Blood Component Utilization Pattern and Crossmatch-to-Transfusion Ratio in a Tertiary Care Hospital: An Ambispective Blood Bank Audit

Abstract

Background:Components of blood are limited resource for therapy and should be used in a rational way. There is a high demand for transfusions at tertiary care hospitals because of requirements of various medical specialties such as medicine, surgery, obstetrics and gynecology, emergency care, pediatrics, intensive care etc. Regular audits of blood utilization using transfusion indices are capable of revealing unnecessary overordering, ineffective blood reserving, wasted components and other ways to improve transfusion practice.Aim:To analyze blood component utilization and crossmatch-to-transfusion ratio at a tertiary care hospital through ambispective audit of the blood bank.Material and Methods:An ambispective observational study was performed in the blood bank of a tertiary care hospital over three years. The first two years were retrospective, and the last year was prospective. Data were obtained from donor records, registers of component preparation, crossmatches, issues, returns, discards, transfusion reactions and prospectively filled proformas. Utilization data per component type and department were analyzed. Crossmatch-to-transfusion ratio, probability of transfusion, transfusion index, return rate, and discard rate were calculated. Results: A total number of 16,482 blood bags were collected and 31,842 blood components were issued over the studied period. The largest component group was the packed red blood cells, then fresh frozen plasma and platelet concentrates. The major users of the blood bank were Departments of Medicine, Obstetrics and Gynecology, Surgery, Emergency Medicine and Intensive Care Units. The overall crossmatch-to-transfusion ratio was 1.16, probability of transfusion was 83.5% and the transfusion index was 1.51. Department of Surgery and Orthopedics had comparatively higher values of crossmatch-to-transfusion ratio than Departments of Emergency, Intensive Care, Obstetric, Pediatric and Medical departments. The results obtained during prospective period were better concerning the documentation of clinical indication, confirmation of transfusion, returning of unused blood units and reasons for discard. Conclusion:There was variation in utilization of blood components on a department level which was clinically significant. Overall utilization of red cells was acceptable, but some procedural departments needed improvement of blood reserving practices. Periodic audits, feedbacks, better documentation and development of local blood ordering guidelines could enhance rational blood component utilization at tertiary care hospitals.