Introduction

Since artificial substitutes for blood as a life-saving measure have not yet been created, human blood is a necessary component of life. Blood transfusion services (BTS) should be watchful enough to ensure the quality and safety of blood bags because of their restricted supply. Section 3(b) of the Drugs and Cosmetics Act of 1940 in India classifies human blood as a "drug". ¹ Since someone needs blood every two seconds worldwide ^{2, 3, 4} , it is crucial to have access to safe and timely blood bags. Numerous chronic conditions, such as severe anaemia and beta-thalassemia major, call for ongoing blood transfusions from healthy donors. One of the 10 quality indicators suggested by the National Accreditation Board for Hospitals & Healthcare Providers (NABH), India, is the percentage of wasted blood components, or "wastage rate". ^{5, 6} To prepare blood and its components and use blood as efficiently as possible, this study attempts to identify the numerous reasons why blood is thrown away.

Material and Methods

This retrospective study was done in the blood bank of a tertiary care hospital for a period of 7 years, from January 1, 2014, to December 31, 2020. The blood bank is connected to the Department of Pathology of the Indian Institute of Medical Science, a rural medical college in Maharashtra, India. The World Health Organization's (WHO) selection standards were followed while choosing the blood donors. Information was gathered from several registries, including the registers for donors, discards, transfusion-transmitted illnesses (TTIs), and components preparation. The justification for eliminating blood and its constituent parts was analyzed. Components were prepared and blood bags were discarded in accordance with our blood bank's norms and the standard operating procedures established by the National Aids Control Organization (NACO), an organization based in India. In addition, there were no exclusion criteria used in the selection of the samples. MS-Excel for Windows was used to study every bit of data. The frequency and percentages were used to represent all category data.

Results

In the seven years from 2014 to 2020, overall 4022 blood bags were collected. Year-wise 475, 544, 502, 424, 576, 742 and 759 units of blood were collected from the year 2014 to 2020, respectively, in the blood bank. (Table 1 ) Platelets, fresh frozen plasma, and packed red blood cells (PRBC) were among the components that were manufactured. So, in total 4022 blood bags were collected from which 391 blood units were discarded with a 9.7 overall discard rate in 7 years. Year-wise discard rate was more in the years 2015 and 2016. When component-wise discard rate was considered 13.4% of whole blood was discarded and least discard rate was platelet component which was 6% (Table 2) Out of 391 wasted units, 87 (22.2%) were discarded due to seroreactivity to transfusion-transmitted illnesses (TTI), 126 (32.22% expired, 127 (32.48) hemolysed and 51(13.04%) were discarded due to leakage or less quantity in the bag. (Table 3) Year-wise data of blood collected and reasons for discard shows that from 2014 to 2022 shows HBV infected blood was followed by HCV infection and the most common quality check reason for discard was either the expiry date of blood collected or Hemolysed blood in almost 32% of cases. (Table 4) and Figure 1

Discussion

Furthermore, blood and its components provide unique and lifesaving therapeutic benefits to patients, making BTS an essential component of modern day-to-day clinical practice. The need for blood and its components is growing due to improved treatment and accurate diagnosis of complex diseases requiring repeated transfusion. Still, due to resource limitations, it is not always possible to perform BTS. As a result, ensuring that blood is properly managed at the blood bank and that staff education is maximised would reduce the needless loss of blood and its byproducts. ⁷ The current study found that from 2013 to 2020, respectively, 42, 70, 60, 58, 55, 53, and 53 units of the 4022 units of blood were wasted. Compared to research by Suresh et al. (5.7%), Bobde et al. (6.63%), Sharma et al. (4.46%), and Kanani et al. (3.5%), the average discard rate for whole blood in the current study was 23.23%. [2,8,9,10,11]. ^{2, 8, 9, 10} The average discard rate in the studies by Morish et al., ⁹ Kora et al. Kumar et al., Thakare et al., Suresh et al., Patil et al., Bobde et al., Sharma et al., Ghaflez et al., and Deb et al. (Table5) were 2.3%, 4.3%, 8.4%, 3.6%, 7.0%, 22.45%, 6.63%, 8.69%, 12.0%, and 14.61%, respectively

Seropositivity for transfusion-transmissible diseases (TTI) such HIV, HBsAg, HCV, VDRL, quality control, less blood (underweight), expired, hemolyzed sample, and polycythemia are a few of the several reasons blood is discarded. ^{11, 12, 13, 14} Our investigation revealed that seropositivity for TTI, followed by expiry date and hemolyzed sample was the most prevalent cause of wastage of whole blood and its components (HBsAg>HIV>HCV>VDRL). It resembles research carried out by Suresh et al. ² . However, it can be reduced by taking a thorough medical history, adhering strictly to the donor selection criteria, and setting up a donor database. Sterile check or quality control, which is carried out as a part of the Drugs and Cosmetics Act of 1940, India, was another cause for rejecting whole blood in the current study. ¹ it must be adhered to by all blood banks. As a result, this could not be avoided. Our study's limitations included fewer blood bags that were blood or were underweight due to phlebotomy failures such as vein collapse, nausea, vomiting, sweating, hematoma development, and fainting during donation. Due to a mismatch between the volume of blood taken and the anticoagulant employed in the bag, such blood bags are inappropriate for transfusion. Such gathering typically takes place during blood donation camps. It can be avoided by choosing healthy donors wisely, encouraging donors, and providing sufficient phlebotomy staff training. ¹¹ Breakage was the most frequent reason for discarding FFP in the current investigation, followed by seropositivity for TTI, expiration, and other factors. It occurs due to improper processing of these component bags, and breaking of FFP bags was mostly noted while removing bags from the deep freezer prior to thawing. ¹³ By performing a thorough visual check of the blood bags during centrifugation, leakage of the bags can be avoided. FFP bags can be handled carefully and covered to minimise breakage ⁸. According to our study, seropositivity, less quantity of blood, and hemolysis were the next most frequent reasons for discarding platelets after the expiry date. The platelet has a five-day shelf life. Due to the non-use of blood products, their risk of dying was, therefore, highest. ¹⁴ Among the produced components in the current investigation, platelets had the greatest discard rate. Optimal preparation in accordance with clinical requirements and increasing usage of the apheresis process can reduce its waste. The loss of blood and its components is unavoidable, but it may be reduced by making the best use of BTS and putting it into practice, as well as by educating and training blood bank workers. Blood and its components can be wasted for several causes, including sterility, storage, decreased bleeding, expiration, hemolyzed samples, and polycythemia.

Conclusion

The loss of blood and its components can be reduced by self-regular audits, cooperation between hospital and blood bank employees, efficient storage and handling of blood units, tight donor selection and deferral criteria, coupled with thorough history taking. Disclosures of Additional Information Human volunteers or tissue were not used in this study, according to all of the authors. Animal subjects: This study did not use any animal subjects or tissue, according to all authors. Competing interests: All authors hereby provide the following disclosures in accordance with the ICMJE uniform disclosure form: Payment and service details: Each author has acknowledged that the work they submitted did not receive any funding from other sources. Financial ties: All authors have indicated that they do not now or over the last three years have any financial ties to any organisations that could be interested in the work that has been submitted.