Trends in blood transfusion and causes of blood wastage: a retrospective analysis in a teaching hospital

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As Taiwan faces an aging population, increasing medical demands pose new challenges to blood resource management. Trend analysis can improve blood supply chain management and allocate blood resources more efficiently and cost-effectively. Methods: A retrospective review was conducted from 2011–2023 in a teaching hospital to examine the utilization and wastage of blood products. Data were collected from hospital information system and blood wastage reports, categorized by cause, and analyzed via SAS software version 9.3. Results: The hospital released 424,197 units of blood products, with leukocyte-reduced red blood cells accounting for 140,971 units. The highest annual wastage rate was 0.29% in 2011, and the annual average was 0.08%. Fresh frozen plasma (36.3%), platelet concentrates (15.2%), and cryoprecipitate (14.3%) were the most frequently discarded. Major causes of wastage included excessive or inappropriate orders (22.3%), inability to reissue blood before expiration (16.7%), and incorrect orders (14.6%). Platelet wastage was caused primarily by improper storage, while thawed plasma could not be repurposed. Utilization of leukocyte-reduced blood products has increased, leading to a significant reduction in transfusion reactions from 1.8% in 2011 to 0.6% in 2023. Conclusions: The study revealed that blood wastage often arises from human error or improper storage conditions. The leading cause of platelet product disposal is incorrect storage temperatures, along with the inability to repurpose thawed plasma for plasma products. The increased use of prestorage leukocyte-reduced blood products has significantly reduced transfusion reactions. Continuous education for healthcare professionals, along with improved inventory monitoring, can further minimize wastage and enhance transfusion quality. Blood utilization Aging Leukocyte reduction Platelet Plasma Wastage Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Blood is an essential component of human survival, and blood transfusion plays an indispensable role in life-saving medical intervention. Because blood is perishable, developing nontoxic anticoagulants and preservatives can improve the practicality and safety of blood transfusion for patients who are at risk of life-threatening blood loss [ 1 ]. Researchers have yet to identify a substitute for blood; and therefore, blood has high value and is a limited substance. According to the literature, demographic changes are often associated with blood supply shortages [ 2 – 4 ]. Increases in older populations and substantial decreases in the number of new-borns per year have led to considerable increases in the proportion of older adults and decreases in the number of blood donors, resulting in a shortage in blood supply. In addition, the global fertility rate has declined from 4.84 in 1950 to 2.23 in 2021 and is expected to further decrease to 1.59 by 2100, leading to a profound demographic shift [ 5 ]. According to the 2024 global fertility statistics released by the Central Intelligence Agency, Taiwan ranks last worldwide in terms of fertility, with a fertility rate of only 1.11. By 2025, the proportion of older adults in Taiwan is projected to reach 20%, making Taiwan a superaged society. As stated by the Taiwan Blood Services Foundation, the number of individuals aged 17–64 years who are capable of donating blood is projected to decrease by nearly 0.9 million by 2030, and the number of individuals older than 65 years is expected to increase by more than 1 million. These factors are likely to lead to insufficient of blood for transfusions, suggesting a potential blood shortage crisis. As indicated by the 2011–2020 annual report released by the Taiwan Blood Services Foundation, the number of first-time blood donors aged under 24 years has decreased from 117,932 to 69,098, representing a reduction from 15.65–11.63% in the proportion of individuals donating decreased [ 6 ]. During the COVID-19 pandemic, a substantial increase in blood wastage was observed, which was the result of the cancelation of elective surgeries and other nonurgent medical procedures (Association for the Advancement of Blood and Biotherapies) [ 7 , 8 ]. This wastage results in a shortage of blood supply, significantly affecting various blood supply services [ 9 ] and transfusion procedures, such as massive transfusion protocols, in many hospitals [ 10 ]. Given the imbalance between increased blood demands and blood supply shortages, hospitals and health-care facilities should focus on reducing their blood wastage and should establish effective policies for blood component utilization. Worldwide, blood wastage has been reported to range between 0% and 6.7% [ 11 , 12 ]. Therefore, avoiding blood wastage should be considered a medical, economic, and patient safety challenge in hospital blood bank management. Reducing the amount of wasted blood can reduce costs and save blood products that can be used for patients in need, and identifying the causes of blood wastage can enhance blood management and increase the safety of blood transfusion. Methods Steps and regulations for blood supply Blood is a valuable resource that is donated by volunteers for use in transfusions to patients in need. Figure 1 depicts the primary blood supply chain and retunes blood policy and criteria in Taiwan. Blood products pass from donors to patients through four steps: donor → blood center → hospital blood bank → patient. The Blood Center of the Taiwan Blood Services Foundation is the only blood provider in Taiwan; it supplies all blood components to Taiwanese hospitals. Among the major blood products supplied by the blood center are: (1) red blood cell (RBC) components, including whole blood (WB), packed RBCs (pRBCs), washed RBCs, and leukocyte-reduced RBCs (LR-RBCs); (2) platelet components, including platelet concentrates, apheresis platelets (phPLTs), and leukocyte-reduced phPLTs (LR-phPLTs); and (3) plasma components, including fresh frozen plasma (FFP), frozen plasmas (FP), and cryoprecipitate (CRYO). In addition, the Blood Center fulfills uncommon blood requests, such as those for human leukocyte antigen or human platelet antigen–matched RBC and platelet products. In scenarios in which blood transfusion is not feasible, blood is immediately returned to the blood bank and reassigned to another patient to prevent blood wastage. In accordance with Taiwan’s blood transfusion guidelines, blood components and platelets should be transported to patients in a temperature-controlled setting within 30 minutes. If these conditions are not met, the blood products should be discarded and should not be reassigned to other patients. When blood products are returned to the blood bank, all bags and containers should be intact and undamaged. For returned blood products to be assigned to other patients, the following conditions must be met. First, unused RBC products should be allowed to settle for 24 hours at a controlled temperature (1°C to 6°C) and undergo visual inspection before they are reassigned. Second, thawed FFP (4°C) should be reassigned within 24 hours. Third, thawed FP (4°C) should be reassigned within 5 days. Fourth, platelets (20°C to 24°C) should be reassigned before their expiry date. Data collection This quantitative, retrospective, cross-sectional, descriptive study was conducted between 2011 and 2023 at Taichung Tzu-Chi Hospital (1,126 beds). All the data collected from the hospital information system (HIS) were deidentified to ensure patient privacy. In this study, we analyzed the trends of utilization for all blood components and explored the primary causes of blood wastage. The hospital’s blood bank is responsible for supplying blood to various departments and units, including the emergency department, internal wards, surgery wards, intensive care units, gynecology and obstetrics wards, chemotherapy and cancer wards, and outpatient clinics. All blood components are requested and documented through the HIS. This information includes the blood group, type of blood component, requested units, issued units, time of issuance, time of blood transfer to the ward or department, and time of transfusion. In addition to routinely monitoring blood wastage as an indicator of quality, proactive measures should be implemented to identify the factors contributing to such wastage. This can aid in establishing an effective blood management system for reducing blood wastage. After laboratory technicians receive a blood transfusion order, they must conduct cross-matching or blood type