Blood is a vital and specialized body fluid essential for human survival. It delivers oxygen and nutrients to tissues while facilitating the removal of metabolic waste products. Since blood cannot be synthetically produced, voluntary donation remains the only means of obtaining it for clinical use. Transfusion of blood is a cornerstone of modern healthcare, particularly in emergencies such as road traffic accidents, obstetric complications including antepartum and postpartum hemorrhage, intraoperative blood loss, and management of hematological disorders. [1] Globally, more than 110 million blood donations are recorded annually, with approximately 15% contributed by the South-East Asian region. [2] Whole blood accounts for nearly 89% of all transfusions, whereas apheresis-derived components make up the remaining 11%. Indications for transfusion differ across regions: in developed countries, blood is primarily used for cardiovascular and transplant surgery, trauma care, and treatment of malignancies, while in developing countries, it is more commonly required for obstetric emergencies and severe pediatric anemia. [3,4] Despite its crucial role, the availability of safe and adequate blood in developing nations remains a significant challenge. Factors such as limited voluntary donors, inadequate storage infrastructure, poor awareness regarding component preparation, and irrational utilization contribute to this issue. [5] Furthermore, excessive ordering of blood for cross-matching, often surpassing actual clinical requirements, results in wastage of resources and strain on blood bank services. This practice is particularly evident in medical and surgical departments, where requests frequently exceed transfusion needs. [6] Optimizing transfusion practices is therefore imperative. Regular audits of blood requisition and utilization, coupled with Hospital Transfusion Committee reviews, can guide evidence-based interventions, reduce costs, and improve the rational use of this invaluable resource. Against this background, the present study was undertaken to assess prevailing transfusion practices in a teaching hospital, to identify and categorize the clinical indications for which blood is transfused, and to highlight the importance of safe and rational transfusion practices for optimizing both patient care and healthcare resources.

The present study was designed as a retrospective, record-based cross-sectional analysis conducted at the blood centre of the institute over a period of one year, from October 2023 to September 2024. Data confidentiality was strictly maintained, and all information was extracted from institutional registers and electronic records. Since the study was based exclusively on secondary data, no patient contact was involved and informed consent was not required. During the study period, transfusion request and cross-match forms submitted by various clinical departments—including Obstetrics and Gynecology, Pediatrics, Medicine, Surgery, Orthopedics, Thalassemia, Casualty, Neurosurgery, ENT/TB Chest—as well as from outside hospitals, were reviewed. Department-wise and indication-wise data were retrieved from the blood centre’s software database for analysis. To evaluate the appropriateness of blood and blood component utilization, the following quality indicators were calculated: 1. Cross-match to Transfusion Ratio (C/T ratio): Defined as the number of units cross-matched divided by the number of units transfused. A ratio ≤2.5 was considered indicative of efficient blood usage [8]. 2. Transfusion Index (TI): Calculated as the number of units transfused divided by the number of patients cross-matched. A value ≥0.5 indicated significant blood utilization [8]. 3. Transfusion Probability (%): Defined as the number of patients transfused divided by the number of patients cross-matched, multiplied by 100. A value ≥30% was regarded as appropriate blood use. 4. Blood Utilization Rate: Calculated as (Units transfused ÷ Units cross-matched) × 100. An overall utilization rate ≥96% for whole blood and blood components was considered acceptable [7]. Inclusion Criteria: All blood units issued from the institute’s blood centre during the study period to the aforementioned clinical departments and outside hospitals were included. Exclusion Criteria: Blood units issued from any external blood bank other than the institute’s blood centre were excluded from the analysis

