In Focus

Blood component wastage

Global patterns, Causes and Solutions

Aparna Krishna

Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India

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Securing a steady blood supply involves balancing hospital needs, fluctuations in donor activity throughout the year and the need for hospitals to maintain adequate stock for sporadic and unexpected emergencies.

WAPI

Blood inventory management is a trade-off between shortage and wastage. Minimizing blood product wastage is an essential element to maintain an adequate inventory. Wastage is usually calculated as a percentage of units issued (WAPI), which accounts only for the issued products and not the size of blood bank inventory. WAPI is a performance indicator used to compare and rank hospitals. It is a metric composed of different types of wastage like time expiry, out of temperature control, deep freezer or refrigerator breakdown and miscellaneous1. It is calculated as follows:

Excessive ordering, inappropriate patient evaluation and errors in blood component orders by physicians can lead to wastage. Death or discharge of a patient before transfusion can result in blood lying outside the cold chain for prolonged periods rendering them unsuitable for return and reuse2.

Survey

The ISBT conducted an international survey of blood component wastage rates in 2015. The majority of participating centers were from Europe and North America3. The survey demonstrated that the median rates of product wastage are low around the world. Platelets had the highest wastage rates due to their shorter expiration time, while red blood cells had the lowest wastage rates as they can be stored in a temperature-controlled device after issue. The median WAPI rates were red blood cells (RBC) 1.7%, platelets 3-4% and fresh frozen plasma (FFP) 4.2%.

The major mechanisms of wastage, in order, were expiry in hospital blood bank > return beyond expiry > storage noncompliance > outdate after issue, according to the survey. Another survey conducted by ISBT in low- and middle-income countries concluded that the wastage rates varied considerably between the countries with discards for all reasons estimated to be between 10-25% for 5 facilities4.

More training, better cold chain compliance and improved inventory management are key factors that can reduce wastage, according to this survey.

National discard rates

The National Health authority of Australia has released national discard rates publicly increasing transparency and accountability. The WAPI for platelets were higher in the remote areas of Australia compared to major cities. Data for platelets and RBC from Australia show that the most common reasons for discard was time expiry and storage related issues5. Implementing evidence-based patient blood management reduces unnecessary blood orders, thereby safeguarding inventory. Modifying blood ordering practices and correcting pre-operative anemia can be achieved through continuous educational initiatives6.

Shelf lives

Blood products have limited shelf lives: 35 days for RBC, 5 days for platelets and 1 year for fresh frozen plasma. Failure to transfuse these products before they expire due to poor inventory management practices leads to avoidable discards. Blood components require strict temperature control: red blood cells at 1-6°C, platelets at 22-24°C with agitation and fresh frozen plasma at -20°C. Temperature excursions during storage or transport affect the quality of blood products. In the event of major equipment failure (eg. refrigerator, deep freezer or agitator), units must be discarded. Tote bags and cooling containers may be used to preserve cold chain during transport7.

Implementing central temperature monitoring facilities, RFID tags and audits can reduce discards due to cold chain issues. Blood components not used in operation theatres and wards must be returned to the blood bank within 30 minutes after issue. Any delay leads to discard of the blood components. However, they may be reassigned within specific time frames: RBC within 72 hours, Thawed FFP within 24 hours and platelets before their expiration date.

