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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 7  |  Issue : 2  |  Page : 155-158

Utilization of blood and blood components in a Tertiary Care Hospital at Bogura, Bangladesh


Department of Transfusion Medicine, TMSS Medical College, Bogura, Bangladesh

Date of Submission17-May-2022
Date of Decision21-Aug-2022
Date of Acceptance30-Aug-2022
Date of Web Publication5-Nov-2022

Correspondence Address:
Brindaban Biswas
Department of Transfusion Medicine, TMSS Medical College, Bogura
Bangladesh
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/gjtm.gjtm_41_22

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  Abstract 


Background and Objectives: Blood and blood components should be transfused cautiously due to potential risks of various transfusion reactions. It is very important for clinicians to be aware of these potential risks. Great progress had been made in the 20th century, by introducing blood component therapy. Now the term “Rational use of blood” came forward. Hence, indiscriminate use of whole blood (WB) should be avoided or minimized. The aim of our article is to demonstrate and evaluate the quantity and pattern of components used in our hospital. Materials and Methods: A retrospective study was carried out in the Department of Transfusion Medicine at a Medical College Hospital from July 2021 to December 2021. Transfusion details were obtained from blood bank records for each patient. Data of all the used blood and components were evaluated and analyzed. Results: Among the male recipients, the majority was of the age group <10 and >50 years, whereas among females, the majority were of age 21–30 and then >50 years. The majority of used blood units were WB (76.48%) followed by red cell concentrate (22.23%) and then platelet concentrate (0.94%). Fresh frozen plasma and cryoprecipitate were not used. The majority of WB was used in patients of trauma or fracture (17.57%), followed by pregnancy-related cases (17.23%), malignancy (10.20%), kidney diseases (7.43%), and others. Conclusion: The use of WB was the most predominant in spite of prevailing facilities for component preparation in our hospital. Our physicians should be oriented to consider and utilize the advantages of using blood components.

Keywords: Apheresis, blood components, immunomodulation


How to cite this article:
Podder S, Al Masud A, Poly NA, Biswas B, Almannie R. Utilization of blood and blood components in a Tertiary Care Hospital at Bogura, Bangladesh. Glob J Transfus Med 2022;7:155-8

How to cite this URL:
Podder S, Al Masud A, Poly NA, Biswas B, Almannie R. Utilization of blood and blood components in a Tertiary Care Hospital at Bogura, Bangladesh. Glob J Transfus Med [serial online] 2022 [cited 2022 Dec 8];7:155-8. Available from: https://www.gjtmonline.com/text.asp?2022/7/2/155/360484




  Introduction Top


Blood transfusion services play a vital role in managing health-care services and are responsible to provide safe and adequate blood and blood components to patients. There is no substitute for blood, and therefore, transfusion of blood is the mainstay of treatment in different medical and surgical conditions.[1] Blood must be transfused cautiously due to its propensity to cause various transfusion reactions, including the transmission of transfusion-transmissible infections such as Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), syphilis, and malaria, besides immunomodulation in the recipients. It is important for clinicians to be aware of these potential risks to the recipients of blood and appropriate use should be ensured.[2] Periodic review of blood component usage is essential to assess the blood utilization pattern in any hospital.[3]

The first documented animal-to-animal (dog) blood transfusion was performed at Oxford in 1665 by Richard Lower, followed by the first animal-to-human blood transfusion by Jean Denis in 1667. The first human-to-human transfusion was performed by James Blundell in 1818.[4],[5] In the 1950s–1960s, blood component therapy was introduced initially.[2],[4] Great progress has been made in utilizing blood components in recent years. The indiscriminate use of whole blood (WB) is not only wasteful but may also be dangerous through circulatory overloads, unnecessary sensitization by plasma or cellular antigens, and improper selection of anticoagulants.[6],[7]

Aims and objectives

The aim of blood components is to improve quality of care for patients by improving the consistency and appropriateness of transfusion practice, promoting the integration of quality management systems into transfusion practice, reducing the overall number of transfusion-related complications, increasing consumer awareness of the benefits and risks of blood component therapy, and conserving a limited resource.[8] In our country, our clinicians and users of blood are habituated to use WB instead of using specific blood components. A few centers have the facilities to prepare and preserve the various components. Hence, articles and research papers on the use of blood and blood components are very rare. The aim of our article is to demonstrate and evaluate the quantity and pattern of their usage in our hospital in relation to age, sex, and various disease profiles.