During the twelve-month study period, the blood centre of the institute issued a total of 14,112 blood components to various clinical departments, as detailed in Table 1. The highest utilization was observed in the Department of Obstetrics and Gynecology, which accounted for 29.47% of the total issued components, followed by the Department of Medicine at 18.65%. Overall, 15,067 cross-match requests were processed during this period, of which 93.66% resulted in component issuance. In contrast, 955 components (6.34%) were subsequently de-crossmatched, as illustrated in Chart 1. Table 1: No. of blood components issued in different departments DEPARTMENTS COMPONENTS ISSUED COMPONENT CROSSMATCHED UNISSUED COMPONENTS OBGY 4159(29.47%) 4426 267 PAEDIATRICS 1294(9.17%) 1415 121 THALASSEMIA 350(2.48%) 350 0 MEDICINE 2626(18.65%) 2688 62 SURGERY 1090(7.72%) 1220 130 ORTHOPEDICS 980(6.94%) 1180 200 CASUALITY 889(6.29%) 938 49 NEUROSURGERY 97(0.68%) 123 26 ENT/TB CHEST 167(1.1%) 205 38 OUTSIDE HOSPITALS 2460(17.5%) 2522 138 TOTAL 14112 15067 955 The study findings revealed that non-utilization of blood components—defined as the absence of demand following a cross-matching request—was most frequently observed in the Departments of Obstetrics and Gynecology and Orthopedics, followed by outside hospitals, the Department of Surgery, and the Department of Pediatrics. In total, 955 blood component units remained unissued. As per the blood bank policy, any cross-matched unit not requisitioned within 72 hours was considered to have no demand and was subsequently de-crossmatched. Table 2: Distribution of utilization of blood and its components according to the different departments DEPARTMENT RCC FFP PC OBGY 2967(32.68%) 649(23.5%) 543(23.9%) PAEDIATRICS 822(9.05%) 303(10.9%) 169(7.5%) THALASSEMIA 350(3.85%) 0 0 MEDICINE 1716(18.89%) 566(20.4%) 344(15.2%) SURGERY 826(9.09%) 175(6.38%) 89(3.9%) ORTHOPEDICS 873(9.62%) 68(2.46%) 31(1.4%) CASUALITY 532(5.86) 165(5.96%) 192(8.47%) NEUROSURGERY 90(0.99%) 3(0.10%) 4(0.19%) ENT/TB CHEST 155(1.70%) 3(0.10%) 9(0.39%) OUTSIDE 751(8.27%) 832(30.2%) 885(39.05%) TOTAL 9082 2764 2266 In the present study, Red Cell Concentrates (RCC) constituted the majority of issued blood components, accounting for 9,082 units (64.35%), followed by Fresh Frozen Plasma (FFP) with 2,764 units (19.59%) and Platelets with 2,266 units (16.06%) (Table 2). Among departments, Obstetrics and Gynecology recorded the highest utilization of RCC with 2,967 units (32.68%), followed by Medicine with 1,716 units (18.89%). For FFP, the largest proportion was issued to outside hospitals (832 units, 30.2%), followed by Obstetrics and Gynecology (649 units, 23.5%). Similarly, platelet utilization was highest in outside hospitals (885 units, 39.05%), followed by Obstetrics and Gynecology (543 units, 23.9%). Table 3: Department wise list of CT ratio, transfusion index and Blood utilization rate DEPARTMENT CTR TI BLOOD UTILIZATION RATE OBGY 1.06 0.93 93.96% PAEDIATRICS 1.09 0.91 91.41% THALASSEMIA 1 1 100% MEDICINE 1.02 0.97 97.69% SURGERY 1.1 0.89 89.34% ORTHOPEDICS 1.2 0.83 83.05% CASUALITY 1.05 0.94 94.77% NEUROSURGERY 1.2 0.78 78.86% ENT/TB CHEST 1.2 0.81 81.46% OUTSIDE HOSPITALS 1.02 0.97 97.54% TOTAL 1.06 0.93 93.66% In the present study, a total of 15,067 blood components were cross-matched, of which 14,112 units were issued, resulting in an overall Cross-match to Transfusion (C/T) ratio of 1.06 for the hospital. Department-wise analysis showed that Orthopedics, Neurosurgery, and ENT/TB Chest recorded the highest C/T ratio (1.2), followed by Surgery (1.1). The Thalassemia ward demonstrated the most efficient blood utilization across the institution. With respect to the Transfusion Index (TI), the lowest values were observed in Neurosurgery (0.78) and ENT/TB Chest (0.81), while the highest were in the Thalassemia ward (1.0) and Medicine (0.97). The overall hospital TI was 0.93, exceeding the threshold of 0.5, thereby indicating significant utilization. The overall hospital blood utilization rate was 93.66%. The Thalassemia ward achieved the highest utilization (100%), followed by Medicine (97.69%), whereas Neurosurgery (78.86%) and ENT/TB Chest (81.46%) recorded the lowest rates. A total of 10,720 patient samples were processed, corresponding to 15,067 cross-matched units. Based on these figures, the transfusion probability was calculated at 71.14%, well above the 30% benchmark, further supporting the evidence of efficient blood usage in the current setting.