check procedures in accordance with standard protocols. In the present study, blood wastage was defined as the delivery of nontransfused blood that was not reassigned to another patient or recipient. This information includes the blood group, type of blood components, requested units, issued units, time of issuance, time of blood transfer to the ward or department, and time of transfusion. Wastage percentage The following equation was used to calculate the percentage of wastage for each blood product: Wastage of each blood product (%) = \(\:\frac{\text{N}\text{u}\text{m}\text{b}\text{e}\text{r}\:\text{o}\text{f}\:\text{w}\text{a}\text{s}\text{t}\text{e}\text{d}\:\text{u}\text{n}\text{i}\text{t}\text{s}\:\text{f}\text{o}\text{r}\:\text{e}\text{a}\text{c}\text{h}\:\text{p}\text{r}\text{o}\text{d}\text{u}\text{c}\text{t}}{\text{S}\text{u}\text{m}\:\text{o}\text{f}\:\text{u}\text{n}\text{i}\text{t}\text{s}\:\text{i}\text{s}\text{s}\text{u}\text{e}\text{d}\:\text{f}\text{o}\text{r}\:\text{e}\text{a}\text{c}\text{h}\:\text{p}\text{r}\text{o}\text{d}\text{u}\text{c}\text{t}}\) × 100 Wastage as a percentage of issued products (WAPI) was calculated for each component as follows [ 12 ]: WAPI (%) = \(\:\frac{\text{S}\text{u}\text{m}\:\text{o}\text{f}\:\text{w}\text{a}\text{s}\text{t}\text{e}\text{d}\:\text{u}\text{n}\text{i}\text{t}\text{s}\:\text{f}\text{o}\text{r}\:\text{e}\text{a}\text{c}\text{h}\:\text{c}\text{o}\text{m}\text{p}\text{o}\text{n}\text{e}\text{n}\text{t}}{\text{S}\text{u}\text{m}\:\text{o}\text{f}\:\text{u}\text{n}\text{i}\text{t}\text{s}\:\text{i}\text{s}\text{s}\text{u}\text{e}\text{d}\:\text{f}\text{o}\text{r}\:\text{e}\text{a}\text{c}\text{h}\:\text{c}\text{o}\text{m}\text{p}\text{o}\text{n}\text{e}\text{n}\text{t}}\) × 100 Results Trend of total blood supply during the study period Figure 2 A presents the total number of blood components issued and wasted between 2011 and 2023 at Taichung Tzu-Chi Hospital. The number of patients who received blood transfusions increased from 8,511 in 2011 to 13,409 in 2023, with an average of 10,745 patients every year. The average number of blood units issued every year was 32,631, and the average number of wasted blood units every year was 26. Figure 2 B depicts the annual blood wastage rates over the study period. The highest annual wastage rate was recorded in 2011 (0.29%), and the average wastage rate was 0.08% over the past decade. Utilization and wastage of blood products During the study period, 424,197 units of blood products were released by the hospital’s blood bank (Table 1 ). These blood components included RBC components (411 units of WB, 76,137 units of pRBCs, 1,253 units of washed RBCs, and 140,971 units of LR-RBCs), platelet components (34,013 units of platelet concentrates, 17,921 units of phPLT, and 20,090 units of LR-phPLT), and plasma components (88,895 units of FFP, 13,434 units of FP, and 31,072 units of CRYO). The rates of blood component wastage (WAPI) were expressed as the ratio of discarded blood components to issued blood components. Wastage rates of 0.04%, 0.09%, and 0.14% were recorded for RBC, platelet, and plasma components, respectively. Among them, plasma components have the highest waste rate of blood components (0.14%), and whole blood has the highest waste rate (1.95%) of blood products. Table 1 Total number of blood components issued and the wastage of blood units during this study Blood products RBC components n = 218,772 Platelet components n = 72,024 Plasma components n = 133,401 Total WB pRBC Washed RBC LR-RBC Platelets phPLT LR-phPLT FFP FP CRYO Blood issue (unit) 411 76,137 1,253 140,971 34,013 17,921 20,090 88,895 13,434 31,072 424,197 Blood wastage (unit) 8 45 8 23 51 12 5 122 14 48 336 Wastage of blood product (%) 1.95 0.06 0.06 0.01 0.15 0.07 0.02 0.14 0.10 0.15 WAPI (%) 0.04 0.09 0.14 0.08 WB: Whole blood, 1 unit of whole blood contains 250 mL; LR: Leukocyte-reduced; FFP: Fresh-frozen plasma; FP: Frozen plasma; CRYO: Cryoprecipitate; WAPI: Wastage as percentage of issues. Figure 3 depicts a pie chart of the utilization and wastage percentages of various blood components for the entire population. According to our findings, the most commonly utilized blood product was RBC components (Fig. 3 A), while the highest wastage rate was observed for FFP, followed by platelet concentrates (Fig. 3 B). Causes of blood wastage In this study, we analyzed the clinical utilization and wastage rates of all the blood components. Table 2 lists the various causes of blood wastage observed throughout the study period. A total of 84 wastage events (involving 336 units of blood products) were identified. To determine the causes of these wastage events, we divided the events into 13 categories. According to our results, excessive ordering was the leading cause (22.3%) of blood wastage, suggesting inaccurate assessments of patient conditions. The primary causes of RBC product wastage were the inability to reassign these products to other patients and the accidental puncturing of blood bags. The main causes of platelet and plasma product wastage were incorrect storage temperatures and improper ordering, respectively. After FFP, FP or CRYO products are thawed, those blood products should be transfused within 4 hours. Otherwise, those blood products should be returned to the blood bank and reassigned to other patients. If those blood products cannot be reissued to other patients before their expiry, they must be discarded. Table 2 The major causes of blood wastage Causes of blood wastage Case (%) RBC components Platelet components Plasma components Excessive order or inappropriate evaluated patient's condition 75 (22.3%) 14 27 34 Unable reissue to other patient before usability period 56 (16.7%) 17 0 38 Order the wrong blood components 49 (14.6%) 3 0 46 Patient die/discharge before transfusion 32 (9.5%) 0 0 32 Wrong storage temperature of platelet components 29 (8.6%) 0 29 0 Blood expired 28 (8.3%) 13 2 11 Accidentally pierce the blood bags 26 (7.7%) 17 5 2 Excessive rewarm the blood component 21 (6.3%) 1 0 20 Accidentally broken the blood bags 9 (2.7%) 8 0 1 Blood products in room temperature over 4 hours 6 (1.8%) 6 0 0 No intravenous access 2 (0.6%) 2 0 0 Partially clot of blood 2 (0.6%) 2 0 0 Wrong transfusion procedure 1 (0.3%) 1 0 0 Total 336 (100%) Utilization trends of prestorage leukocyte-reduced blood products Since 2014, the Blood Center of the Taiwan Blood Services Foundation has been responsible for supplying LR-RBCs to all medical facilities. In 2017, our hospital started to employ LR-RBCs for clinical use. Since 2016, many facilities have shifted from using pRBCs to using prestorage LR-RBCs and LR-phPLTs. The increase in the utilization rate of prestorage leukocyte-reduced blood products was accompanied by a major decline in transfusion reactions in our hospital from 2015–2017 (Fig. 4 ). Discussion In this study, we analyzed trends in blood utilization and identified the causes of blood wastage in clinical practice in Taiwan. The management of the blood supply chain is considered vital. Over the past decade, we have implemented several management approaches and education courses that have led to a low rate of blood wastage. To effectively utilize blood products and reduce their wastage, the Blood Center and hospital blood banks jointly established several criteria for inventory management (Fig. 1 ). These criteria ensure that excess or nontransfused blood products are returned to the blood bank for reassignment to other patients. We examined the utilization trends of blood products in a hospital between 2011 and 2023 and explored the causes of blood product wastage. As indicated in Fig. 2 , our hospital had an annual average wastage rate of 0.08%, which is relatively low. Previous studies have reported blood wastage rates ranging from 0.2–7% [ 13 , 14 ]. The rate of blood wastage decreased from 0.29% in 2011 to 0.10% in 2012, reaching 0.01% in 2016. The Blood Transfusion Management Committee is responsible for ensuring safe transfusion practices and implementing patient management initiatives. The committee plays a key role in guaranteeing the safety and appropriateness of blood transfusions for patients at our hospital. Over the past decade, our hospital has established several protocols for blood management, including (1) inviting clinical physicians who have misused or discarded blood products to present reports and engage in discussions with the committee, helping to strengthen blood product management; (2) limiting the transfer of RBC products from the blood bank to the ward to one bag at a time, preventing excessive requests, incorrect orders, or unnecessary rewarming; and (3) using cooling containers