Official Journal of
the British Blood Transfusion Society
Transfusion Medicine | ORIGINAL ARTICLE
Blood wastage management in a regional blood transfusion
centre
H. Javadzadeh Shahshahani & N. Taghvai
Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
Received 23 September 2016; accepted for publication 21 May 2017
SUMMARY
Objectives: The aim of this study was to determine the rate of
blood component wastage before and after interventions at Yazd
Blood Transfusion Center.
Background: The growing need for blood components along
with blood safety issues and rising costs constantly pressurise
blood centres to improve their efficiency. Reducing the quantity
of discarded blood at all stages of the supply chain can decrease
the total costs.
Methods: Data on discarded blood components were extracted
from the database of Yazd Blood Transfusion Center. Multi-
ple interventions, including implementation of wastage manage-
ment standard operating procedures and reduction of red blood
cells (RBCs) inventory level, were implemented. Discard rates of
blood components in the 3 years after intervention (2013–2015)
were compared with the discard rates in the 3 years before inter-
ventions.
Results: The total wastage rate of blood components decreased
by almost 60%. Discard rates of RBCs, platelets and plasma
decreased from 9·7%, 18·5% and 5·4% to 2·9%, 10·5% and 2·3%,
(P < 0·001) after intervention, respectively. The most prevalent
reason for discarding units was expiration of RBCs and platelets.
Plasma units were discarded mostly due to technical faults dur-
ing processing. The cost saving of reduction in blood wastage was
estimated to be 1,500,000 dollars.
Conclusion: Interventions had a significant impact on the
reduction of blood wastage with respect to both cost and blood
supply saving.
Key words: blood transfusion, blood components, wastage.
INTRODUCTION
The main aim of blood centres worldwide is the provision of
safe and sufficient blood and blood components. Safe blood and
Correspondence: Hayedeh Javadzadeh Shahshahani, Yazd Blood
Transfusion Center, Abuzar Square, Yazd 8915913971, Iran.
Tel.: +98 3538247427; fax: +98 3538247417; e-mail:
hjavadzadeh@yazdbto.ir
First published online 29 June 2017
doi: 10.1111/tme.12433
blood components are the most important parts of patient care
systems of all countries and depend on the generosity of donors
and government support for finance of blood collection, produc-
tion of blood components, laboratory investigations and storage
and distribution of blood and blood components (Veihola et al.,
2008; National Blood Authority, 2013; Bots et al., 2016).
The yearly cost of blood components in Iran is ∼500 mil-
lion dollars, and with the ever-growing need for higher safety
levels of blood supply, this figure is constantly on the rise. It
is therefore necessary to increase the efficiency of blood sup-
ply along with the reduction in inappropriate use of blood in
order to overcome the pressures of increasing costs of blood
(Veihola et al., 2006; Collins et al., 2015). Accordingly, two basic
pathways should be the top priority: the first half of the blood
chain from blood collection to blood distribution in blood trans-
fusion centres and reducing the blood discard rate and patient
blood management in healthcare centres (Heitmiller et al., 2010;
Zoric et al., 2013; Yazer et al., 2016). Increased efficiency at blood
transfusion centres, together with management of blood usage at
hospitals, leads to decreased costs and prevention of wastage of
national resources (Morish et al., 2012). The Blood Transfusion
Organization of Iran, with its branches in all of the provinces of
the country, is the sole agency responsible for the supply of blood
and blood components. However, it has no involvement in the
second part of the chain in hospitals (Javadzadeh Shahshahani
et al., 2015; Pourfathollah et al., 2015).
A few studies on blood components wastage in blood centres
have been published in different countries (Kajja et al., 2010;
Baesler et al., 2014). Blood wastage rates range from 0·2 to 30%
in different studies depending on the type of blood component
level (Veihola et al., 2008). However, there has been no study to
date on blood wastage management in Iranian blood transfusion
centres. The present paper aimed to investigate the blood wastage
levels at the Blood Transfusion Center of Yazd province in Iran.
Several interventions were also implemented in order to reduce
wastage to an acceptable.
MATERIALS AND METHODS
In this interventional study, the baseline levels of blood com-
ponent wastages in the donation, processing, laboratory and
© 2017 British Blood Transfusion Society

distribution departments of Yazd Blood Transfusion Center
from the beginning of 2010 to the end of 2012 were obtained.
