Blood Component Utilization, Return, and Expiration Patterns across Four Teaching Hospitals in South Khorasan, Iran: A Multicenter Cross-Sectional Study
-
Maziar Nasiri
,
Mobina Nakhaei Shamahmood
,
Mohammad Reza Zabihi
,
Alireza Zangooie
,
Shaghayegh Alinezhad
,
Zahra Salehi
,
Fatemeh Mezginejad
Abstract
Background: Efficient utilization of blood components is a major goal in transfusion medicine, particularly in healthcare systems facing rising demand and limited donor resources. This study evaluated patterns of blood component utilization, return, and expiration in four teaching hospitals in Birjand, South Khorasan, Iran.
Materials and Methods: This multicenter cross-sectional study was conducted over six months (September 2024–March 2025) in hospitals affiliated with Birjand University of Medical Sciences. Data on requests, issuance, transfusion, and return of blood components were extracted from blood bank and hospital information systems. In total, 622 requests and 10,295 issued units were analyzed. Utilization rate, return rate, and crossmatch-to-transfusion (C:T) ratio were calculated. The Kruskal–Wallis test was used to compare return rates among hospitals.
Results: The overall utilization rate was 97.54%, with a return rate of 2.46% and a C:T ratio of 1.05. Significant inter-hospital variability was observed (P < 0.0001). Razi Hospital accounted for 71.3% of returned units (return rate: 6.10%), while Iranmehr Hospital achieved near-complete utilization (0.02%). ICUs and CCUs represented over 75% of returns, and leukocyte-reduced red blood cells were the most frequently returned component (64.5%). A total of 261 units were discarded, mainly due to expiration (74.3%), with B+ showing the highest expiration frequency (19.9%).
Conclusion: Although overall transfusion efficiency was high, substantial variability in return and expiration patterns suggests that targeted, data-driven interventions may further reduce wastage and improve patient safety.
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17. Whitaker B, Rajbhandary S, Kleinman S, et al. Trends in United States blood collection and transfusion: results from the 2013 AABB blood collection, utilization, and patient blood management survey. Transfusion. 2016;56(9):2173-2183.
18. Anani Sarab G, Asadi Fard M, Mesbahzadeh B. Study of blood utilisation in Vali-e Asr educational hospital in Birjand Iran. J Transl Med Res. 2015;22(2):176-181.
19. Najafzadeh M, Zardast M, Assari F, et al. The use of blood and blood products in Vali-e Asr Educational Hospital (Birjand, Iran). J Iran Blood Transfus. 2018;15(1):21-27.
20. Chegini A, Ebrahimi A, Maghari A, et al. Evaluation of red blood cell use and the estimation of the wasted costs of unnecessary blood crossmatches. Sci J Iran Blood Transfus Organ. 2015;12(3):207-214.
21. Far RM, Rad FS, Abdolazimi Z, et al. Determination of rate and causes of wastage of blood and blood products in Iranian hospitals. Turk J Haemato. 2014;31(2):161–167.
22. Borgman MA, Spinella PC, Perkins JG, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma. 2007;63(4):805-13.
23. Kiekkas P, Tzenalis A, Gklava V, et al. Delayed admission to the intensive care unit and mortality of critically ill adults: systematic review and meta-analysis. Biomed Res Int. 2022;2022:4083494.
24. Ramirez-Arcos S, Marks DC, Acker JP, et al. Quality and safety of blood products. J Blood Transfus. 2016;2016:2482157.
25. Meneses M, Marques I, Barbosa-Póvoa A. Blood inventory management: ordering policies for hospital blood banks under uncertainty. Int Trans Oper Res. 2023;30(1):273-301.
26. Bakmohammadi N, Karimi H, Vahdani H. Optimal policy of ordering blood units in the hospital according to compatibility and priority transfers between blood groups under uncertainty conditions: a case study. Transfus Apher Sci. 2023;62(2):103529.
27. Sadana D, Kummangal B, Moghekar A, et al. Adherence to blood product transfusion guidelines—an observational study of the current transfusion practice in a medical intensive care unit. Transfus Med. 2021;31(4):227-235.
28. Alsughayyir J, Alghamdi A, Almuqrin AM, et al. Reducing blood product wastage: insights from a retrospective study in a tertiary health facility. PLoS One. 2026;21(3):e0344521.
