Blood transfusion remains an essential component of modern clinical care and is frequently required for correction of anaemia, restoration of circulating red-cell mass, management of acute blood loss and support during major surgical and critical-care interventions. Despite major advances in transfusion safety, blood remains a biological therapeutic product associated with potential adverse events, resource limitations and substantial costs related to collection, testing, processing, storage and administration1-3. Consequently, transfusion should be based on a clearly established clinical indication, and periodic review of blood utilization is an important component of transfusion-service quality assurance1,2. The increasing demand for blood and blood components has made rational component therapy particularly important. Institutional assessment of utilization patterns can identify areas of excessive demand, facilitate inventory planning and provide information for development of transfusion policies and clinician education2-4. Blood-component utilization varies considerably according to the case mix and specialty profile of an institution. Ishore et al. reported that PRBCs were the most frequently utilized component in a tertiary care hospital in West Bengal, accounting for 42% of component use, followed by FFP and platelets.[5] Mondal et al. similarly observed PRBC predominance, with PRBCs accounting for 54.15% of utilization, followed by FFP at 30.9%.[6] Giridharan et al. reported PRBC utilization of 54%, FFP utilization of 26.8%, whole-blood utilization of 13.5% and platelet utilization of 5.5%.[7] Such differences emphasize that local evaluation is necessary because transfusion demand is strongly influenced by the distribution of medical, surgical, emergency, oncological, renal and critical-care services. Understanding utilization according to diagnosis is equally important. Hospital-based analyses can identify the diseases responsible for the greatest component demand and thereby assist the blood bank in forecasting inventory requirements.[4] Recent studies have also demonstrated substantial specialty-level variation in blood utilization, with medicine, surgery, obstetrics, emergency services and specialized units contributing differently depending on institutional case mix.[5,8-10] OBJECTIVES • To study the distribution of blood request and blood-component utilization across clinical departments. • To determine the most frequent clinical diagnoses and indications associated with transfusion of blood and blood components

This was a prospective observational study conducted in the Department of Immunohematology and Blood Transfusion, Government Medical College Srinagar. The institution is a 1300-bed tertiary care teaching hospital providing multispecialty medical and surgical services to the population of Kashmir. The study was conducted over 24 months, from January 2024 to December 2025. All requests for blood and blood components received by the blood bank during the study period from inpatient wards, operation theatres, intensive care units, emergency departments, outpatient treatment areas and clinical departments of GMC Srinagar and its associated hospitals were eligible for inclusion. Incomplete blood-request forms were excluded. Data were obtained from blood-bank records, transfusion issue registers, component issue registers and the Hospital Information System/electronic medical records. For the present manuscript, variables relevant to the clinical-utilization objectives were extracted, including component type, blood group, hospital and clinical department, clinical diagnosis and stated indication for transfusion. Component preparation was also described to provide an overview of the blood-bank workload. The available study dataset consisted primarily of aggregated frequency counts. Therefore, results were summarized using descriptive statistics as frequencies and percentages. No inferential statistical test or statistical software was specified in the source material for these utilization-pattern analyses.