Data collection
Data related to discarded blood components were collected and
analysed. Blood component wastage was defined as components
that did not meet the required standards of hospitals or fraction-
ation centres during collection, processing and storage. The main
reasons included expiry date, inappropriate volume, haemolysis
of red blood cells (RBCs), contamination of plasma or platelets
with RBCs, blood bag leakage, reactive infectious disease tests
and inappropriate temperature during storage or transportation.
Blood component wastage ratio was calculated by dividing the
number of wasted RBCs, platelet (PLT) or plasma units by the
number of the same components produced that year. Moreover,
total wastage ratio was calculated by dividing the total wastage
of RBCs, PLT and plasma units by the number of total produced
components.
Intervention
A series of interventions were implemented to reduce the blood
component wastage level beginning in 2013 (Box 1). The impact
of these interventions was evaluated from 2013 to the end of
2015.
Statistical analysis
Data were extracted from integrated Software of Yazd Blood
Transfusion Center and analysed based on descriptive statistics.
The McNemar test was used to determine if there were differ-
ences on the proportion of blood component wastage before and
after intervention. The McNemar test assesses the significance
of the difference between two correlated proportions. Data were
analysed using spss 17.5 software (IBM Corporation, New York,
NY, USA).
This research project was approved by the Hematology
Research Center of Shahid Sadoughi University of Medical
Sciences.
RESULTS
The total number of blood components prepared or wasted
from 2010 to 2015 were described (Fig. 1). The blood compo-
nent wastage rate as a percentage of the number of units pre-
pared showed an ascending trend from 2010 to 2012, whereas
it descended from 2013 to 2015. Despite a 2–4% increase
in the production of blood components in 2014–2015, the
total wastage rate decreased from 5·7% to 2·1%. The total
amount of wastage prior to intervention was 31 248 units, and
it decreased to 13 270 units after intervention (57% reduction in
total wastage).
Wastage of blood components was significantly reduced after
intervention (RBCs: from 9·7 to 2·9%, PLT: from 18·5 to 10·6%,
© 2017 British Blood Transfusion Society
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Blood wastage management in blood centre 349
INTERVENTIONS
The objective of reducing wastage was started with plans in
2013 with a series of quantitative objectives.
(1) The optimal inventory level for RBCs was
re-evaluated such that the inventory was reduced to
7 days of hospital requirement.
(2) Standard operating procedure (SOP) was prepared
for blood wastage management:
(a) Blood donor recruitment and blood collec-
tion was adjusted on the basis of demand
from hospitals rather than the annual
increase of blood collection rate of the
previous years.
(b) Daily monitoring of inventory was planned
to reduce blood donor recruitment and
mobile teams at the time of sufficient inven-
tory levels.
(c) Calibrated and validated equipment was
used for storage of blood components that
was equipped with electronic temperature
monitoring and alarm system linked to
the monitoring system with audible alarm,
together with automatic SMS text warnings
to key personnel.
(3) Continual educational programmes were intro-
duced to improve performance of staff to minimise
technical faults leading to wastage of blood com-
ponents. These training courses included standard
methods of blood collection, processing, transporta-
tion and storage based on Standard Operational
Procedures of Iranian Blood Transfusion Organiza-
tion (IBTO).
(4) A special focus was placed on optimising
dispatching:
(a) Dispatching according to the expiry date
of blood components to prevent expired
components during storage.
(b) Training sessions for staff of distribution
department, especially for staff working in
the evening, night and weekend shifts.
(c) Dispatching surplus blood components to
blood centres in other provinces that had
lower levels.
(5) Regular monitoring of blood components wastage.
In cases of non-conformity, the root causes were
found and corrective actions performed if needed.
plasma: from 5·4 to 2·3%) (McNemar Test, P < 0·001). The high-
est wastage rate was seen in PLTs, followed by RBCs. The lowest
wastage rate was related to plasma units. RBCs showed the high-
est reduction of wastage rate after intervention.
The reasons for blood component wastage in post-
intervention years were compared with pre-intervention years
Transfusion Medicine, 2017, 27, 348–353
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350 H. Javadzadeh Shahshahani and N. Taghvai

Fig. 1. Frequency of total blood components prepared and wasted from 2010 to 2015. The total number of blood components prepared or wasted from
2010 to 2015. The blood component wastage rate as a percentage of the number of units prepared showed an ascending trend from 2010 to 2012, whereas
it descended from 2013 to 2015. Despite a 2–4% increase in the production of blood components in 2014–2015, the total wastage rate decreased from
5·7% to 2·1%. The total amount of wastage prior to the intervention was 31 248 U, and it decreased to 13 270 U after intervention.