29. Madkaiker D, Iyer K, Chenna D, et al. SOS–Save our supplies: understanding reasons to tackle the challenge of wasted returned blood products. Transfus Clin Biol. 2024;31(2):76-80.
30. Nikpoor A, Daneshvar H, Sanei Moghaddam E, et al. Assessment of requisition and consumption indices of blood in educational hospitals in Kerman city. Sci J Iran Blood Transfus Organ. 2013;10:12-9.
31. Ravikanth C, Babu BS, Arun R, et al. Analysis of blood and blood component wastage and its reasons among various departments in a tertiary care teaching hospital in Southern India. Natl J Lab Med. 2022;11(2): PO37-PO39.
32. Quang HV, Nhung LTK, Thuy PTT, et al. Blood-stream infections: causative agents, antibiotic resistance and associated factors in older patients. Mater Sociomed. 2024;36(1):82-89.
33. Benzil DL, Auron M, Otrock ZK, et al. A maximum surgical blood ordering schedule: Does it add value?. Vox Sang. 2025;120(4):411-418.
34. Woodrum C, Wisniewski M, Triulzi D, et al. The effects of a data driven maximum surgical blood ordering schedule on preoperative blood ordering practices. Hematology. 2017;22(9):571-577.
2. Ansari S. Blood management by transfusion triggers: when less is more. Blood Transfus. 2012;10(1):28.
3. Schreiber GB, Kleinman SH, Korelitz JJ. The risk of transfusion-transmitted viral infections. N Engl J Med. 1996;334(26):1685-1690.
4. https://www.who.int/publications/i/item/9789240121546
5. Kermani FR. Trend of blood donation including coronavirus pandemic: a nationwide cross-sectional study during 2017–2022 in Iran. Transfus Clin Biol. 2025;32(3):272-279.
6. Haran H, Kumar S, James S. Stemming the flow: causes and solutions for blood and blood component wastage in a tertiary care hospital. Cureus. 2024;16(5): e59493.
7. Chien JH, Yao CY, Chen HF, et al. Trends in blood transfusion and causes of blood wastage: a retrospective analysis in a teaching hospital. BMC Health Serv Res. 2025;25(1):67.
8. Karami SH, Sanei Moghadam E, Khosravi SO. Consumption trend of blood and blood components in Zahedan teaching hospitals. J Iran Blood Transfus. 2009;5(4):257-266.
9. Emadi SA, Moosazadeh M, Sajadi N, et al. Blood reservation and transfusion for elective surgeries: a cross-sectional study. Int J Surg Open. 2025;63(3):215-218.
10. Belayneh T, Abdissa Z, Tegene B. Blood requisition and utilization practice in surgical patients at University of Gondar Hospital, northwest Ethiopia. J Blood Transfus. 2013;2013: 758910.
11. JM, DS. Efficiency of packed red cell utilization and establishment of effective maximum surgical blood order schedule in elective coronary artery bypass graft surgery in a specialized tertiary care center. Philipp J Anesthesiol. 2024;29(2):60-65.
12. Javadzadeh Shahshahani H, Akhavan Tafti F. Frequency of blood components wastage and associated factors in Yazd healthcare centers. Iran J Blood Cancer. 2016;8(4):112-116.
13. Yadla L, Shaik S, Sujatha C, et al. Causes of donor blood wastage in a blood centre from a tertiary care hospital, Tirupati, India: a cross-sectional study. J Clin Diagn Res. 2025;19(11): ): EC07-EC09
14. Merdin A, Aydin Ü. Evaluation of the distribution of ABO and Rh blood groups in geriatric patients aged ≥85 years: a retrospective single-center study. Medicine (Baltimore). 2025;104(27):e43154.
15. Kumar S, Singh S, Chaurasiya P. Epidemiology of ABO and rhesus blood groups in blood donors at a North Indian tertiary care hospital. Santosh Univ J Health Sci. 2024;10(2):184-187.
16. Andalibi M, Afshari A, Tayefi M, et al. Prevalence of ABO and Rh blood groups and their association with demographic and anthropometric factors in an Iranian population: Mashhad study. East Mediterr Health J. 2020;26(8):916-922.