or tote bags to transport various blood products, accompanied by a portable thermometer to monitor storage temperature throughout the journey. This prevents these products from being exposed to room temperature for too long, thereby safeguarding their integrity. Disseminating information on transfusion practices and educating medical staff and nurses may reduce blood wastage [ 11 , 15 ]. At our hospital, blood wastage is caused in part by nurses inadvertently piercing blood bags during transfusion procedures. To address this issue, we conduct transfusion courses for all clinicians and nurses at least twice a year and provide them with information on how to avoid piecing blood bags. Although limited evidence is available regarding the effectiveness of continuing education in reducing blood wastage, at our institution, such education has led to a reduction in blood wastage rates over the past decade. This suggests that raising awareness about blood wastage and providing ongoing education on transfusion practices to clinicians and nurses can increase vigilance and help prevent it. Good inventory management is essential for ensuring that the supply of blood components and products meets patients’ transfusion needs while minimizing wastage. Blood inventory management is a complex process that requires coordination between a central blood supply center and blood banks to balance supply and demand. The main goal of the blood bank is to reduce blood wastage while maintaining a sufficient inventory of blood products for patients. Blood product management involves various aspects, including external factors such as communication between the blood donation center and the hospital, delays in blood product delivery, and insufficient blood supply at the blood donation center. Internal factors include delayed delivery of blood products, insufficient inventory in the hospital, incorrect temperatures, improper rewarming of blood products, excessive blood orders, and personnel unfamiliar with blood transfusion operations. Striking a balance between blood component utilization and storage in the hospital blood bank is essential [ 16 ]. Excessive stock of blood products can lead to expiration and is one of the causes of blood wastage [ 7 , 17 ]. To avoid stock excess and shortages, our blood bank uses fixed stock units of blood products to maintain its inventory. In our hospital, the maximum number of stock units of RBC components (LR-RBCs) is 1.5–2 times the amount of blood issued. Because platelet products rapidly degenerate, we request these products from the blood bank daily and transfuse them in the evening. For surgical patients or patients admitted to the intensive care unit, physicians are asked to order the required platelet products one day before transfusion. This strategy reduces the turnaround time of platelet components in our blood bank, helping to prevent wastage. After the implementation of LR products (LR-phPLTs, LR-RBCs), the frequency of transfusion reactions decreased in our hospital (Fig. 4 ). By reducing white blood cells in RBC components before storage, the levels of IL-1, IL-6, IL-8, and TNF-α may be lowered, enhancing transfusion safety [ 16 ] and mitigating advanced transfusion reactions and allergies in recipients [ 18 ]. In 2014, the Taiwan Blood Services Foundation began providing LR-RBCs to all medical facilities. When prestorage LR-RBC products are adequately supplied for clinical transfusions, the frequency of transfusion reactions, such as febrile nonhemolytic transfusion reactions, significantly decreases [ 16 , 19 ]. Although this provision offers numerous benefits, the cost of LR-RBCs is approximately double that of non-LR-RBC products (pRBCs) (US $ 30.8 vs. US $ 15.80, US $ 1 = NT $ 30). Given the high cost, physicians may be inclined to use these valuable blood components more appropriately. Additionally, owing to Taiwan’s health insurance policy and transfusion guidelines, our hospital did not fully incorporate LR-RBCs into clinical use until 2017. From 2015 to 2017, the rate of blood wastage at our hospital decreased, which coincided with a substantial reduction in the frequency of transfusion reactions due to the use of prestorage LR-RBC products. Furthermore, improving blood management can help reduce healthcare expenses. Physicians must administer blood components appropriately during or after transfusions to avoid complications, such as volume overload or transfusion reactions. Blood transfusions are a crucial aspect of modern medical care. Over the past decade, the demand for blood components has risen, likely owing increasing life expectancy and an aging global population. In Taiwan, a significant reduction in blood donations among younger generations has been observed, which is attributed to the declining birth rate. Currently, the supply of blood products nearly matches, or at times even falls short of, the demand. With the increasing demand for blood transfusions in Taiwan’s rapidly aging society, a shortage of blood donations is expected in the near future [ 17 ]. To prevent a potential blood shortage crisis, minimizing wastage and ensuring the effective and appropriate use of all blood products are crucial [ 20 ]. Under Taiwan’s National Health Insurance system, a single unit of pRBCs costs only US $ 15.8 (US $ 1 = NT $ 30), which is considerably lower than that in the United States (US $ 200–US $ 300) [ 21 ] and the United Kingdom (approximately US $ 38) [ 22 ]. The cost of blood products typically includes various operational and maintenance expenses, such as equipment depreciation and personnel salaries at blood centers, as well as utility costs. Other services, including donor recruitment, blood collection, testing, storage, and delivery to hospitals, are also factored into the overall cost. Despite Taiwan’s lower blood product costs than those of other countries, physicians and healthcare staff must strive to avoid inappropriate transfusions and minimize wastage. Conclusions In this study, we explored the patterns of blood component utilization and developed several strategies to mitigate blood product wastage. Disseminating information about blood wastage among clinicians and technicians in blood banks, as well as providing continuing education for all medical staff, are essential for enhancing the safety of blood transfusions. Physicians should use blood components carefully to minimize wastage, especially given the anticipated blood shortage in Taiwan due to its rapidly aging population. Abbreviations WB whole blood pRBC packed red blood cells LR-RBC leukocyte-reduced RBCs PLT platelet concentration phPLT apheresis platelets LR-phPLT leukocyte-reduced apheresis platelets FFP fresh frozen plasma FP frozen plasma CRYO cryoprecipitate. Declarations Acknowledgements This study was extracted and analyzed from Taichung Tzu-Chi Hospital. We thank all the members of the blood bank in the hospital. We would also like to express our appreciation to Ms. Hsuan-Hui Wang of Taichung Blood Center of the Taiwan Blood Services Foundation for the consultation of blood supply and utilization. Funding This work was supported by grants from the Central Taiwan University of Science and Technology, Taichung, Taiwan (CTU103-P-18) and from the Education of Taiwan, Taiwan (PMN1122369). Author contributions Chien JH contributed to study conceptualization, investigation, formal analysis, and writing–original draft. Yao CY contributed to study supervision and writing–review & editing. Chen HF participated in data collection analysis of the manuscript. Ho TF contributed to project administration, supervision, funding acquisition, conceptualization, methodology, and writing–review & editing. 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Effects of Prestorage Leukoreduction on the Rate of Febrile Nonhemolytic Transfusion Reactions to Red Blood Cells in a Tertiary Care Hospital. Annals of medical and health sciences research. 2015;5:185–8. Jadwin DF, Fenderson PG, Friedman MT, Jenkins I, Shander A, Waters JH, et al. Determination of Unnecessary Blood Transfusion by Comprehensive 15-Hospital Record Review. Joint Commission journal on quality and patient safety. 2023;49:42–52. Toner RW, Pizzi L, Leas B, Ballas SK, Quigley A, Goldfarb NI. Costs to hospitals of acquiring and processing blood in the US: a survey of hospital-based blood banks and transfusion services. Applied health economics and health policy. 2011;9:29–37. Cataife G, Pagano MB. How much does a blood transfusion cost? Transfusion. 2018;58:833–5. