|Year : 2019 | Volume
| Issue : 2 | Page : 61-66
Pattern of utilization of blood and blood components in a teaching hospital
Atul B Hulwan, Sujata R Kanetkar, Sunil V Jagtap, Pradnya P Kale
Department of Pathology, Krishna Institute of Medical Sciences Deemed to be University, Karad, Maharashtra, India
|Date of Submission||25-Dec-2018|
|Date of Decision||08-Feb-2019|
|Date of Acceptance||18-Apr-2019|
|Date of Web Publication||25-Nov-2019|
Dr. Atul B Hulwan
Department of Pathology, Krishna Institute of Medical Sciences Deemed to be University, Karad, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Blood is the most precious and unique gift that one human being can give to another human being. The blood transfusion service is the very vital component of healthcare services. Till date we are not able to prepare whole blood artificially and no effective substitute is invented, so blood donor is very precious. The primary responsibility of blood transfusion services is to provide safe, sufficient and timely supply of blood and blood products. The component separation has maximized the utility of one whole blood unit. The emphasis has shifted from the use of whole blood to component therapy, as blood is a scarce and precious resource. Aim and Objectives: To study Pattern of utilization of blood and blood components in a teaching hospital with the indications for transfusions for different components during the study period. Material and Methods: This observational descriptive study for 18 months (July 2014- December2015) on pattern of utilization of blood and blood components was carried out in the Blood Bank of Department of Pathology in a Krishna Institute of Medical College and Research centre, Karad. Results: There were total 10358 transfusions which were carried out during the study period of 18 months. Whole blood and component utilization was calculated in all these transfusions. Conclusion: It is important for the blood bank to be able to fulfill the demands for this life-saving product and at the same time, evaluate and assess the existing trends of blood ordering. Hence, periodic review and audit of blood component usage is essential to assess the blood utilization pattern in any hospital.
Keywords: Blood audit, blood components, transfusion medicine
|How to cite this article:|
Hulwan AB, Kanetkar SR, Jagtap SV, Kale PP. Pattern of utilization of blood and blood components in a teaching hospital. J Datta Meghe Inst Med Sci Univ 2019;14:61-6
|How to cite this URL:|
Hulwan AB, Kanetkar SR, Jagtap SV, Kale PP. Pattern of utilization of blood and blood components in a teaching hospital. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2020 Apr 4];14:61-6. Available from: http://www.journaldmims.com/text.asp?2019/14/2/61/271558
| Introduction|| |
Blood transfusion has come a long way from the early 20th century when it was a complex and risky procedure. Currently, transfusion medicine is a specialty in its own right.
Blood is an amazing fluid. Blood is the most precious and unique gift that one human being can give to another human being. Till date, we are not able to prepare blood artificially and no effective substitute is invented, so blood donor is very precious.
The primary responsibility of blood transfusion services is to provide safe, sufficient, and timely supply of blood and blood products. At the same time, the blood transfusion services should ensure that the blood donation is safe and causes no harm to the donor.,
The emphasis has shifted from the use of whole blood to component therapy as blood is a scarce and precious resource. Currently, good clinical practice guidelines mandate transfusion therapy for specific well-established indications and use of blood components rather than whole blood. The component separation has maximized the utility of one whole blood unit.
It is important for the blood bank to be able to fulfill the demands for this life-saving product and at the same time to evaluate and assess the existing trends of blood ordering. Hence, periodic review of blood component usage is essential to assess the blood utilization pattern in any hospital. In addition, not many studies from India have evaluated the use of component therapy partially because components are not made available by most blood banks.
| Materials and Methods|| |
This observational, descriptive study for 18 months (July 2014–December2015) on the pattern of utilization of blood and blood components was carried out in the Blood Bank of Department of Pathology in Krishna Institute of Medical College and Research Centre, Karad, Maharashtra, India. Different components prepared in the blood bank were noted. Data regarding sex of the patient, indication of transfusion, blood or blood component to be used, different blood groups used, and department and units where transfusion to be carried out were noted down from the daily records of blood bank. The transfusions were also categorized according to the unit of department using the blood or blood components.
- All the transfusions of blood or blood components during the study period in our hospital.