During the study period, 26,584 whole-blood donations were recorded. Component separation yielded 63,666 blood components, comprising 25,918 PRBC units, 25,806 FFP units, 11,276 RDP units and 666 whole-blood units. PRBCs and FFP together constituted more than four-fifths of all components prepared. Table 1: Blood components prepared during the study period Blood component Units prepared Percentage (%) Packed red blood cells (PRBC) 25,918 40.7 Fresh frozen plasma (FFP) 25,806 40.5 Random donor platelets (RDP) 11,276 17.7 Whole blood (WB) 666 1.1 Total 63,666 100.0 PRBCs constituted the largest proportion of prepared components, closely followed by FFP. Whole blood accounted for only 1.1% of the total, demonstrating the predominance of component preparation over whole-blood availability. The table-derived total of 63,666 was used because it is internally consistent with the component counts; the source narrative elsewhere reports 63,660. Overall clinical utilization A total of 46,888 clinically utilized component units were recorded in the diagnosis- and hospital-based utilization tables. PRBCs accounted for 25,219 units (53.8%), FFP for 13,495 (28.8%), RDPs for 8,012 (17.1%) and SDAPs for 162 (0.3%). Table 2: Overall clinically utilized blood components Component Units utilized Percentage (%) PRBC 25,219 53.8 FFP 13,495 28.8 RDP 8,012 17.1 SDAP 162 0.3 Total 46,888 100.0 Figure 1: Overall clinical utilization of blood components during the study period. Diagnosis-wise utilization Diseases of the digestive system constituted the largest diagnostic category, accounting for 10,412 units (22.2%), followed closely by injury, poisoning and external injury with 10,192 units (21.7%). Genitourinary diseases accounted for 6,180 units (13.2%), while neoplasms and critical-care conditions accounted for 4,106 and 3,713 units, respectively. Table 3: Blood-component utilization according to clinical diagnosis Clinical diagnosis/category PRBC FFP RDP SDAP Total Infection 839 383 574 47 1,843 Neoplasm 2,888 325 857 36 4,106 Diseases of blood and blood-forming organs 1,165 338 139 3 1,645 Endocrine, metabolic and nutritional diseases 3,093 0 2 0 3,095 Mental and behavioural disorders 2 0 0 0 2 Diseases of nervous system 861 694 526 5 2,086 Diseases of eye 3 0 0 0 3 ENT diseases 171 0 45 0 216 Respiratory diseases 159 99 55 3 316 Diseases of digestive system 5,092 3,947 1,358 15 10,412 Skin and subcutaneous diseases 315 85 24 0 424 Musculoskeletal diseases 98 17 89 0 204 Genitourinary diseases 3,683 2,214 276 7 6,180 Circulatory diseases 267 102 42 2 413 Pregnancy, childbirth and puerperium 40 81 238 1 360 Perinatal conditions 35 61 478 0 574 Critical care 1,489 1,215 1,005 4 3,713 Injury, poisoning and external injury 4,233 3,744 2,187 28 10,192 Reconstructive procedures 136 89 29 0 254 PNH and other hospitals* 650 101 88 11 850 Total 25,219 13,495 8,012 162 46,888 *PNH and other hospitals is retained as recorded in the source table, although it represents a referral/location category rather than a disease diagnosis. Digestive diseases and injury/poisoning together accounted for approximately 44% of diagnosis-classified component utilization. Both categories required substantial PRBC and FFP support. Genitourinary disease was the third largest diagnostic group, predominantly requiring PRBCs and FFP. Neoplasms showed substantial PRBC and platelet use, while critical-care cases required all three major components. Indication-wise utilization The indication-based analysis contained 53,382 component-use entries. The higher total compared with the 46,888 hospital/diagnosis-classified clinical units reflects inclusion of 6,494 FFP units used for plasma fractionation in the indication table. Correction of laboratory abnormalities involving haemoglobin, INR or platelet count was the most frequent indication, accounting for 18,039 entries (33.8%), followed by intraoperative use (11,679; 21.9%), active bleeding (10,281; 19.3%) and postoperative use (6,185; 11.6%). Table 4: Indication-wise utilization of blood and blood components Indication Units/entries Percentage (%) Hb/INR/platelet-count based indication 18,039 33.8 Active bleeding 10,281 19.3 Intraoperative 11,679 21.9 Postoperative 6,185 11.6 Plasmapheresis/RF/PLEX 704 1.3 Plasma fractionation 6,494 12.2 Total 53,382 100.0 Laboratory-guided correction constituted approximately one-third of all recorded indications. Active bleeding together with intraoperative and postoperative requirements accounted for 28,145 entries, demonstrating the substantial contribution of emergency and perioperative transfusion support. Hospital-wise utilization SMHS Hospital was the principal consumer of blood components, accounting for 31,729 of 46,888 units (67.7%). The Super Specialty Hospital accounted for 12,853 units (27.4%), SMHS-associated hospitals for 1,456 units (3.1%), and private nursing homes/other institutions for 850 units (1.8%). Table 5: Hospital-wise distribution of clinically utilized blood components Hospital PRBC FFP RDP SDAP Total Percent SMHS Hospital 16,285 9,718 5,621 105 31,729 67.7 SMHS & associated hospitals 334 260 840 22 1,456 3.1 Super Specialty Hospital 7,950 3,416 1,463 24 12,853 27.4 PNH & others 650 101 88 11 850 1.8 Total 25,219 13,495 8,012 162 46,888 100.0 Within the SMHS cluster, Medical Emergency was the largest PRBC-consuming department (5,323 units), followed by Medicine (4,594), Surgery (1,950) and Radiation Oncology (1,617). Surgery showed particularly high FFP utilization (2,874 units), while Medicine was the largest RDP user (1,987 units). At the Super Specialty Hospital, Nephrology was the largest overall consumer, using 4,042 units, followed by Surgical Gastroenterology, Clinical Haematology and Medical Oncology. These patterns demonstrate that transfusion demand was distributed across both acute emergency services and chronic high-intensity specialties.