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 14 Jan, 2025 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Revision requested 12 Sep, 2024 Editor assigned by journal 12 Sep, 2024 Submission checks completed at journal 12 Sep, 2024 First submitted to journal 11 Sep, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5068119","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":353214684,"identity":"63d4b74d-7b21-4649-a491-cd93874f1e30","order_by":0,"name":"Ju-huei Chien","email":"","orcid":"","institution":"Taichung Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation","correspondingAuthor":false,"prefix":"","firstName":"Ju-huei","middleName":"","lastName":"Chien","suffix":""},{"id":353214685,"identity":"bcebc7f7-e6f6-47d4-b35a-96c99f60a12c","order_by":1,"name":"Chao-yuan Yao","email":"","orcid":"","institution":"Taichung Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation","correspondingAuthor":false,"prefix":"","firstName":"Chao-yuan","middleName":"","lastName":"Yao","suffix":""},{"id":353214686,"identity":"0aeb914d-6ad1-4a77-ad6b-6b2a67f80a4f","order_by":2,"name":"Hui-fen Chen","email":"","orcid":"","institution":"Taichung Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation","correspondingAuthor":false,"prefix":"","firstName":"Hui-fen","middleName":"","lastName":"Chen","suffix":""},{"id":353214687,"identity":"60c0315f-a6eb-48cc-ada7-c6055675a731","order_by":3,"name":"Tsing-Fen Ho","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwUlEQVRIiWNgGAWjYDAC5jMMDB9gHB5idPCw5TAwzmAwYGBgg2iRIEoLMw9JWuzZeA8+tqn5kzh/fgPjg7dtDHUGBwjawpdsnHPMIHHDMQZmw7ltDBKEtcj3mEnnNgC1sDGwSfMCtZgRtoXHTNoSqGV+GwP7b+K1MAK1NBxjYGMmTssxHmPDnmPGxhuOJTZLzjknIbmfkBb2Nh7DBz9q5GTnNx8++OFNmQ2/ZAMBLUiAEaSWcLSMglEwCkbBKCACAADFWzVCVmTxPwAAAABJRU5ErkJggg==","orcid":"","institution":"Central Taiwan University of Science and Technology","correspondingAuthor":true,"prefix":"","firstName":"Tsing-Fen","middleName":"","lastName":"Ho","suffix":""}],"badges":[],"createdAt":"2024-09-11 04:18:57","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5068119/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5068119/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12913-024-12170-x","type":"published","date":"2025-01-14T15:57:31+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":69809307,"identity":"9ea38ac2-b635-4018-bba5-280c65aedb13","added_by":"auto","created_at":"2024-11-25 12:25:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":77892,"visible":true,"origin":"","legend":"\u003cp\u003eBlood supply chain and retuning blood policy/criteria in the healthcare system\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5068119/v1/5afa549b2f8c5fa245db3e36.png"},{"id":69809730,"identity":"7021b841-5cbd-451e-a23b-a06db666a3ee","added_by":"auto","created_at":"2024-11-25 12:33:10","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":59564,"visible":true,"origin":"","legend":"\u003cp\u003eThe trend of total blood supply at Taichung Tzu-Chi Hospital during 2011- 2023. (A) The trend of blood utilization includes patient number, issued blood, the annual blood wastage, and the annual wastage rate. (B) The issued blood (●) and wastage rate (bar chart) from 2011 to 2023.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5068119/v1/2e36f4fd7e58e57f718f9d17.png"},{"id":69811254,"identity":"948205ec-405f-4e39-81a9-72515095c11e","added_by":"auto","created_at":"2024-11-25 12:41:10","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":88611,"visible":true,"origin":"","legend":"\u003cp\u003eTotal blood products issued and wasted during 2011- 2023. (A) The percentage of issued blood by different blood components. (B) The rate of wastage by different blood products. WB: whole blood; pRBC: packed red blood cells; LR-RBC: leukocyte-reduced RBCs; PLT: platelet concentration; phPLT: apheresis platelets; LR-phPLT: leukocyte-reduced apheresis platelets; FFP: fresh frozen plasma; FP: frozen plasma; CRYO: cryoprecipitate.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5068119/v1/397e0bf18dc600e3a04091c4.png"},{"id":69809310,"identity":"ef7a7469-09c2-4012-aa06-f60c9cd46af7","added_by":"auto","created_at":"2024-11-25 12:25:10","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":74939,"visible":true,"origin":"","legend":"\u003cp\u003eThe transfusion with prestorage LR-RBCs (■) compared with packed RBCs (▲) significantly decreased the transfusion reaction (●) since 2016.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5068119/v1/7060295be6238285e4137d20.png"},{"id":74284621,"identity":"dab7d36b-8624-4d56-9a75-d4e98a785667","added_by":"auto","created_at":"2025-01-20 16:09:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":944560,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5068119/v1/56b49fce-8dd9-4f50-ac95-e7000883de6d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Trends in blood transfusion and causes of blood wastage: a retrospective analysis in a teaching hospital","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBlood is an essential component of human survival, and blood transfusion plays an indispensable role in life-saving medical intervention. Because blood is perishable, developing nontoxic anticoagulants and preservatives can improve the practicality and safety of blood transfusion for patients who are at risk of life-threatening blood loss [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Researchers have yet to identify a substitute for blood; and therefore, blood has high value and is a limited substance. According to the literature, demographic changes are often associated with blood supply shortages [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Increases in older populations and substantial decreases in the number of new-borns per year have led to considerable increases in the proportion of older adults and decreases in the number of blood donors, resulting in a shortage in blood supply. In addition, the global fertility rate has declined from 4.84 in 1950 to 2.23 in 2021 and is expected to further decrease to 1.59 by 2100, leading to a profound demographic shift [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. According to the 2024 global fertility statistics released by the Central Intelligence Agency, Taiwan ranks last worldwide in terms of fertility, with a fertility rate of only 1.11. By 2025, the proportion of older adults in Taiwan is projected to reach 20%, making Taiwan a superaged society. As stated by the Taiwan Blood Services Foundation, the number of individuals aged 17\u0026ndash;64 years who are capable of donating blood is projected to decrease by nearly 0.9\u0026nbsp;million by 2030, and the number of individuals older than 65 years is expected to increase by more than 1\u0026nbsp;million. These factors are likely to lead to insufficient of blood for transfusions, suggesting a potential blood shortage crisis. As indicated by the 2011\u0026ndash;2020 annual report released by the Taiwan Blood Services Foundation, the number of first-time blood donors aged under 24 years has decreased from 117,932 to 69,098, representing a reduction from 15.65\u0026ndash;11.63% in the proportion of individuals donating decreased [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDuring the COVID-19 pandemic, a substantial increase in blood wastage was observed, which was the result of the cancelation of elective surgeries and other nonurgent medical procedures (Association for the Advancement of Blood and Biotherapies) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This wastage results in a shortage of blood supply, significantly affecting various blood supply services [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and transfusion procedures, such as massive transfusion protocols, in many hospitals [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Given the imbalance between increased blood demands and blood supply shortages, hospitals and health-care facilities should focus on reducing their blood wastage and should establish effective policies for blood component utilization. Worldwide, blood wastage has been reported to range between 0% and 6.7% [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Therefore, avoiding blood wastage should be considered a medical, economic, and patient safety challenge in hospital blood bank management. Reducing the amount of wasted blood can reduce costs and save blood products that can be used for patients in need, and identifying the causes of blood wastage can enhance blood management and increase the safety of blood transfusion.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSteps and regulations for blood supply\u003c/h2\u003e \u003cp\u003eBlood is a valuable resource that is donated by volunteers for use in transfusions to patients in need. