Transfusion pattern of blood products in a blood bank at a tertiary care hospital

Objectives: Blood products in modern-day transfusion practice include, Packed Red Blood Cells, Platelets, Leucocytes, Plasma, Cryoprecipitate, and individual plasma factors. The objective was to study the pattern of usage of various blood products for the commonest clinical indications and to have an overview of the production of blood components. Materials and Methods: In this study, usage of various blood products like Packed Red Blood Cells, Platelet concentrates, Fresh Frozen Plasma, and Cryoprecipitate were studied in the blood bank of Trichy SRM medical college hospital and research center, using blood bank records and correlating with clinical data during the period of June 2015 June 2020. Observation and result: The pattern of usage among 14,511 units of blood components from June 2015 – June 2020 showed the frequency of usage of Packed Red Blood Cells was more than Fresh Frozen Plasma and whole blood. The usage of whole blood was more than Platelet concentrates and Cryoprecipitate. The most frequently used component was Packed Red blood cells – 7841 units (54%). The second most frequently used component was fresh frozen plasma – 3889 units (26.8%). In the next frequency whole blood1955 units (13.5%), platelet concentrates 797 units (5.5%) and cryoprecipitate – 29 units (0.2%) were used. Conclusion: There has been an appropriate increase in the usage of blood products to meet the clinical demand in treating the patients with an increase in pathological conditions. Specific blood component transfusion should be encouraged for specific indications to reduce non-essential overload to the patients.


Introduction
Blood transfusion and blood conservation are complementary activities that constitute the clinical arena of transfusion medicine. Blood components can be prepared in a licensed blood bank that has the required space, specialized equipment, storage facilities, and trained personnel. The advent of blood component therapy was by use of factor VIII for hemophiliacs which commenced in the U.K in 1980, prepared by fractionation of human plasma. This is not just for checking infections, but also to minimize the other side effects of blood transfusion [1].
Transfusion of whole blood creates hazards to the patients which were noted in the past few decades. So transfusion of blood components has been considered, to be a low risk and safe procedure [2].
In the United Kingdom and other western countries,  Table-1 [11].
Whole Blood: According to the ASA guidelines for whole blood transfusion, acute loss of blood if more than 30% and the patient is at the risk of hemorrhagic shock, the transfusion of whole blood is the component of choice to restore blood volume and oxygen-carrying capacity [12,13,14,15].
Transfusion of whole blood has also been used for anemia in patients. But in modern-day practices replacement of whole blood by individual components plays a vital role to prevent overload to the patients [  [16,17,18]. In anticipated surgical blood loss > 1000 ml or if the patient needs urgent surgery and has hemoglobin < 10g/dl, transfusion is indicated. If there is an acute loss of blood with a reduction of 30-40% of blood volume, transfusion of RBCs along with crystalloids is indicated. Whole blood or packed red blood cells along with crystalloids are indicated for transfusion if there is acute blood loss > 40% of blood volume [19,20].
Other indications for packed red blood cells include, anemia associated with incipient/established cardiac failure or if hemoglobin value < 6 g/dl, patients approaching delivery with hemoglobin value < 7         [16].
The second most frequently used component was  With awareness creation and frequent clinical collaborations, and increased demand has been observed. With age and gender-specific findings, it is been inferred that patients who received critical blood transfusion were between 20 -39 years of age which is comparable with previous age-specific transfusion studies by Petz, Lawrence [27] where most transfusion been done in adult age groups been found.

Limitations
The study limits to analyze the pattern of usage of major four blood components which have been prepared in the blood bank. Further, the study to be extended to all other minor blood components of plasma protein derivatives and leukocytes to know the overall pattern of usage. And also through this study, analysis of the most common indications for each component irrespective of the age of the Recipients for transfusion was done. Hence further extension of this study can be made for age-specific indications for which the blood components are used to minimize immediate as well as long term sequelae of transfusions.

Conclusion
There has been an increase in the usage of blood products yearly to meet the clinical demand in treating patients with various morbidities. Instead of whole blood transfusion, specific blood component transfusion is encouraged for specific indications to reduce non-essential overload to the patients, which has been achieved in our department of transfusion medicine. This is observed clearly in the present study.
Preparation of blood component which has been frequently used (packed red cells) in our tertiary care hospital is encouraged which is also evident from the present study. Prevalence of anemia, thrombocytopenia with the risk of infections like malaria and dengue, von Willebrand disease, and trauma among the population nearby have been noted as other conditions worth in-depth study in relation to transfusion practice, in the patients from this area.

What does the study add to the existing knowledge
The highest achievement in this new modern era in the field of Transfusion medicine is the separation of one unit of blood into its various components for the transfusion so that more Blood component transfusions must be encouraged than the whole blood transfusion, to minimize avoidable transfusion reactions, allogeneic sensitization, volume overload and to use one unit of blood to save many lives. This simple study can be done in all the institutions to know the common indications and pattern of usage of blood components of blood transfusion in various geographical areas to promote the economy of voluntarily donated blood to save many lives with one unit of blood.