%) and June 2022 (10.63%). The months of July 2022 (9.19%) and March 2022 (9.77%) saw the largest percentage of blood units discarded, respectively.
Blood unit expiration dates were caused by incorrect storage, broken bags from long-term return, and an improper FIFO system thereafter. This study assisted us in enhancing the management of blood stocks to reduce preventable unneeded discards. This evaluation helped us to establish and implement the policy for preventing the unnecessary wastage in order to improve the proper management of blood units. In the first 6 months of 2012, 254 (4%) units were abandoned. According to Bedi et al., the most prevalent cause of discarded blood units was outdated, which accounted for 45.7% of the 254 units in concern.[2] Another study was conducted by Kurup, and according to their findings, red blood cells make up the least amount of the reasons blood units are wasted, followed by expired blood units, broken seals, broken cold chains, broken bags, returned after 30 min, and clotted blood. Four hundred and eighty-seven (11.7%), 1892 (45.5%), and 1788 (42.9%) units of blood were lost in each of the years 2012, 2013, and 2014, respectively.[1]
In addition, our study placed a strong emphasis on the distribution or use of blood units for both inpatients and outpatients. Based on the patient classification, we were able to analyze the need for blood units in this study. In this case, we discovered that inpatients consumed more blood units (95.09%) than outpatients (nil), emergency patients (1.91%), and outside consumers (2.98%) combined. This study also showed that inpatients used more blood units following recipient screening throughout their hospital stay, indicating that they understood the need of analyzing consumer demand for blood transfusion analysis before making a decision. The requirement for blood transfusions could be evaluated according to inpatient hospitalization. As per study done by Gaur et al. found that the blood supplied for inpatients who were hospitalized in various wards, including surgical wards (62.6 %), general surgery (62.6 %), and other wards, orthopedics (20. %), neurosurgery (19 %), gynecology (15.3%), otolaryngology (5.2 %), heart and lungs surgery (2.6%), others (2.2 %), hospital wards (37.4%).[13] The results of this study also showed that inpatient utilization was higher.
In our research, we paid particular attention to the various parts of blood unit collection, storage, usage, and disposal. We discovered that almost 95% of blood components, including packed cells (99.56%), platelets (99.53%), FFP (97.03%), and platelets from a single donor (99.07%), were collected over the period of 18 months. used 74.1% of platelets, 95.17% of FFP, 95.78% of packed cells, and 99.07% of platelets from a single donor. 3.97% of the packed cells, 14.45% of the platelets, 4.82% of the FFP, and nil of the single donor's platelets were discarded because the bag was outdated and cracked. Over the course of 18 months, there were 0.23% of packed cells, 0.46% of platelets, 2.96% of FFP, and 0.92% of platelets from a single donor. Another study by Vaghela and Jokhi stated that red cell concentrate accounted for 3114 of the 5811 total units supplied in 2021, followed by FFP with 1434, platelet-rich concentrate with 1175, and WB with 84. With only n = 4 units, cryoprecipitate was the component that was least used in a whole year.[6] As per Kurup, during their study period 2012, 2013, and 2014, packed cells (82.8%, 69.2%, and 68.3%) were most frequently collected, followed by FFP (3.3%, 12.1%, and 15.5%), platelet (8.5%, 14%, and 14%), cryoprecipitate (2.8%, 3.9%, and 2.2%), and WB (2.6%, 0.9%, and 0%), respectively.[1]
Our study also examined the group-specific blood component stock kept to meet customer demand. O+ had a higher proportion (41.7%). All groups of packed cells maintained some levels of stock; however, AB− and the negative group's stock were the lowest, and AB+ was the lowest compared to other positive groups of packed cells. A + 16.66%, B + 30.79%, A − 1.14%, B − 1.82%, and O − 2.76% are examples of further group stocks. The maintained stock level of platelets and FFP was also determined throughout a period of 18 of our study period. The supply of platelets from the A group comprised 17.77%, B group 35.65%, AB group 4.99%, and O group 41.57%. Group O (41.79%), Group B (33.7%), Group AB (5.69%), Group A of FFP (18.79%), and no nil stock maintained of all groups of blood components. O + blood type was the most often collected blood type, with 48.0%, 3484 (48.7%), and 51.2% in 2012, 2013, and 2014, respectively, according to Kurup's study. B + units (22.5%), A + units (21.5%), and C + units (19.9%) made up the hospital's second-most collected blood groups, while B + units (21.3%), A + units (20.3%), and C + units (19.3%) for the years 2012, 2013, and 2014, respectively, were recorded. The blood groups that were least frequently collected were the negative blood groups, with blood group AB topping the list.[1]
| Conclusion | | |
The purpose of this study was to assess how often blood and blood components were used in a teaching hospital setting. We determined that the blood units were collected by voluntary and replacement donors, which helped us to make the decision to increase the number of voluntary donors. We also discovered reactive and nonreactive blood unit's percentages so that we could improve the screening system to prevent further complications. We determined that stock of collected blood and blood component was available to meet consumer demand based on their requirements.
Our study provided a clear image of how to maintain the stock level of blood units and blood components by explicitly stating the percentage of collection, stock level maintained for emergency needs, and percentage of utilized blood and blood components. We were able to determine the number of blood and blood component discards over the course of the study and the causes of these discards so that we could implement the best inventory control for blood units in accordance with our analysis of GroupWise blood units' stock level maintenance to satisfy customer needs.
Therefore, each blood center should assess its collection, stock keeping, causes of wastage, and promotional initiatives to raise awareness of blood donation, and should develop its own corrective methods.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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