Storage

Other common causes of discard include storage problems leading to clots, hemolysis, discoloration, lipemia, bag leakage or breakage (eg. in the centrifuge or while connecting to the patient), positive direct antiglobulin test of donor, or detection of irregular antibodies while antibody screening of donor. Biannual training programme for nurses, medical staff and doctors have been shown to be effective in reducing wastage7. Ongoing education for clinicians, nurses and blood bank personnel on blood handling, transportation, transfusion guidelines reduce clinical errors and mishandling8. Surplus stock can accumulate due to collection during blood donation camps, seasonal variations in transfusion needs, donor motivation campaigns without demand assessment and stock piling of rare blood groups. Inefficient first-in-first-out (FIFO) practices or lack of digital inventory tracking can cause units to remain unused until expiry. Implementing pre-storage leukoreduction has reduced wastage by decreasing the incidence of transfusion reactions to a significant extent according to Chien et al. Strict criteria of massive transfusion protocol (MTP) activation and regular team training help prevent unnecessary preparation of large blood volumes7. Product outdating is a major contributor to blood discards. The optimal blood inventory level differs for each hospital, depending on factors such as clinical services offered, distance from blood supplier, average monthly transfusion activity and time of year. Redistributing near- outdated blood from low usage to high usage hospitals is a feasible solution. The unused plasma products may be sent for plasma fractionation or redistributed to high usage centers. Hajjaj et al. designed and validated two transport containers for redistribution of blood, which were cost effective9.

Wasted units

Every wasted unit represents a lost opportunity to treat another patient. Additionally, wastage increases the financial burden and operational costs of the blood bank. Donors give blood altruistically to help patients. Wastage undermines trust in the health care system and demotivate future donations. Using computerized blood bank systems for real time tracking helps manage stock levels efficiently. Predictive analytics based on historical data and patient needs allow better planning, avoiding both overstocking and understocking. Staples et al. analyzed the utility of monthly Blood stock management schemes (BSMS) component reports in UK. The survey demonstrated that having feedback and reporting mechanisms enables hospitals to review stock management performance regularly and implement changes required for good inventory practice10. Establishing a blood utilization committee to review transfusion practices, monitor wastage data and implement targeted interventions tailored to institutional needs is mandatory at every hospital.

Conclusions

In conclusion, identifying the mechanisms of wastage and effective strategies including accurate forecasting, optimized inventory systems, adherence to best practices and ongoing education can substantially reduce blood wastage rates.

References

  1. Stanger SHW, Yates N, Wilding R, Cotton S. Blood Inventory Management: Hospital Best Practice. Transfus Med Rev. 2012 Apr;26(2):153–63.
  2. Heddle NM, Liu Y, Barty R, Webert KE, Whittaker S, Gagliardi K, et al. Factors affecting the frequency of red blood cell outdates: an approach to establish benchmarking targets. Transfusion (Paris). 2009 Feb;49(2):219–26.
  3. Yazer MH, Abraham S, Beckman N, Folléa G. International Society for Blood Transfusion international survey on blood product wastage in hospitals. ISBT Sci Ser. 2016 Apr;11(1):24–31.
  4. Beckman N, Ansah J, Follea G, Yazer MH. International Society for Blood Transfusion international survey on blood product wastage in low‐ and middle‐income countries. ISBT Sci Ser. 2019 Aug;14(3):260–8.
  5. Blood product wastage, National Blood Authority, Australia (www.blood.gov.au)
  6. Yates N, Stanger S, Wilding R, Cotton S. Approaches to assessing and minimizing blood wastage in the hospital and blood supply chain. ISBT Sci Ser. 2017 Feb;12(1):91–8.
  7. Chien J Huei, Yao C yuan, Chen H fen, Ho TF. Trends in blood transfusion and causes of blood wastage: a retrospective analysis in a teaching hospital. BMC Health Serv Res. 2025 Jan 14;25(1):67.
  8. Levin JH, Collins L, Adekunle O, Jackson HT, Vaziri K, Schroeder M, et al. Blood product wastage reduction by utilising low‐cost, low‐impact multimodal physician‐to‐physician communication initiatives. Transfus Med. 2019 Dec;29(6):389–93.
  9. Hajjaj OI, Modi D, Cameron T, Barty R, Owens W, Heddle N, et al. Reducing blood product wastage through the inter‐hospital redistribution of near‐outdate inventory. Transfusion (Paris). 2024 Jul;64(7):1207–16.
  10. Staples S, Evans H, Caulfield J, Bend M, Foy R, Murphy MF, et al. Opportunities to improve feedback to reduce blood component wastage: Results of a national scheme evaluation. Transfusion (Paris). 2024 Jul;64(7):1223–32.
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