Blood component transfusion plays a pivotal role in patient management; however, its use is associated with potential risks, including transfusion reactions, infections, and transmission of blood-borne diseases such as hepatitis B, hepatitis C, and HIV. Moreover, as blood is a human-derived product, its supply is inherently limited and the costs involved are considerable. Over-ordering and unnecessary cross-matching can result in wastage, depletion of inventory, and an additional workload on blood bank personnel. Given these challenges, judicious utilization of blood and its components is essential to ensure patient safety and optimize resource management. [9] The present study was undertaken to assess blood ordering practices across various clinical departments, with the aim of identifying strategies to minimize unnecessary transfusions and promote rational utilization of blood inventory. Findings demonstrated that although the majority of cross-matched units were utilized, 955 units (6.33%) were not transfused, leading to wastage of manpower, financial resources, and blood products, while also delaying availability for patients in actual need. In the current study, the overall Cross-match to Transfusion (C/T) ratio was 1.06, which is well below the benchmark of 2.5, indicating efficient utilization. This value is much lower than that reported by Raghuwanshi B et al. [16] (6.31) and closely aligns with Devi et al. [12] (1.02). Similarly, the Transfusion Index (TI) was 0.93, which is consistent with reports by Biman Mondal et al. [10] (0.92), Suresh K et al. [11] (0.94), and Devi et al. [12] (0.97), whereas lower values have been observed in studies by Kour S et al. [14] (0.60) and Raghuwanshi B et al. [16] (0.65). A TI ≥0.5 is considered indicative of significant utilization, confirming the appropriateness of practices in the present study. When departmental variations were examined, the C/T ratio was observed as follows: Surgery (1.1), Medicine (1.02), Orthopedics (1.2), Pediatrics (1.09), and Obstetrics and Gynecology (1.6). These findings are favorable when compared with Kumari S et al. [17], who reported higher ratios across Surgery (2.1), Orthopedics (1.9), and Obstetrics and Gynecology (2.7). Comparable values were also noted in studies by Biman Mondal et al. [10], Suresh K et al. [11], and Kour S et al. [14], though most of these reported relatively higher ratios across departments. The blood utilization rate in the present study was 93.66%, which approaches the ideal benchmark of 96% for whole blood and components. This is markedly higher than the rates reported by Biman Mondal et al. [10] (78.95%), Kumari S et al. [17] (64.15%), and Kour S et al. [14] (51.72%), thereby highlighting efficient utilization in the current setting. Furthermore, the Transfusion Probability (T%) was 71.14%, which is comparable to findings by Kaur D et al. [18] (79.0%) and Mangwana S et al. [19] (83.07%), both suggestive of effective utilization. In contrast, the study by Kumari S et al. [17] reported a much lower probability (42.5%). Collectively, these indicators reflect a rational and efficient pattern of blood utilization in the present study, with practices largely consistent with or superior to previously published data.

The present study highlights efficient blood utilization practices, with 14,112 components issued during the study period and key indicators—C/T ratio (1.06), Transfusion Index (0.93), and utilization rate (93.66%)—all within acceptable standards. Although 955 units (6.34%) were de-crossmatched due to non-utilization, overall usage was rational. Implementation of strategies such as MSBOS and TSSAC, along with regular audits and hospital transfusion committee reviews, can further optimize blood utilization, reduce wastage, and ensure safe and judicious transfusion practices.

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