(Fig. 2). Expired units were defined as blood components that Table 1. Frequency of blood components issued to the hospitals in
were expired in the blood transfusion centre before delivery to comparison to the components requested by hospitals in the
pre-intervention and post-intervention years
hospitals. Causes of preparation wastage included conditions in
which the standard requirements during component processing Blood components No. of units requested No. of units issued (%)
were not met. These included inappropriate volume, abnormal
colour of the component, contamination with RBCs, rupture or Pre-intervention
leakage of blood bags and so on. Reactive test results for infec- RBCs 98 459 93 854 (95·3)
tious diseases and inappropriate temperature during storage Platelet 61 787 49 281 (79·8)
Plasma 37 129 34 874 (93·9)
or transport were also reasons for component wastage. Other
Post-intervention
reasons included withdrawing of components due to donor call
RBCs 102 995 102 131 (99·2)
back, look back and blood donation in the deferral period and Platelet 64 050 59 097 (92·3)
ABO/Rh blood group discrepancies. Plasma 43 719 43 091 (98·6)
The RBC wastage rate was calculated as a percentage of units
prepared. The major reason for RBC wastage was expiry. After
intervention, RBCs wastage due to expiration decreased dramat-
ically. Similar to RBCs, expiration was the main cause of PLT implementation of certain corrective actions to obviate the
wastage. Technical faults during preparation and inappropriate root causes occurring within production and storage of blood
storage were other important causes of PLT wastage. After the components were effective factors in the reduction of wastage.
intervention, PLT wastage due to preparation decreased by 89%, There were many reasons for wastage, of which expiration was
which was the highest rate of reduction of wastage during prepa- the most important one. One of the qualitative goals defined
ration among blood components. Wastage during preparation for blood transfusion centres in 2011 and 2012 was the annual
was the most common cause of plasma wastage. The number of increment of blood collection, which was not planned based
plasma units discarded due to expiration or inappropriate tem- on hospitals’ demand, and it played an important role in the
perature during storage or transportation was nil after interven- increased rate of wastage. In 2012, 13·3% of prepared compo-
tion (Fig. 2). nents were wasted. Discard rate of blood components in central
Blood components issued to the hospitals increased after the India was 14·6%, which was similar to the present study’s results
interventions (P < 0·001) (Table 1). (Kumar et al., 2014). In 10 European countries, the wastage level
was reported to range between 0·2 and 7·7%, with an average
of 4·5% (Veihola et al., 2006). This was much lower than the
DISCUSSION
wastage rate in the present study. In early 2013, the adjustment
Simple interventions resulted in a significant drop in blood of blood collection level based on hospitals’ demand led to a
component wastage. Among different types of blood com- highly significant reduction of wastage. From the beginning of
ponents, RBCs showed the highest reduction of wastage rate 2015, the RBCs’ inventory level in the Yazd blood transfusion
after intervention. Continuous monitoring of wastage and the centre decreased by 2 more days. Reduction in RBCs’ inventory

Transfusion Medicine, 2017, 27, 348–353 © 2017 British Blood Transfusion Society

Fig. 2. Reasons for RBCs, platelet (PLT) and plasma wastage in
post-intervention years compared with pre-intervention years (wastage
calculated as a percentage of the number of units prepared). The reasons
for blood component wastage in post-intervention years compared to
pre-intervention years (wastage calculated as a percentage of the num-
ber of units prepared). The major reason for RBCs wastage was expiry.
After intervention, RBCs wastage due to expiration decreased dramati-
cally. Similar to RBCs, expiration was the main cause of platelet wastage.
Technical faults during preparation and inappropriate storage were other
important causes of platelet wastage. Unlike other components, prepara-
tion wastage was the most common cause of plasma wastage. Number of
plasma units discarded due to expiration or inappropriate temperature
during storage or transportation was nil after intervention
level had a dramatic impact on the expiration rate of RBCs so
that the number of expired units decreased from 64% of total
RBCs wastage in 2014 to 9% of total RBCs wastage in 2015.