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e depicts the primary blood supply chain and retunes blood policy and criteria in Taiwan. Blood products pass from donors to patients through four steps: donor \u0026rarr; blood center \u0026rarr; hospital blood bank \u0026rarr; patient. The Blood Center of the Taiwan Blood Services Foundation is the only blood provider in Taiwan; it supplies all blood components to Taiwanese hospitals. Among the major blood products supplied by the blood center are: (1) red blood cell (RBC) components, including whole blood (WB), packed RBCs (pRBCs), washed RBCs, and leukocyte-reduced RBCs (LR-RBCs); (2) platelet components, including platelet concentrates, apheresis platelets (phPLTs), and leukocyte-reduced phPLTs (LR-phPLTs); and (3) plasma components, including fresh frozen plasma (FFP), frozen plasmas (FP), and cryoprecipitate (CRYO). In addition, the Blood Center fulfills uncommon blood requests, such as those for human leukocyte antigen or human platelet antigen\u0026ndash;matched RBC and platelet products.\u003c/p\u003e \u003cp\u003eIn scenarios in which blood transfusion is not feasible, blood is immediately returned to the blood bank and reassigned to another patient to prevent blood wastage. In accordance with Taiwan\u0026rsquo;s blood transfusion guidelines, blood components and platelets should be transported to patients in a temperature-controlled setting within 30 minutes. If these conditions are not met, the blood products should be discarded and should not be reassigned to other patients. When blood products are returned to the blood bank, all bags and containers should be intact and undamaged. For returned blood products to be assigned to other patients, the following conditions must be met. First, unused RBC products should be allowed to settle for 24 hours at a controlled temperature (1\u0026deg;C to 6\u0026deg;C) and undergo visual inspection before they are reassigned. Second, thawed FFP (4\u0026deg;C) should be reassigned within 24 hours. Third, thawed FP (4\u0026deg;C) should be reassigned within 5 days. Fourth, platelets (20\u0026deg;C to 24\u0026deg;C) should be reassigned before their expiry date.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eThis quantitative, retrospective, cross-sectional, descriptive study was conducted between 2011 and 2023 at Taichung Tzu-Chi Hospital (1,126 beds). All the data collected from the hospital information system (HIS) were deidentified to ensure patient privacy. In this study, we analyzed the trends of utilization for all blood components and explored the primary causes of blood wastage. The hospital\u0026rsquo;s blood bank is responsible for supplying blood to various departments and units, including the emergency department, internal wards, surgery wards, intensive care units, gynecology and obstetrics wards, chemotherapy and cancer wards, and outpatient clinics. All blood components are requested and documented through the HIS. This information includes the blood group, type of blood component, requested units, issued units, time of issuance, time of blood transfer to the ward or department, and time of transfusion. In addition to routinely monitoring blood wastage as an indicator of quality, proactive measures should be implemented to identify the factors contributing to such wastage. This can aid in establishing an effective blood management system for reducing blood wastage. After laboratory technicians receive a blood transfusion order, they must conduct cross-matching or blood type check procedures in accordance with standard protocols. In the present study, blood wastage was defined as the delivery of nontransfused blood that was not reassigned to another patient or recipient. This information includes the blood group, type of blood components, requested units, issued units, time of issuance, time of blood transfer to the ward or department, and time of transfusion.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eWastage percentage\u003c/h2\u003e \u003cp\u003eThe following equation was used to calculate the percentage of wastage for each blood product:\u003c/p\u003e \u003cp\u003eWastage of each blood product (%) = \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\frac{\\text{N}\\text{u}\\text{m}\\text{b}\\text{e}\\text{r}\\:\\text{o}\\text{f}\\:\\text{w}\\text{a}\\text{s}\\text{t}\\text{e}\\text{d}\\:\\text{u}\\text{n}\\text{i}\\text{t}\\text{s}\\:\\text{f}\\text{o}\\text{r}\\:\\text{e}\\text{a}\\text{c}\\text{h}\\:\\text{p}\\text{r}\\text{o}\\text{d}\\text{u}\\text{c}\\text{t}}{\\text{S}\\text{u}\\text{m}\\:\\text{o}\\text{f}\\:\\text{u}\\text{n}\\text{i}\\text{t}\\text{s}\\:\\text{i}\\text{s}\\text{s}\\text{u}\\text{e}\\text{d}\\:\\text{f}\\text{o}\\text{r}\\:\\text{e}\\text{a}\\text{c}\\text{h}\\:\\text{p}\\text{r}\\text{o}\\text{d}\\text{u}\\text{c}\\text{t}}\\)\u003c/span\u003e\u003c/span\u003e \u0026times; 100\u003c/p\u003e \u003cp\u003eWastage as a percentage of issued products (WAPI) was calculated for each component as follows [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]:\u003c/p\u003e \u003cp\u003eWAPI (%) = \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\frac{\\text{S}\\text{u}\\text{m}\\:\\text{o}\\text{f}\\:\\text{w}\\text{a}\\text{s}\\text{t}\\text{e}\\text{d}\\:\\text{u}\\text{n}\\text{i}\\text{t}\\text{s}\\:\\text{f}\\text{o}\\text{r}\\:\\text{e}\\text{a}\\text{c}\\text{h}\\:\\text{c}\\text{o}\\text{m}\\text{p}\\text{o}\\text{n}\\text{e}\\text{n}\\text{t}}{\\text{S}\\text{u}\\text{m}\\:\\text{o}\\text{f}\\:\\text{u}\\text{n}\\text{i}\\text{t}\\text{s}\\:\\text{i}\\text{s}\\text{s}\\text{u}\\text{e}\\text{d}\\:\\text{f}\\text{o}\\text{r}\\:\\text{e}\\text{a}\\text{c}\\text{h}\\:\\text{c}\\text{o}\\text{m}\\text{p}\\text{o}\\text{n}\\text{e}\\text{n}\\text{t}}\\)\u003c/span\u003e\u003c/span\u003e \u0026times; 100\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eTrend of total blood supply during the study period\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003eA presents the total number of blood components issued and wasted between 2011 and 2023 at Taichung Tzu-Chi Hospital. The number of patients who received blood transfusions increased from 8,511 in 2011 to 13,409 in 2023, with an average of 10,745 patients every year. The average number of blood units issued every year was 32,631, and the average number of wasted blood units every year was 26. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003eB depicts the annual blood wastage rates over the study period. The highest annual wastage rate was recorded in 2011 (0.29%), and the average wastage rate was 0.08% over the past decade.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eUtilization and wastage of blood products\u003c/h2\u003e \u003cp\u003eDuring the study period, 424,197 units of blood products were released by the hospital\u0026rsquo;s blood bank (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). These blood components included RBC components (411 units of WB, 76,137 units of pRBCs, 1,253 units of washed RBCs, and 140,971 units of LR-RBCs), platelet components (34,013 units of platelet concentrates, 17,921 units of phPLT, and 20,090 units of LR-phPLT), and plasma components (88,895 units of FFP, 13,434 units of FP, and 31,072 units of CRYO). The rates of blood component wastage (WAPI) were expressed as the ratio of discarded blood components to issued blood components. Wastage rates of 0.04%, 0.09%, and 0.14% were recorded for RBC, platelet, and plasma components, respectively. Among them, plasma components have the highest waste rate of blood components (0.14%), and whole blood has the highest waste rate (1.95%) of blood products.