The present study provides a large two-year assessment of blood-component utilization in a tertiary care hospital system. The principal finding was the clear predominance of component therapy, with PRBCs forming the largest proportion of clinically utilized blood products. Among 46,888 diagnosis- and hospital-classified component units, PRBCs accounted for 53.8%, followed by FFP at 28.8%, RDP at 17.1% and SDAP at 0.3%. The predominance of PRBC transfusion is consistent with several hospital-based studies. Mondal et al. reported that PRBCs constituted 54.15% of blood-component utilization, a proportion remarkably similar to the 53.8% observed in the present study.[6] Giridharan et al. also reported PRBC utilization of 54%7. In comparison, Ishore et al. reported a somewhat lower PRBC contribution of 42%5. These observations confirm that red-cell support generally constitutes the largest component of transfusion workload, although its relative contribution varies according to institutional case mix. FFP accounted for 28.8% of clinically utilized components in the present analysis. This proportion lies between that reported by Ishore et al. (24%) and Mondal et al. (30.9%), and is close to the 26.8% reported by Giridharan et al.5-7. The comparatively high use of FFP in the present institution is compatible with the substantial burden of digestive disorders, trauma, major surgical care and critical illness, all of which contribute to plasma requirements. RDPs accounted for 17.1% of clinically used components. This was higher than the 7.45% reported by Mondal et al. and the 5.5% reported by Giridharan et al., but lower than the 23% platelet utilization described by Ishore et al.5-7. Differences between centres may reflect variation in the relative volume of oncology, haematology, infection-related thrombocytopenia, critical care and high-risk surgical services. The diagnosis-wise findings provide important information for inventory planning. Diseases of the digestive system were responsible for the greatest utilization, accounting for 10,412 units, followed closely by injury, poisoning and external causes with 10,192 units. Genitourinary diseases constituted the third largest category. Hospital-based analyses have similarly demonstrated that the distribution of blood use according to diagnosis varies substantially between institutions, making local diagnosis-based analysis valuable for forecasting and resource allocation.[4] The indication-based analysis demonstrated that laboratory-guided indications involving haemoglobin, INR or platelet count were the most frequent recorded reason for component use, accounting for 33.8% of entries. However, intraoperative use, active bleeding and postoperative use together represented a substantial proportion of utilization. These findings illustrate that transfusion support within a large tertiary institution serves both correction of haematological or coagulation abnormalities and management of acute or perioperative blood loss. Other Indian studies have demonstrated substantial variation in the clinical circumstances leading to transfusion. Ishore et al. identified pregnancy/childbirth-related conditions and elective surgery as major indications in their hospital population5. Nayan et al., studying obstetric transfusion specifically, found postpartum haemorrhage, placental abruption and placenta previa to be prominent transfusion scenarios10. Kaur et al. reported perioperative blood loss and anaemia as leading indications for PRBC utilization in their audit9. The differing patterns reinforce the importance of interpreting transfusion utilization in the context of institutional specialty composition rather than applying a uniform expected pattern across hospitals. The hospital-wise analysis further supports this concept. SMHS Hospital accounted for more than two-thirds of clinically utilized components, reflecting its high-volume emergency, medical and surgical workload. Medical Emergency was the largest PRBC consumer, while Medicine required large quantities of PRBCs, FFP and platelets. In contrast, at the Super Specialty Hospital, Nephrology represented the largest overall user. Ishore et al. also reported Medicine as an important source of blood requisition5, whereas Kaur et al. found that surgical specialties generated 67% of PRBC requisitions in their institution9. These contrasts illustrate the strong effect of institutional case mix on transfusion demand. Another important observation was the limited role of whole blood in component preparation, accounting for only 1.1% of components recorded in the preparation table. Earlier hospital audits have reported greater whole-blood utilization; for example, Mondal et al. reported 7.45% and Giridharan et al. 13.5%.6,7 The current pattern therefore reflects a predominantly component-oriented transfusion service. Overall, the findings indicate that transfusion demand at this tertiary-care centre is broad but concentrated in predictable high-use services. PRBCs remain the principal therapeutic component, while FFP and platelets contribute substantially to the transfusion burden. Digestive diseases, trauma-related conditions and genitourinary diseases are major diagnostic drivers, whereas laboratory-guided correction, operative requirements and active bleeding are the principal recorded indications. Such information can assist in demand forecasting, blood-bank inventory planning and development of specialty-specific transfusion policies. Limitations The study was observational and relied on blood-bank and hospital records. Incomplete request forms were excluded, and the available aggregate dataset limits assessment of patient-level outcomes. The source data also contain a small inconsistency in the reported total number of prepared components, with the narrative reporting 63,660 and the component tables summing to 63,666; the table-derived total of 63,666 has therefore been used transparently in this manuscript. Patient-level demographic and outcome analyses were not sufficiently presented in the source dataset to be incorporated into this paper.

Blood utilization in this tertiary-care teaching hospital was predominantly component based, with PRBCs representing more than half of clinically utilized components, followed by FFP and platelets. Transfusion demand was concentrated in high-volume acute and specialty services, particularly Medical Emergency, Medicine, Surgery, Nephrology, Oncology and critical-care units. Diseases of the digestive system and trauma-related conditions together accounted for almost half of diagnosis-classified blood-component utilization, while genitourinary disease represented another major source of demand. Laboratory-guided correction of haemoglobin, INR or platelet abnormalities was the most frequent recorded indication, although intraoperative requirements and active bleeding also contributed substantially. Periodic analysis of component-, diagnosis-, indication- and department-specific utilization can provide valuable information for blood-bank inventory planning, anticipation of high-demand clinical areas and development of institutional transfusion strategies.

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