- Units issued outside hospitals other than our hospital for transfusion.
The data were analyzed for the pattern of blood and blood component usage by different specialties, for different indications in different patients. The results obtained were tabulated and pattern of utilization was noted.
| Results|| |
Total number of transfusions
There were a total of 10,358 transfusions which were carried out during the study period of 18 months. Whole blood and component utilization was calculated in all these transfusions. Of all transfusions, 139 were whole blood transfusions, 6871 were packed cell transfusions, 1674 were fresh frozen plasma (FFP) transfusions, 1670 were platelet transfusions, and four were cryoprecipitate [Table 1].
Total transfusions were divided according to single use, double use, and three or more times use. A total of 4693 (45.31%) transfusions were single unit, 3118 (30.10%) were double unit, while 2547 (24.59%) were three or more units.
Total transfusions were divided according to the gender of recipient. There were 5756 male and 4602 female recipient patients. The male-to-female ratio was 1.25:1 [Table 2].
The pattern of utilization has shown reducing trend for whole blood use. Meanwhile, the utilization for the packed cell volume (PCV) was increasing. The study was started in July 2014; since then, the pattern of component usage was calculated and analyzed till December 2015. In the study period, the average transfusions were 575 per month [Table 3]. Also noted during the study period that, fresh frozen plasma transfusions were increased, with decrease in platelet use.
The pattern of utilization of different components according to the specialized departments was also analyzed.
The maximum use of blood and components was noted in medicine department (34.94%), followed by surgery department (24.30%). Minimum transfusions were carried out in the orthopedics department (6.10%) [Table 4].
The utilization was divided according to blood group of the components. The maximum used blood group was O Rh positive (30.26%). The Rh-positive blood group predominated in the use. The least used blood group was AB Rh negative (0.28%) [Table 5].
During the study period, the data were analyzed for blood group of ordered blood and blood group of issued blood. There was no compatible blood group transfusion for blood due to sufficient amount of availability of all the blood groups in the blood bank.
Total transfusions were analyzed for the indications of transfusion. The most common indication was anemia (33.87%). For anemia, the commonly used component was PCV. Few times even whole blood was used for anemic patients. Another indication for transfusion was operative purpose (23.82%). The most common component used for operative purpose was PCV followed by platelets. Transfusion for bleeding was 2022, and FFP was the most common component used followed by platelets [Table 6].
Department-wise distribution of component usage
There were a total of 3619 transfusions carried out during the study period in the department of medicine, of which 2084 (57.59%) were packed cell transfusions, 679 (18.76%) were platelet transfusion, 47 (1.29%) were whole blood transfusion, 805 (22.25%) were FFP, and four (0.11%) were cryoprecipitate. All cryoprecipitate counted in the study were utilized by the medicine department [Table 7].
|Table 7: Total number of blood and blood component utilized in the department of medicine|
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There were a total of 2518 transfusions carried out during the study period in the department of surgery, of which 1869 (74.22%) were packed cell transfusion, 310 (12.31%) were platelet transfusion, 25 (0.99%) were whole blood transfusion, and 314 (12.48%) were FFP. There was no use of cryoprecipitate [Table 8].
|Table 8: Total number of blood and blood component utilized in the department of surgery|
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Of total transfusions, department of pediatrics used 993 total transfusions. 845 (85.09%) were packed cell transfusions and 33 (3.32%) were platelet transfusions. The whole blood was used in 26 (2.62%), while 89 (8.97%) were FFP [Table 9].
|Table 9: Total number of blood and blood component utilized in the department of pediatrics|
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Obstetrics and Gynecology
There were a total of 1566 transfusions carried out in the department of obstetrics and gynecology during this period. Packed cell transfusions were performed in 928 (59.25%), 232 (14.82%) were platelet transfusions, 23 (1.47%) were whole blood transfusions, and 383 (24.46%) were FFP [Table 10].
|Table 10: Total number of blood and blood component utilized in the department of obstetrics-gynecology|
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Orthopedics used a total of 632 transfusions. 551 (87.18%) were packed cell transfusions, while 30 (4.74%) were platelet transfusions. 18 (2.85%) whole blood transfusions and 33 (5.23%) FFP were utilized by orthopedics [Table 11].