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTotal number of blood components issued and the wastage of blood units during this study\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"16\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBlood products\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eRBC components\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;218,772\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003ePlatelet components\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;72,024\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e \u003cp\u003ePlasma components\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;133,401\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c16\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003epRBC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWashed\u003c/p\u003e \u003cp\u003eRBC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLR-RBC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePlatelets\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ephPLT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLR-phPLT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eFFP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eFP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003eCRYO\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood issue (unit)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e411\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76,137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,253\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e140,971\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e34,013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e17,921\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e20,090\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e88,895\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e13,434\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e31,072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e424,197\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood wastage (unit)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e336\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWastage of blood product (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWAPI (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"16\"\u003eWB: Whole blood, 1 unit of whole blood contains 250 mL; LR: Leukocyte-reduced; FFP: Fresh-frozen plasma; FP: Frozen plasma; CRYO: Cryoprecipitate; WAPI: Wastage as percentage of issues.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e depicts a pie chart of the utilization and wastage percentages of various blood components for the entire population. According to our findings, the most commonly utilized blood product was RBC components (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003eA), while the highest wastage rate was observed for FFP, followed by platelet concentrates (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003eB).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eCauses of blood wastage\u003c/h2\u003e \u003cp\u003eIn this study, we analyzed the clinical utilization and wastage rates of all the blood components. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e lists the various causes of blood wastage observed throughout the study period. A total of 84 wastage events (involving 336 units of blood products) were identified. To determine the causes of these wastage events, we divided the events into 13 categories. According to our results, excessive ordering was the leading cause (22.3%) of blood wastage, suggesting inaccurate assessments of patient conditions. The primary causes of RBC product wastage were the inability to reassign these products to other patients and the accidental puncturing of blood bags. The main causes of platelet and plasma product wastage were incorrect storage temperatures and improper ordering, respectively. After FFP, FP or CRYO products are thawed, those blood products should be transfused within 4 hours. Otherwise, those blood products should be returned to the blood bank and reassigned to other patients. If those blood products cannot be reissued to other patients before their expiry, they must be discarded.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe major causes of blood wastage\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCauses of blood wastage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCase (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRBC\u003c/p\u003e \u003cp\u003ecomponents\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePlatelet components\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePlasma components\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExcessive order or inappropriate evaluated patient's condition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(22.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnable reissue to other patient before usability period\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrder the wrong blood components\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(14.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient die/discharge before transfusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(9.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWrong storage temperature of platelet components\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(8.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood expired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAccidentally pierce the blood bags\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExcessive rewarm the blood component\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(6.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAccidentally broken the blood bags\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(2.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood products in room temperature over 4 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo intravenous access\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartially clot of blood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWrong transfusion procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e336 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eUtilization trends of prestorage leukocyte-reduced blood products\u003c/h2\u003e \u003cp\u003eSince 2014, the Blood Center of the Taiwan Blood Services Foundation has been responsible for supplying LR-RBCs to all medical facilities. In 2017, our hospital started to employ LR-RBCs for clinical use. Since 2016, many facilities have shifted from using pRBCs to using prestorage LR-RBCs and LR-phPLTs. The increase in the utilization rate of prestorage leukocyte-reduced blood products was accompanied by a major decline in transfusion reactions in our hospital from 2015\u0026ndash;2017 (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we analyzed trends in blood utilization and identified the causes of blood wastage in clinical practice in Taiwan. The management of the blood supply chain is considered vital. Over the past decade, we have implemented several management approaches and education courses that have led to a low rate of blood wastage. To effectively utilize blood products and reduce their wastage, the Blood Center and hospital blood banks jointly established several criteria for inventory management (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). These criteria ensure that excess or nontransfused blood products are returned to the blood bank for reassignment to other patients. We examined the utilization trends of blood products in a hospital between 2011 and 2023 and explored the causes of blood product wastage. As indicated in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, our hospital had an annual average wastage rate of 0.08%, which is relatively low. Previous studies have reported blood wastage rates ranging from 0.2\u0026ndash;7% [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The rate of blood wastage decreased from 0.29% in 2011 to 0.10% in 2012, reaching 0.01% in 2016.\u003c/p\u003e \u003cp\u003e The Blood Transfusion Management Committee is responsible for ensuring safe transfusion practices and implementing patient management initiatives. The committee plays a key role in guaranteeing the safety and appropriateness of blood transfusions for patients at our hospital. Over the past decade, our hospital has established several protocols for blood management, including (1) inviting clinical physicians who have misused or discarded blood products to present reports and engage in discussions with the committee, helping to strengthen blood product management; (2) limiting the transfer of RBC products from the blood bank to the ward to one bag at a time, preventing excessive requests, incorrect orders, or unnecessary rewarming; and (3) using cooling containers or tote bags to transport various blood products, accompanied by a portable thermometer to monitor storage temperature throughout the journey. This prevents these products from being exposed to room temperature for too long, thereby safeguarding their integrity.\u003c/p\u003e \u003cp\u003eDisseminating information on transfusion practices and educating medical staff and nurses may reduce blood wastage [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. At our hospital, blood wastage is caused in part by nurses inadvertently piercing blood bags during transfusion procedures. To address this issue, we conduct transfusion courses for all clinicians and nurses at least twice a year and provide them with information on how to avoid piecing blood bags. Although limited evidence is available regarding the effectiveness of continuing education in reducing blood wastage, at our institution, such education has led to a reduction in blood wastage rates over the past decade. This suggests that raising awareness about blood wastage and providing ongoing education on transfusion practices to clinicians and nurses can increase vigilance and help prevent it.