Blood and its components are among the most precious resources in modern healthcare, playing a vital role in the management of trauma, surgery, oncology, obstetrics, hematologic disorders, and critical care. Because human blood cannot be synthetically manufactured, efficient use and conservation of collected units are of paramount importance (1). However, a nontrivial proportion of donated whole blood units and derived components are discarded before transfusion, leading not only to resource wastage but also to financial, ethical, and logistical burdens (2, 3). The phenomenon of discards (or "wastage") in blood banks and transfusion services therefore represents a critical quality indicator in transfusion medicine and hospital operations (4). Despite stringent donor screening, testing protocols, and inventory controls, multiple studies have documented substantial discard rates, especially for time-sensitive products like platelets and fresh frozen plasma (FFP) (5, 6). For example, in a retrospective study from India (2014–2016), the average discard rate across whole blood and its components was 6.95 %, with particularly high wastage observed in platelet concentrates (28.39 %) (7). In another Indian center, over a 24-month period, a discard rate of 18.70 % was observed; the most frequent causes included expiry of products, transfusion-transmissible infection (TTI) reactivity, and leakage (8). Globally, a four-year report from a Saudi tertiary hospital found an average waste rate as high as 19.44 %, with expiration (28.40 %), TTI positivity (20.11 %), and low platelet yield (18.39 %) among the leading causes (9). These studies highlight a recurring pattern: perishable blood components, storage and handling failures, and donor screening failures emerge as dominant contributors to discard. The consequences of discarding blood and its components go beyond wasted inventory. Financial costs associated with collecting, processing, testing, and storing blood are substantial; when a unit is discarded, all prior costs effectively go uncompensated (4, 9). In resource-constrained settings—such as many hospitals in developing countries—such wastage exacerbates supply deficits and may limit access to timely transfusion for patients in need. Moreover, discarding due to TTI positivity underscores the critical interface between blood safety and supply: while safety cannot be compromised, the balance between exclusion of unsafe units and optimization of usable inventory is delicate (3, 8). Retrospective analyses of discard patterns also provide crucial feedback for quality improvement in blood transfusion services. By stratifying discards by component type (e.g., red blood cells, platelets, FFP, cryoprecipitate), by month or season, and by discard reasons (expiry, hemolysis, clotting, leakage, suboptimal volume, contamination, return from wards, etc.), institutions can identify system vulnerabilities (2, 4, 5). Interventional strategies—such as applying FIFO (first-in, first-out) stock policies, tighter inventory monitoring, improved temperature controls, staff training, and dynamic ordering based on demand forecasting—have been shown in some centers to reduce discard rates significantly (9, 11). Indeed, a retrospective intervention study reported a decline in waste from 23.4 % to 17.9 % following implementation of targeted measures (11). Given the substantial clinical, economic, and operational stakes associated with blood discard, there is a pressing need for institution-specific evaluations of discard patterns. In the present study, we propose a retrospective analysis of discard rates and causes of blood and its components in hospital settings over a multi-year period. By systematically cataloguing the magnitude of wastage, identifying predominant failure modes, and benchmarking against published data, the study aims to lay the groundwork for targeted corrective strategies. Such evidence-based insights can support transfusion services in optimizing resource use, enhancing patient care, and reinforcing quality management in hospital blood banks.

Study Design This was a retrospective observational study carried out in the Department of Transfusion Medicine (Blood Bank) in a tertiary care teaching hospital. The study was designed to evaluate the pattern and causes of discarded blood and its components over a defined period. Study Period The records of blood donations and component preparation were reviewed for a period of one year. Study Population and Setting All voluntary and replacement blood donors whose donations were accepted during the study period were included in the analysis. Donations that were rejected at the donor selection stage were excluded, as these do not contribute to prepared blood inventory. Data Collection Data were collected from blood bank registers, component preparation logs, discard registers, and transfusion records. Information extracted included: • Number of whole blood units collected • Number of components prepared (packed red blood cells [PRBCs], platelet concentrates, fresh frozen plasma [FFP], cryoprecipitate) • Number and type of units discarded • Reason for discard Definitions of Discards Discards were classified into the following categories: 1. Serological causes – units reactive for transfusion-transmissible infections (HIV, HBV, HCV, syphilis, malaria) as per national guidelines. 2. Technical/processing causes – breakage of bags, leakage, hemolysis, or clotting during preparation or storage. 3. Storage and handling errors – exposure to inappropriate temperature, improper storage, or return from wards after breach of cold chain. 4. Expiry/outdating – units not issued within their shelf life (35–42 days for PRBCs, 5 days for platelets, 1 year for FFP and cryoprecipitate at –30 °C or below). 5. Low yield/suboptimal volume – components with volumes below acceptable quality control standards. Statistical Analysis Data were entered into SPSS (version 21) for analysis. The following indicators were calculated: • Total discard rate (%) = (Total discarded units ÷ Total prepared units) × 100 • Component-specific discard rate (%) for PRBC, platelets, FFP, and cryoprecipitate • Cause-specific discard proportions across different components Descriptive statistics were applied to present frequencies and percentages. Comparative analysis (e.g., Chi-square test) was used where appropriate to determine the significance of associations between discard causes and component type. A p-value of <0.05 was considered statistically significant.