Despite a 3% increment of RBC component production in 2015,
the wastage rate reduced to 1·1%. Reduction of national RBCs’
inventory can result in a reduced number of discarded RBCs
and can increase the proportion of fresher blood in the national
inventory. Sending surplus blood components to other blood
centres that had lower levels was also enhanced. The total num-
ber of RBC units sent to blood centres in other provinces was
8910 U (7·3% of prepared RBCs units) during pre-intervention
© 2017 British Blood Transfusion Society
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Blood wastage management in blood centre 351
years that increased to 9968 U (8·4%) during post-intervention
years. Blood centres all over the world implement policies in
order to reduce wastage and increase efficiency. The strategies
conducted in Australia in order to reduce RBC wastage include
the reduction of the national RBC inventory as well as increment
of efficiency of supply chain from the blood collection point to
distribution of blood components (Veihola et al., 2008; Morish
et al., 2012; National Blood Authority, 2013).
Amongst produced blood components, PLTs had the highest
rate of wastage. After the implementation of the intervention,
PLT wastage decreased from 23% in 2012 to 12·6% in 2013. In
2014, despite a decrease in the preparation wastage rate, PLT
wastage rate increased (16%), which was mostly due to PLT
expiration (95% of total PLT wastage). PLT components have
a very short shelf life, which is the main cause of expiration.
According to the IBTO standards, PLT units are prepared by
a PLT-rich plasma method. Prior to the interventions, most of
the PLT units that could be manufactured were indeed man-
ufactured, regardless of demand. At the end of 2014, certain
corrective actions were conducted, such as preparation of PLT
production based on weekly demands and sending surplus
PLT units to blood centres in adjacent provinces. In cases
with reduced PLT demands, double blood bags were used, and
only RBCs and plasma were prepared. Therefore, PLT wastage
reduced to 3·8% in 2015. However, these interventions did not
have an adverse effect on proportion of PLT units issued to the
hospitals (Table 1). Other studies also showed that highest rate
of wastage were related to PLT component. In central India, 37%
of PLT units were discarded, in which expiry was the most com-
mon cause of wastage (Kumar et al., 2014). A study conducted
in Malaysia indicated that PLT wastage was 6%. However, the
units discarded due to expiry date and transfusion-transmitted
diseases were not included (Morish et al., 2012). In Canadian
Blood Services, the optimal PLT inventory level is 80–100% of
the daily national requirement (National Advisory Committee
on Blood and Blood Products, 2015).
In a study about the efficiency of PLT production in Euro-
pean countries, the mean discard rate was 13% (Veihola et al.,
2008). The most common cause of PLT wastage in these studies
was related to PLT expiration and technical problems at the time
of PLT preparation. Recently, various studies have been con-
ducted to manage PLT inventory (De Kort et al., 2011; Gomez
et al., 2015). van Dijk et al. (2009) designed a model to reduce
PLT wastage (from 15–20% to 0·1%) with regards to the fact
that PLT units have short expiry dates. The model aimed to bal-
ance between PLT production and hospital demands, prevent
PLT expiration and prevent the inventory shortage. However, a
certain amount of PLT wastage is unavoidable to ensure its avail-
ability when it is needed.
Technical problems were the main cause of plasma wastage.
Contamination with RBCs occurs due to inadequate separation
of platelet-rich plasma (PRP) from RBCs at the time of centrifu-
gation or separation by extractor. To prevent this, the centrifuged
blood bags should be gently removed from centrifuge and then
carefully put in an extractor. Human intervention plays an
Transfusion Medicine, 2017, 27, 348–353

352 H. Javadzadeh Shahshahani and N. Taghvai
important role in processing of blood components. Therefore,
sufficient and continuous training to personnel and use of
proper and update techniques facilitates the reduction of tech-
nical wastages. Breakage was the other important reason for
plasma wastage. Frozen plasma is very sensitive to fracture, and
in case of inappropriate transport, it experiences breakage and
leakage. Accordingly, staff training with regards to the proper
transportation and storage of frozen plasma in order to reduce
wastage due to breakage of plasma bears great importance.
Reduced plasma preparation wastage indicates the effectiveness
of interventions (Fig. 2). With regards to sending plasma for
fractionation, plasma expiration gradually decreased to zero
in 2014 and 2015. Since 2005, IBTO initiated a contract frac-
tionation programme to use surplus plasma for improving the
availability and affordability of plasma-derived medicine. The
volume of plasma shipped for fractionation has gradually signif-
icantly increased in subsequent years (Cheraghali, 2012). In the
Yazd Blood Transfusion Center, the rate of plasma shipment to a
fractionator during 2010–2015 increased by 40% (from 19 000
to 27 000 plasma units), and therefore, plasma wastage rate due
to expiration decreased significantly.