\u003c/p\u003e \u003cp\u003eGood inventory management is essential for ensuring that the supply of blood components and products meets patients\u0026rsquo; transfusion needs while minimizing wastage. Blood inventory management is a complex process that requires coordination between a central blood supply center and blood banks to balance supply and demand. The main goal of the blood bank is to reduce blood wastage while maintaining a sufficient inventory of blood products for patients. Blood product management involves various aspects, including external factors such as communication between the blood donation center and the hospital, delays in blood product delivery, and insufficient blood supply at the blood donation center. Internal factors include delayed delivery of blood products, insufficient inventory in the hospital, incorrect temperatures, improper rewarming of blood products, excessive blood orders, and personnel unfamiliar with blood transfusion operations. Striking a balance between blood component utilization and storage in the hospital blood bank is essential [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Excessive stock of blood products can lead to expiration and is one of the causes of blood wastage [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. To avoid stock excess and shortages, our blood bank uses fixed stock units of blood products to maintain its inventory. In our hospital, the maximum number of stock units of RBC components (LR-RBCs) is 1.5\u0026ndash;2 times the amount of blood issued. Because platelet products rapidly degenerate, we request these products from the blood bank daily and transfuse them in the evening. For surgical patients or patients admitted to the intensive care unit, physicians are asked to order the required platelet products one day before transfusion. This strategy reduces the turnaround time of platelet components in our blood bank, helping to prevent wastage.\u003c/p\u003e \u003cp\u003eAfter the implementation of LR products (LR-phPLTs, LR-RBCs), the frequency of transfusion reactions decreased in our hospital (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e4\u003c/span\u003e). By reducing white blood cells in RBC components before storage, the levels of IL-1, IL-6, IL-8, and TNF-α may be lowered, enhancing transfusion safety [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and mitigating advanced transfusion reactions and allergies in recipients [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In 2014, the Taiwan Blood Services Foundation began providing LR-RBCs to all medical facilities. When prestorage LR-RBC products are adequately supplied for clinical transfusions, the frequency of transfusion reactions, such as febrile nonhemolytic transfusion reactions, significantly decreases [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Although this provision offers numerous benefits, the cost of LR-RBCs is approximately double that of non-LR-RBC products (pRBCs) (US\u003cspan\u003e$\u003c/span\u003e30.8 vs. US\u003cspan\u003e$\u003c/span\u003e15.80, US\u003cspan\u003e$\u003c/span\u003e1\u0026thinsp;=\u0026thinsp;NT\u003cspan\u003e$\u003c/span\u003e30). Given the high cost, physicians may be inclined to use these valuable blood components more appropriately. Additionally, owing to Taiwan\u0026rsquo;s health insurance policy and transfusion guidelines, our hospital did not fully incorporate LR-RBCs into clinical use until 2017. From 2015 to 2017, the rate of blood wastage at our hospital decreased, which coincided with a substantial reduction in the frequency of transfusion reactions due to the use of prestorage LR-RBC products.\u003c/p\u003e \u003cp\u003eFurthermore, improving blood management can help reduce healthcare expenses. Physicians must administer blood components appropriately during or after transfusions to avoid complications, such as volume overload or transfusion reactions. Blood transfusions are a crucial aspect of modern medical care. Over the past decade, the demand for blood components has risen, likely owing increasing life expectancy and an aging global population. In Taiwan, a significant reduction in blood donations among younger generations has been observed, which is attributed to the declining birth rate. Currently, the supply of blood products nearly matches, or at times even falls short of, the demand. With the increasing demand for blood transfusions in Taiwan\u0026rsquo;s rapidly aging society, a shortage of blood donations is expected in the near future [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. To prevent a potential blood shortage crisis, minimizing wastage and ensuring the effective and appropriate use of all blood products are crucial [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Under Taiwan\u0026rsquo;s National Health Insurance system, a single unit of pRBCs costs only US\u003cspan\u003e$\u003c/span\u003e15.8 (US\u003cspan\u003e$\u003c/span\u003e1\u0026thinsp;=\u0026thinsp;NT\u003cspan\u003e$\u003c/span\u003e30), which is considerably lower than that in the United States (US\u003cspan\u003e$\u003c/span\u003e200\u0026ndash;US\u003cspan\u003e$\u003c/span\u003e300) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and the United Kingdom (approximately US\u003cspan\u003e$\u003c/span\u003e38) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The cost of blood products typically includes various operational and maintenance expenses, such as equipment depreciation and personnel salaries at blood centers, as well as utility costs. Other services, including donor recruitment, blood collection, testing, storage, and delivery to hospitals, are also factored into the overall cost. Despite Taiwan\u0026rsquo;s lower blood product costs than those of other countries, physicians and healthcare staff must strive to avoid inappropriate transfusions and minimize wastage.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this study, we explored the patterns of blood component utilization and developed several strategies to mitigate blood product wastage. Disseminating information about blood wastage among clinicians and technicians in blood banks, as well as providing continuing education for all medical staff, are essential for enhancing the safety of blood transfusions. Physicians should use blood components carefully to minimize wastage, especially given the anticipated blood shortage in Taiwan due to its rapidly aging population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eWB\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;whole blood\u003c/p\u003e\n\u003cp\u003epRBC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;packed red blood cells\u003c/p\u003e\n\u003cp\u003eLR-RBC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;leukocyte-reduced RBCs\u003c/p\u003e\n\u003cp\u003ePLT\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;platelet concentration\u003c/p\u003e\n\u003cp\u003ephPLT\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;apheresis platelets\u003c/p\u003e\n\u003cp\u003eLR-phPLT\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;leukocyte-reduced apheresis platelets\u003c/p\u003e\n\u003cp\u003eFFP\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;fresh frozen plasma\u003c/p\u003e\n\u003cp\u003eFP\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;frozen plasma\u003c/p\u003e\n\u003cp\u003eCRYO \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; cryoprecipitate.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was extracted and analyzed from Taichung Tzu-Chi Hospital. We thank all the members of the blood bank in the hospital. We would also like to express our appreciation to Ms. Hsuan-Hui Wang of Taichung Blood Center of the Taiwan Blood Services Foundation for the consultation of blood supply and utilization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by grants from the Central Taiwan University of Science and Technology, Taichung, Taiwan (CTU103-P-18) and from the Education of Taiwan, Taiwan (PMN1122369).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChien JH contributed to study conceptualization, investigation, formal analysis, and writing–original draft. Yao CY contributed to study supervision and writing–review \u0026amp; editing. Chen HF participated in data collection analysis of the manuscript. Ho TF contributed to project administration, supervision, funding acquisition, conceptualization, methodology, and writing–review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have disclosed no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Institutional Review Board of Taichung Tzu-Chi Hospital approved this study (REC111-36).