The most familiar blood components include red cell concentrate (RCC) or packed RBC (PRBC), platelet-rich plasma, platelet concentrate (PC), fresh plasma, fresh frozen plasma (FFP), and cryoprecipitate (Cryoppt). After the invention of the apheresis machine or cell separator, we can now collect from blood donors the following components: granulocyte concentrate, peripheral blood stem cells, neocytes (young red cells), single donor platelet (SDP), etc., Now the term “Rational use of blood and blood products” implies the use of the right product in the right dose at the right time for the right patient.[7],[9]


  Materials and Methods Top


Study design

A retrospective study was carried out in the Department of Transfusion Medicine in a Medical College Hospital, in Bangladesh from July 2021 to December 2021.

Study subjects

We collected data about all patients who had received blood and its components.

Study methodology

Data were obtained from the request forms and blood bank records for each patient. Only completed blood bank records were included in the study. Data included the age and sex of recipients, name of blood components used, name of diseases requiring transfusion, and other related details.

Statistics

This being a simple study, the frequency of component usage was calculated manually as percentage and proportion.

Ethics

Confidentiality regarding the patient's identity has been maintained throughout the article.


  Results Top


A total of 1480 units of blood and its components were transfused to patients with various diseases in different wards. The majority of blood recipients were of age group greater than 50 years (28%), followed by 21–30 years (19.52%), 31–40 years (14.16%), and below 10 years (13.51%). Among them, 598 (40.41%) were males and 882 (59.59%) were females [Table 1]. Among the male blood recipients, the majority were of age group <10 and >50 years, whereas among females, the majority were of age 21–30 and then >50 years.
Table 1: Distribution of age in relation to gender

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[Table 2] described the distribution of blood and blood components among the recipients. The majority of blood units were WB (76.48%), followed by RCC (22.23%) and PC (0.94%). The use of FFP and Cryoppt was not found in this study period. The majority of blood and blood components (59.59%) were used by female patients, who received WB (46.01%), PRBC/RCCs (12.64%), and PCs only (0.94%).
Table 2: Use of different blood components according to gender

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[Table 3] demonstrated the distribution of blood and blood components to patients with different disease profiles. The majority of WB was used in patients of trauma or fracture (17.57%), followed by pregnancy-related cases (17.23%), malignancy (10.20%), kidney diseases (7.43%), and others. Most of the PRBCs were used in patients of thalassemia (16.48%), followed by malignancy cases (1.01%), chronic kidney diseases (0.81%), and others. Out of only 19 PC units, the majority was used in hepatic disease (0.40%), followed by malignancy, COVID-19 patients, and others. According to the disease profile, users of blood and blood components were highest in patients of thalassemia (21.21%), followed by trauma or fracture patients (18.24%), pregnancy-related cases (17.57%), malignancies (11.55%), and others.
Table 3: Distribution of blood components according to their disease profile

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  Discussion Top


Our study showed that the majority of male blood recipients belonged to two age groups: >50 years (37.46%) and <10 years (20.00%). This may be due to age-specific increments in numbers of geriatric illness and thalassemia, respectively. Female recipients were highest among the 21–30 years (26.87%), followed by the >50 years (22.90%) age group, which may be due to childbirth complications and geriatric illness, respectively. A report from South India showed that RCC requirements in male patients were marginally higher than in females in the 17–40 age groups related to childbirth. However, the use of PC and FFP was higher among younger males.[10]

Our findings revealed that females (59.59%) received the maximum units of blood, and those were WB (76.48%), followed by RCC (22.23%) and PC (0.94%). FFP and Cryoppt, on the other hand, were not used during our study period. Our findings differ from another study in Pakistan, where male patients received more (57.5%) units of blood than females (42.4%).[11]

Our findings revealed that blood and its components were not being used rationally, although the facilities prevailed. Rational use of blood implies that right blood product should be given to the right patient only when needed and in the right amount. One example of rational use of blood components may be a study in South India which showed the use of all components where maximum used components was RCC (50.97%), followed by FFP (25.01%), PC (22.76%), Cryoppt (0.81%), and WB (0.45%).[12] Again a study from India, but from Jaipur, revealed that blood components such as RCC were used in 61%, FFP in 21%, and RDP in 16%, but SDP and Cryoppt were used in 1% and 0.05%, respectively, including WB (0.41%).[1] Another study described that RCC (32.6%) was the maximum utilized product followed by FFP (32.3%), PC (31.2%), and least WB (3.9%).[10] In these studies, WBs were used in minimum percentages, whereas in our study, we used 76.5%.

In Bangladesh, only 17 blood centers produce blood components which convert only 10% of total blood collection into blood components. However, blood components are not so widely practiced in most of the blood centers in Bangladesh, mostly due to the lack of facilities and orientation on rational use of blood and blood components that a 2012 report showed.[13] Currently, nearly 30% of collected blood is separated into RCC components (46%), PC (23%), and FFP (31%).[14]+ An annual national report obtained from the reference laboratory of the Safe Blood Transfusion Program (SBTP), Bangladesh, revealed that total of 174984 units of blood components were prepared all over the country as RCC as the majority components (46.01%), followed by FFP (29.99%), PC (22.69%), and others.[15] In our center, facilities are there for the use of blood components, but demand is rare. In comparison, about 35% of total collected blood is separated into blood components in Nepal,[16] unlike in the developed/high-income countries where it is ~97%.