17. Whitaker B, Rajbhandary S, Kleinman S, et al. Trends in United States blood collection and transfusion: results from the 2013 AABB blood collection, utilization, and patient blood management survey. Transfusion. 2016;56(9):2173-2183.
18. Anani Sarab G, Asadi Fard M, Mesbahzadeh B. Study of blood utilisation in Vali-e Asr educational hospital in Birjand Iran. J Transl Med Res. 2015;22(2):176-181.
19. Najafzadeh M, Zardast M, Assari F, et al. The use of blood and blood products in Vali-e Asr Educational Hospital (Birjand, Iran). J Iran Blood Transfus. 2018;15(1):21-27.
20. Chegini A, Ebrahimi A, Maghari A, et al. Evaluation of red blood cell use and the estimation of the wasted costs of unnecessary blood crossmatches. Sci J Iran Blood Transfus Organ. 2015;12(3):207-214.
21. Far RM, Rad FS, Abdolazimi Z, et al. Determination of rate and causes of wastage of blood and blood products in Iranian hospitals. Turk J Haemato. 2014;31(2):161–167.
22. Borgman MA, Spinella PC, Perkins JG, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma. 2007;63(4):805-13.
23. Kiekkas P, Tzenalis A, Gklava V, et al. Delayed admission to the intensive care unit and mortality of critically ill adults: systematic review and meta-analysis. Biomed Res Int. 2022;2022:4083494.
24. Ramirez-Arcos S, Marks DC, Acker JP, et al. Quality and safety of blood products. J Blood Transfus. 2016;2016:2482157.
25. Meneses M, Marques I, Barbosa-Póvoa A. Blood inventory management: ordering policies for hospital blood banks under uncertainty. Int Trans Oper Res. 2023;30(1):273-301.
26. Bakmohammadi N, Karimi H, Vahdani H. Optimal policy of ordering blood units in the hospital according to compatibility and priority transfers between blood groups under uncertainty conditions: a case study. Transfus Apher Sci. 2023;62(2):103529.
27. Sadana D, Kummangal B, Moghekar A, et al. Adherence to blood product transfusion guidelines—an observational study of the current transfusion practice in a medical intensive care unit. Transfus Med. 2021;31(4):227-235.
28. Alsughayyir J, Alghamdi A, Almuqrin AM, et al. Reducing blood product wastage: insights from a retrospective study in a tertiary health facility. PLoS One. 2026;21(3):e0344521.
29. Madkaiker D, Iyer K, Chenna D, et al. SOS–Save our supplies: understanding reasons to tackle the challenge of wasted returned blood products. Transfus Clin Biol. 2024;31(2):76-80.
30. Nikpoor A, Daneshvar H, Sanei Moghaddam E, et al. Assessment of requisition and consumption indices of blood in educational hospitals in Kerman city. Sci J Iran Blood Transfus Organ. 2013;10:12-9.
31. Ravikanth C, Babu BS, Arun R, et al. Analysis of blood and blood component wastage and its reasons among various departments in a tertiary care teaching hospital in Southern India. Natl J Lab Med. 2022;11(2): PO37-PO39.
32. Quang HV, Nhung LTK, Thuy PTT, et al. Blood-stream infections: causative agents, antibiotic resistance and associated factors in older patients. Mater Sociomed. 2024;36(1):82-89.
33. Benzil DL, Auron M, Otrock ZK, et al. A maximum surgical blood ordering schedule: Does it add value?. Vox Sang. 2025;120(4):411-418.
34. Woodrum C, Wisniewski M, Triulzi D, et al. The effects of a data driven maximum surgical blood ordering schedule on preoperative blood ordering practices. Hematology. 2017;22(9):571-577.
| Files | ||
| Issue | Vol 20 No 3 (2026) | |
| Section | Original Article(s) | |
| Keywords | ||
| Blood component utilization; Blood return; Blood expiration; Transfusion efficiency | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Nasiri M, Nakhaei Shamahmood M, Zabihi MR, Zangooie A, Alinezhad S, Salehi Z, Mezginejad F. Blood Component Utilization, Return, and Expiration Patterns across Four Teaching Hospitals in South Khorasan, Iran: A Multicenter Cross-Sectional Study. Int J Hematol Oncol Stem Cell Res. 2026;20(3):278-290.