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHess JR. An update on solutions for red cell storage. Vox sanguinis. 2006;91:13\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eRoh J, Choi SJ, Kim S, Min H, Kim HO. Blood Supply and Demand in Korea: What is in Store for the Future? Yonsei medical journal. 2020;61:400\u0026ndash;5.\u003c/li\u003e\n\u003cli\u003eGreinacher A, Fendrich K, Brzenska R, Kiefel V, Hoffmann W. Implications of demographics on future blood supply: a population-based cross-sectional study. Transfusion. 2011;51:702\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eAli A, Auvinen MK, Rautonen J. The aging population poses a global challenge for blood services. Transfusion. 2010;50:584\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eGBD 2021 Fertility and Forecasting Collaborators. Global fertility in 204 countries and territories, 1950-2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet (London, England). 2024;403:2057\u0026ndash;99.\u003c/li\u003e\n\u003cli\u003e\u0026ndash;2020 annual report released by the Taiwan Blood Services Foundation. Bing. https://www.blood.org.tw\u003c/li\u003e\n\u003cli\u003eNgo A, Masel D, Cahill C, Blumberg N, Refaai MA. Blood Banking and Transfusion Medicine Challenges During the COVID-19 Pandemic. Clinics in laboratory medicine. 2020;40:587\u0026ndash;601.\u003c/li\u003e\n\u003cli\u003eNguyen A, Burnett-Greenup S, Riddle D, Enderle J, Carman C, Rajendran R. Blood usage and wastage at an academic teaching hospital before the initial wave of COVID-19 and during and after its quarantine periods. Laboratory medicine. 2024;55:198\u0026ndash;203.\u003c/li\u003e\n\u003cli\u003eChiem C, Alghamdi K, Nguyen T, Han JH, Huo H, Jackson D. The Impact of COVID-19 on Blood Transfusion Services: A Systematic Review and Meta-Analysis. Transfusion medicine and hemotherapy : offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie. 2021;30:1\u0026ndash;12.\u003c/li\u003e\n\u003cli\u003eJacobs JW, Booth GS. Blood shortages and changes to massive transfusion protocols: Survey of hospital practices during the COVID-19 pandemic. Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis. 2022;61:103297.\u003c/li\u003e\n\u003cli\u003eZoric L, Daurat G, Demattei C, Macheboeuf M, Boisson C, Bouix O, et al. Blood wastage reduction: a 10-year observational evaluation in a large teaching institution in France. European journal of anaesthesiology. 2013;30:250\u0026ndash;5.\u003c/li\u003e\n\u003cli\u003eAmini Kafi-Abad S, Omidkhoda A, Pourfatollah AA. Analysis of hospital blood components wastage in Iran (2005-2015). Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis. 2019;58:34\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eYazer MH, Dunbar NM, Cohn C, Dillon J, Eldib H, Jackson B, et al. Blood product transfusion and wastage rates in obstetric hemorrhage. Transfusion. 2018;58:1408\u0026ndash;13.\u003c/li\u003e\n\u003cli\u003eChong D, Lam JCM, Feng XYJ, Heng ML, Mok YH, Chiang LW, et al. Blood Lost: A Retrospective Review of Blood Wastage from a Massive Transfusion Protocol in a Tertiary Paediatric Hospital. Children (Basel, Switzerland). 2022;9.\u003c/li\u003e\n\u003cli\u003eHeitmiller ES, Hill RB, Marshall CE, Parsons BJ, Berkow LC, Barrasso CA, et al. Blood wastage reduction using Lean Sigma methodology. Transfusion. 2010;50:1887\u0026ndash;96.\u003c/li\u003e\n\u003cli\u003eWang RR, Triulzi DJ, Qu L. Effects of prestorage vs poststorage leukoreduction on the rate of febrile nonhemolytic transfusion reactions to platelets. American journal of clinical pathology. 2012;138:255\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eYazer M. The Pittsburgh centralized transfusion model: less is more. Transfusion. 2007;47 2 Suppl:164S-168S; discussion 182S-183S.\u003c/li\u003e\n\u003cli\u003eStanger SH, Yates N, Wilding R, Cotton S. Blood inventory management: hospital best practice. Transfusion medicine reviews. 2012;26:153\u0026ndash;63.\u003c/li\u003e\n\u003cli\u003eRajesh K, Harsh S, Amarjit K. Effects of Prestorage Leukoreduction on the Rate of Febrile Nonhemolytic Transfusion Reactions to Red Blood Cells in a Tertiary Care Hospital. Annals of medical and health sciences research. 2015;5:185\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eJadwin DF, Fenderson PG, Friedman MT, Jenkins I, Shander A, Waters JH, et al. Determination of Unnecessary Blood Transfusion by Comprehensive 15-Hospital Record Review. Joint Commission journal on quality and patient safety. 2023;49:42\u0026ndash;52.\u003c/li\u003e\n\u003cli\u003eToner RW, Pizzi L, Leas B, Ballas SK, Quigley A, Goldfarb NI. Costs to hospitals of acquiring and processing blood in the US: a survey of hospital-based blood banks and transfusion services. Applied health economics and health policy. 2011;9:29\u0026ndash;37.\u003c/li\u003e\n\u003cli\u003eCataife G, Pagano MB. How much does a blood transfusion cost? Transfusion. 2018;58:833\u0026ndash;5.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Blood utilization, Aging, Leukocyte reduction, Platelet, Plasma, Wastage","lastPublishedDoi":"10.21203/rs.3.rs-5068119/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5068119/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Blood is a vital medical resource that is sourced from primarily nonremunerated donations. As Taiwan faces an aging population, increasing medical demands pose new challenges to blood resource management. Trend analysis can improve blood supply chain management and allocate blood resources more efficiently and cost-effectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A retrospective review was conducted from 2011–2023 in a teaching hospital to examine the utilization and wastage of blood products. Data were collected from hospital information system and blood wastage reports, categorized by cause, and analyzed via SAS software version 9.3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The hospital released 424,197 units of blood products, with leukocyte-reduced red blood cells accounting for 140,971 units. The highest annual wastage rate was 0.29% in 2011, and the annual average was 0.08%. Fresh frozen plasma (36.3%), platelet concentrates (15.2%), and cryoprecipitate (14.3%) were the most frequently discarded. Major causes of wastage included excessive or inappropriate orders (22.3%), inability to reissue blood before expiration (16.7%), and incorrect orders (14.6%). Platelet wastage was caused primarily by improper storage, while thawed plasma could not be repurposed. Utilization of leukocyte-reduced blood products has increased, leading to a significant reduction in transfusion reactions from 1.8% in 2011 to 0.6% in 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The study revealed that blood wastage often arises from human error or improper storage conditions. The leading cause of platelet product disposal is incorrect storage temperatures, along with the inability to repurpose thawed plasma for plasma products. The increased use of prestorage leukocyte-reduced blood products has significantly reduced transfusion reactions. Continuous education for healthcare professionals, along with improved inventory monitoring, can further minimize wastage and enhance transfusion quality.\u003c/p\u003e","manuscriptTitle":"Trends in blood transfusion and causes of blood wastage: a retrospective analysis in a teaching hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-25 12:25:05","doi":"10.21203/rs.3.rs-5068119/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-12T15:24:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-12T09:06:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-12T09:05:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2024-09-11T04:17:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e5412738-ca45-4638-8d0c-b9d28df66f1e","owner":[],"postedDate":"November 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-20T16:02:13+00:00","versionOfRecord":{"articleIdentity":"rs-5068119","link":"https://doi.org/10.1186/s12913-024-12170-x","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2025-01-14 15:57:31","publishedOnDateReadable":"January 14th, 2025"},"versionCreatedAt":"2024-11-25 12:25:05","video":"","vorDoi":"10.1186/s12913-024-12170-x","vorDoiUrl":"https://doi.org/10.1186/s12913-024-12170-x","workflowStages":[]},"version":"v1","identity":"rs-5068119","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5068119","identity":"rs-5068119","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}