Usually, the usage pattern of blood components reflects the relative frequency of various diseases condition. We use WB in the majority of patients with trauma/fractures (17.57%), followed by pregnancy issues (17.23%) in malignancies. (For Authors – Discussion abbreviated by editors – There is nothing new in the article – Just being published so that there is some data from Bangladesh for others to refer to).


  Conclusion Top


The study provides information on blood component usage in our tertiary care hospital. In comparison to other studies, the use of blood components here is quite disappointing. The use of WB is predominant here despite facilities for component preparation and preservation. Our clinicians must be encouraged to use blood components through scientific seminars, workshops, and journal presentations.

Acknowledgment

The authors offer sincere thanks to Mr. Salman Ali, assistant supervisor, at Indus hospital blood center for his contribution in this case.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Handa A, Bundas S, Pal A. Utilization pattern of bloods & its components in a tertiary care super specialty hospital. Int J Community Med Public Health 2020;7:4526-9.  Back to cited text no. 1
    
2.
Sharma R, Sanwalka M. Utilization of blood and blood products in a tertiary care hospital-A descriptive cohort study. IP J Diagn Pathol Oncol 2020;5:313-7.  Back to cited text no. 2
    
3.
Gaur DS, Negi G, Chauhan N, Kusum A, Khan S, Pathak VP. Utilization of blood and components in a tertiary care hospital. Indian J Hematol Blood Transfus 2009;25:91-5.  Back to cited text no. 3
    
4.
Rahman M. A Guide to Blood Transfusion. 2nd ed., Ch. III. Anwara Begum, Dhaka; 1998. p. 22-37.  Back to cited text no. 4
    
5.
Arya RC, Wander G, Gupta P. Blood component therapy: Which, when and how much. J Anaesthesiol Clin Pharmacol 2011;27:278-84.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Chowdhury FS, Siddiqui MA, Islam K, Nasreen Z, Begum HA, Begum HA. Use of blood and blood components in Dhaka medical college hospital. Bangladesh J Med 2015;26:18-24.  Back to cited text no. 6
    
7.
Karim S, Hoque E, Hoque MM, Syeda MM, Islam K. Blood component therapy. AKMMC (Anwar Khan Modern Med Coll) J 2018;9:142-7.  Back to cited text no. 7
    
8.
Clinical Practice Guidelines on the Use of Blood Components. A Joint Initiative of the National Health and Medical Research Council and the Australasian Society of Blood Transfusion; 2001.  Back to cited text no. 8
    
9.
Rahman MM, Saha D, Saha S, Alam SM, Giti S. Blood transfusion requests: An audit in a blood transfusion wing of a referral laboratory. JAFMC (Armed Forces Med Coll) 2015;11:3-6.  Back to cited text no. 9
    
10.
Ambroise MM, Ravichandran K, Ramdas A, Sekhar G. A study of blood utilization in a tertiary care hospital in South India. J Nat Sci Biol Med 2015;6:106-10. [doi: 10.4103/0976-9668.149101].  Back to cited text no. 10
    
11.
Nadia A. Utilization of blood and its components at a tertiary care hospital in Pakistan (Abstract). J Blood Disord Transfus 2018;9:32. [doi: 10.4172/2155-9864-C3-037].  Back to cited text no. 11
    
12.
Prakash P, Basavaraj V, Kumar RB. Recipient hemovigilance study in a university teaching hospital of South India: An institutional report for year 2014-2015. Global J Transfus Med AATM 2017;2:124-9.  Back to cited text no. 12
    
13.
WHO. Situation Assessment of Public and Private Blood Centers in Bangladesh. DGHS and MOHFW, Bangladesh in collaboration with the World Health Organization and the OPEC Fund for International Development (OFID). WHO; 2012. p. 44.  Back to cited text no. 13
    
14.
Personal Communication. Prof. Md. Ashadul Islam, Chairman, Dept. of Transfusion Medicine, BSMMU and Vice President, AATM and Gen. Secretary, National Safe Blood Transfusion Expert Committee, Bangladesh.  Back to cited text no. 14
    
15.
SBTP (Safe Blood Transfusion Program), 2021, DGHS, MOHFW, Dhaka, Bangladesh.  Back to cited text no. 15
    
16.
Ghartimagar D. Rational clinical use of blood and blood products – A summary. J Pathol Nepal 2017;7:1111-7.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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