|Table 11: Total number of blood and blood component utilized in the department of orthopedics|
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There were a total of 1030 transfusions in the department of radiotherapy. Packed cell transfusions were carried out in 594 (57.66%), 386 (37.48%) were platelet transfusions, while 50 (4.86%) were FFP. No whole blood or cryoprecipitate was used by the department of radiotherapy during the study period [Table 12].
|Table 12: Total number of blood and blood component utilized in the department of radiotherapy|
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| Discussion|| |
The availability of donated blood and the demand for blood components must be balanced to provide adequate supply. At present, the supply of donated blood is unable to keep up with the demand. It is important to study the pattern of utilization of blood and blood components in the hospital. Such studies help to find out trend of usage which helps decrease the cost of treatment, reduces wastage of blood components and improves the infrastructure for storage of blood components for future.
The present study was conducted over 18 months' period. The total number of transfusions observed during study period was 10,358.
The most common component use was attributed to PCV (66.33%), followed by platelets (16.12%) and FFP (16.17%). Similar findings were noted by studies done by Garg et al. and Qureshi et al. A rarely used component was cryoprecipitate (0.03%). This is comparable with the study done by Qureshi et al. in 2015.
In our study, the whole blood use was only 1.35% out of whole transfusions. Similar finding was noted by Venkatachalapathy and Das (8.55%) in 2012.
The data of transfusion for 18 months were analyzed overall. We observed that the whole blood use has been replaced by PCV transfusions [Graph 1].
The use of whole blood from July 2014 has reduced till December 2015 from 10.63% to 0.32%. There was marked decline in utilization of whole blood as observed by Ambroise et al.
The whole blood utilization was limited to few indications such as heavy blood loss and emergency. Also noted was in the given period – the use of whole blood reduced, gradually indicating the impact of transfusion medicine in teaching. However, this was not in concordance with the study done by Gaur et al., indicating lack of awareness [Table 13].
|Table 13: Utilization of whole blood and packed cell volume (comparison with different studies)|
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In the past, bleeding diathesis was a common indication for platelet use. Now, the use of platelets is reduced due to availability of FFP and increasing awareness about proper component use as seen in our study [Graph 2].
There was male predominance for transfusion with male: female ratio of 1.25:1. Similar finding was noted by Gaur et al., with the ratio being 1.6:1 (F). However, this does not carry any statistical significance.
A very striking difference was seen in the use of blood and blood components by the specialty departments. In our study, the maximum transfusions were seen in the medicine department (34.94%). A study done by Agrawal et al. also shows similar results (44.13%) for medicine department.
The most commonly used blood group was O positive (30.26%). Similar finding noted by Agarwal P et al with O + use being 34.43%, and Venkatachalapathy et al (40.54%). 'O' Positive being predominant group for blood transfusion. This corresponds to percentage of blood group distribution in India.
Among all blood groups, AB negative was the least (0.28%) commonly used similar to Venkatachalapathy (0.68%).
The most common overall indication for transfusion was anemia. Similar finding was observed by other studies.,,
Cryoprecipitate was used by only medicine department for hemophiliac patients. No other study has seen internal use of cryoprecipitate in individual department.
Radiotherapy department in our hospital has also utilized PCV for most of the patients. According to Schrijvers, anemia is common in patients of cancer. The prevalence of anemia in cancer is around 40%. Platelets were also commonly utilized (37.48%) by the radiotherapy department due to most patients presenting as bleeding disorder secondary to malignancies.
The pattern of utilization of blood and blood components is relevant for quality management of transfusion practice, cost analyses, and planning local and regional blood donation programs. The study provides data regarding requirement of blood and blood component use in this teaching hospital. It is necessary to study the different component requirement so as to improve component separation to avoid wastage and shortage. Regular clinical meetings on transfusion medicine for indication of different components are necessary to achieve judicial use of components. More such studies are needed to standardize the component utilization to improve patient care.
| Conclusion|| |
The periodic review and audit of blood component usage is essential to assess the blood utilization pattern in any hospital or community. This is useful for blood transfusion services is to provide safe, sufficient and timely supply of blood and blood products in the community.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13]