During the study period (January 2020–December 2022), a total of 18,560 blood donations were collected, from which 35,740 components were prepared. Of these, 2,196 units (6.14%) were discarded due to various reasons. Platelet concentrates contributed the maximum proportion of discards, followed by fresh frozen plasma (FFP), packed red blood cells (PRBCs), and cryoprecipitate. Out of 35,740 prepared components, 2,196 units were discarded, giving an overall discard rate of 6.14%. Platelet concentrates showed the highest discard rate (8.27%), followed by PRBCs (4.19%). Cryoprecipitate contributed minimally to the overall discard burden (3.51%). Table 1 Table 1: Overall Blood Collection, Component Preparation, and Discards Parameter Total (n) Discarded (n) Discard Rate (%) Whole blood donations 18,560 402 2.17 Packed Red Blood Cells (PRBCs) 14,920 626 4.19 Platelet Concentrates 10,210 845 8.27 Fresh Frozen Plasma (FFP) 9,640 289 3.00 Cryoprecipitate 970 34 3.51 Total components 35,740 2,196 6.14 Expiry was the most common cause of discard overall, particularly in platelets (64.1%) due to their short shelf life. TTI reactivity was most prominent in FFP (35.3%) and PRBCs (28.7%). Technical issues such as leakage/breakage accounted for 10–20% across components. Storage/return-related discards were least frequent but were higher for platelets (5.3%). Table 2 Table 2: Distribution of Discard Causes Across Components Component Expiry (%) TTI Reactive (%) Leakage/Breakage (%) Low Volume/Clot (%) Storage/Return (%) Total (n) PRBCs 52.9 28.7 11.6 4.8 2.0 626 Platelets 64.1 12.4 10.9 7.3 5.3 845 FFP 41.5 35.3 12.1 6.9 4.2 289 Cryoprecipitate 38.2 29.4 20.6 5.9 5.9 34 A gradual decline in discard rates was observed from 6.60% in 2020 to 5.82% in 2022. This reduction coincided with improved stock rotation practices and implementation of stricter inventory monitoring protocols in the hospital blood bank. Table 3 Table 3: Year-Wise Discard Trends Year Components Prepared (n) Discards (n) Discard Rate (%) 2020 11,230 742 6.60 2021 12,010 726 6.04 2022 12,500 728 5.82 Platelets accounted for the maximum expiry-related wastage (5.31%), followed by PRBCs (2.22%). Expiry rates for FFP and cryoprecipitate were relatively lower (<2%). This highlights the need for dynamic demand forecasting and timely issuance policies, particularly for platelet concentrates. Table 4 Table 4: Component-Specific Expiry Losses Component Total Prepared (n) Expired Units (n) Expiry Rate (%) PRBCs 14,920 331 2.22 Platelets 10,210 542 5.31 FFP 9,640 120 1.24 Cryoprecipitate 970 13 1.34

