A retrospective analysis of blood requisition versus utilization practices at national blood bank, jigme dorji wangchuck national referral hospital, Thimphu, Bhutan

Abstract

Background and Objectives: Although National Guidelines on Clinical Use of Blood has been developed, it is a common practice to order blood based on the subjective anticipation of blood loss, instead of evidence-based requirement at National Referral Hospital, Thimphu. However, National Blood Bank follows the maximum surgical blood ordering schedule, thereby saving the resources and making blood available for emergency patients. Nonetheless, the need-based assessment is not conducted to determine the efficacy of the practice. This study aimed to assess the effectiveness of the current practice of following the national guidelines on maximum surgical ordering of blood by evaluating the blood requisition versus utilization practice. Materials and Methods: A hospital-based retrospective study was conducted at national blood bank over a 1-year period (January–December 2018). Demographic data, such as age and sex, and clinical wards with maximum transfusion done were recorded. Blood utilization indices were computed for cross-match-to-transfusion ratio (C:T, <2.5), transfusion index (TI, >0.5) and transfusion probability (%T, >30) to indicate significant blood usage. All data were processed and analyzed with software programs Microsoft Excel 2013 and GraphPad Prism (v 7.04). Results: Of 4012 blood units cross-matched, 3205 blood units were transfused to patients (C:T ratio 1). Majority (65.33%) of the patients were females and 34.66% were males. The overall TI was 1.49 and %T was 73.07%, implying significant blood usage. The maximum request for blood was made from gynecological and obstetrics ward, emergency, and daycare blood transfusion unit. Similarly, the patients transfused with the cross-matched units were also found to be highest for these wards. Conclusion: The study demonstrates that the current practice of maximum blood ordering schedule is effective in saving valuable time and resources. However, there is a need to sensitize the requesting physician on rational order for effective management of the blood inventory.