The reduction of wastage during storage after interventions
was due to accurate implementations of SOPs for maintenance
of temperature during storage and validation of components’
temperature during transportation. It is important that blood
components be transported at the appropriate temperature.
Therefore, all transit containers, packing materials and pro-
cedures have been validated for various transport times and
environmental temperatures. These validations have been
performed in advance to ensure that blood components are
maintained at the correct temperature for the duration of antici-
pated transport time. Validation has been repeated periodically.
Using appropriate containers for the correct number of blood
units, equilibration of transit containers to their storage tem-
perature prior to filling with components, minimising dead air
space in packaging containers and transporting blood compo-
nents exactly according to the validation documents minimised
wastages. In the present study, wastage level reduced to zero
after interventions (Fig. 2).
A certain level of blood component wastage was inevitable,
which included discarded units due to reactive infectious test
results with a rate of ∼0·5% of prepared units. The blood dona-
tions are all screened for HBsAg, HIV antigen/antibody and
anti-HCV using approved and similar commercially available
ELISA kits across the country. Treponemal antibodies are also
screened as a marker for syphilis infection. According to the
IBTO regulation, initial reactive donations are discarded. The
repeatedly reactive samples are confirmed using HBsAg confir-
matory assay, HIV I/II Western Blot (WB) and HCV recombi-
nant immunoblot assay (RIBA). The confirmed positive donors
are recalled for counselling and follow up (Kafi-abad et al., 2009).
Discard rates due to reactive infectious tests vary widely among
blood centres. In a study of blood services in Uganda, the discard
rate due to infectious test reactivity was nearly 6% (Kajja et al.,
2010). Analysis of reasons for discarding blood components in
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central India showed that 1·2% of RBCs or FFP units were dis-
carded due to seropositivity for transfusion-transmissible infec-
tions (TTIs) (Kumar et al., 2014). The total blood discard rate
due to positive serology in a blood centre in Curitiba-Brazil was
5% (Monich et al., 2016). The screening test results for TTIs
in The Netherlands and the Austrian Red Cross Blood Estab-
lishment showed that the annual average for repeatedly reactive
donations was ∼0·1%. Based on the Guide of the Council of
Europe, these units were rejected (De Kort et al., 2016). These
differences in discard rates among various blood centres may be
due to the variation in the prevalence of TTIs among popula-
tions who are eligible for blood donation, policies for educat-
ing and selecting healthy donors and type of donors (voluntary
non-remunerated donors from lower risk population).
Reduced wastages during post-intervention years led to the
saving of more than 8000 blood units collected and the produc-
tion of 18 000 blood components units and ∼1 500 000 dollars.
During the study period, although the overall total num-
ber of prepared units decreased, it then proceeded to increase.
The present study was limited to the first half of the blood
chain; therefore, it is essential to develop recommendations for
the proper use of blood components to minimise inappropriate
use. Implementation of a proper inventory management system
at the hospital blood banks can also result in a reduction in
blood wastage and unnecessary demands. Recent studies show
that improvement in inventory management resulted in a sig-
nificant decline in wasted blood units by the hospitals (Chung
et al., 2016). Implementation of a patient blood management
programme in ∼40% of AABB hospitals was associated with
a decrease in the number of transfused units (Whitaker et al.,
2016).
CONCLUSION
The present study was the first interventional research in Iran
on the management of wastage of blood and blood components
and showed that interventions implemented to reduce blood
wastage were effective. Establishment of a centralised informa-
tion department in the country to determine the surplus of each
provincial centre, along with the accurate need of all centres, can
lead to effective inventory management and a significant drop in
wastage of blood and blood components in the country.
ACKNOWLEDGMENTS
H. J. S. designed the research, analysed the data and prepared
the manuscript; H. J. S. and N. T. reviewed the manuscript
and approved it. The authors thank Dr S. Amini Kafiabad,
Dr F. Amiri, M. Bahri, H. Dehghanizadeh who helped in the
study and Dr M. T. Yavari for the final English revision of the
manuscript.
CONFLICT OF INTEREST
The authors have no competing interests.
© 2017 British Blood Transfusion Society

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