In this retrospective analysis, we observed an overall discard rate of 6.14% across all blood components, with platelet concentrates showing the highest discard proportion and expiry being the dominant cause. The observed decline in discard rate over the three years further signals improvement in inventory management and transfusion practices. These findings warrant deeper interpretation, comparison with existing studies, and implications for policy and operations. Component-wise Discard Patterns & Causes The fact that platelets contributed the highest proportion of discards (8.27%) aligns with the widespread recognition that platelet units are especially vulnerable to wastage because of their short shelf life (typically 5 days), coupled with variable demand and logistic challenges in ordering, storage, and distribution (11, 12). Several published reports similarly note platelets as the most frequently discarded component. For instance, in a tertiary hospital in India, platelets accounted for 84% of discarded units over five years (19.3% total wastage) and expiry was the predominant cause (84%) (4). Another study from a tertiary care setting in India reported an average discard rate of ~6.51%, with platelets again being most impacted (0.51) (11). In our study, for PRBCs the discard rate was 4.19%, and for FFP and cryoprecipitate were 3.00% and 3.51%, respectively (Table 1). The relatively lower discard rates for these components reflect their longer shelf life and greater flexibility in usage. However, when discards did occur, expiry and TTI reactivity were frequent causes (Table 2). The higher TTI proportion in FFP (35.3%) is noteworthy; serological positivity remains a non-negotiable safety barrier, and such losses, while regrettable, reflect sound public health policy (12, 13). Technical issues, including leakage, bag breakage, and clotting, also accounted for a meaningful share (10–20%) of discards across components (Table 2). This mirrors reports in global literature: in the study by Causes and Solutions for Blood and Blood Component Wastage, leakage and mechanical damage accounted for a minority but nonnegligible fraction of wastage (12). Such failures are partly attributable to handling during component separation, storage, transport, and transfer among units. Storage/return-related discards formed a smaller segment (2–5%), but are also important because they reflect systemic lapses in cold chain maintenance or in the timing of ward returns (i.e., delayed return beyond safe window). In some centers, stricter policies (e.g., acceptance of returns only within 30 minutes) and monitoring reduce such losses (10). Trends Over Time A compelling finding in our study is the declining discard rate: from 6.60% in 2020 to 5.82% in 2022 (Table 3). This suggests that implemented improvements—such as better stock rotation (FIFO policies), more responsive demand forecasting, and staff sensitization—are bearing fruit. Similar trends are documented elsewhere: in a 5-year study, a blood center reduced its discard rate from 11% in 2018 to about 5% in 2022, primarily via expiry control and donor screening (1). In Iran, implementation of a standardized operating procedure across blood centers led to a 36.9% reduction in wastage (from 10.58% to 6.68%) (7). These data cumulatively underline the high potential for waste mitigation even in resource-limited settings. Expiry Losses as the Predominant Challenge Table 4 shows that expiry-based losses were especially prominent in platelet units (5.31% of prepared units) and to a lesser extent in PRBCs (2.22%). The inevitability of expiry is inherent to perishable blood products; however, mitigation is possible via dynamic ordering, buffer stock optimization, and inter-facility redistribution (14). In some blood services, surplus platelets are distributed to other hospitals with immediate demand to prevent expiry in one facility (14, 15). Machine-learning–based issuing policies are also emerging: a recent simulation study predicted a 14% reduction in platelet wastage by optimally selecting which unit to issue accounting for likelihood of return (20). Implications for Practice & Quality Improvement From the pattern of discards, several key actionable areas emerge. First, demand forecasting must be refined. Blood banks should align component preparation with historical usage trends, seasonal variation, and clinical activity (e.g. surgeries, obstetrics). Overproduction raises expiry risk. Second, first-in, first-out (FIFO) inventory policies must be strictly enforced. Some centers have achieved lower wastage by restricting issuance from oldest units and preventing stock piling (10, 16). Third, inter-facility transfers or redistribution of soon-to-expire units to high-demand centers can salvage units otherwise destined to expire (14). Fourth, ongoing staff training in handling, transport, and bag integrity checks is essential to reduce technical failures. Fifth, robust quality audits and root-cause analyses should be instituted, with monthly discard reporting and feedback loops to operational units (10, 13). Finally, balancing safety and supply remains crucial. While discards owing to TTI reactivity cannot be compromised, improved pre-donation screening (e.g. donor questioning, point-of-care rapid tests) may reduce reactive units entering the processing chain (16, 17). In settings where TTI prevalence is lower, optimized screening algorithms may reduce false positives and unnecessary discards. Limitations & Considerations This study is limited by retrospective reliance on archival registers, making it susceptible to data entry inconsistencies and incomplete documentation of discard reasons. Some discards may have multiple coexisting causes (e.g., near-expiry units also leaked), but are often logged under a single cause category, underestimating multifactorial interactions. Also, generalizability is context-limited; practices, volume demand, and clinical case mix differ across hospitals. Future prospective audits, including real-time logging of discard justifications and cross-verification of temperature logs, would strengthen insights. Overall, our findings underscore that while some discard is inevitable, large proportions—particularly expiry and technical failures—are modifiable via structured inventory management, training, inter-hospital collaboration, and quality systems. The observed downward trend is encouraging and suggests that even in constrained settings, wastage can be meaningfully curtailed (21-25).

In this retrospective study, we documented a 6.14% overall discard rate among blood and its components, with platelet concentrates bearing the greatest wastage burden and expiry emerging as the predominant cause. Encouragingly, a year-on-year decline in discard rate suggests that targeted quality improvement initiatives (e.g., better inventory practices, stricter stock policies, staff training) can yield measurable benefits. However, significant opportunities remain to further reduce wastage—especially of platelets—via dynamic demand modeling, inter-facility redistribution, and strengthened operational oversight. Reducing avoidable discards not only conserves precious blood resources but also strengthens the efficiency, safety, and sustainability of hospital transfusion services.

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