Blood Wastage: Causes, Economic Burden, And Prevention Strategies - A Narrative Review

Table no. 1: Reported cost of blood and blood components in different countries ^(15,16)

Table no 2: Financial impact of blood component wastage

Loss of blood components constitutes a major financial drain, and evidence suggests that successful measures for minimizing wastage can lead to large cost savings for transfusion services.

PREVENTIVE STRATEGIES

At the level of donor

• Donors will not be permanently postponed if blood bank employees are properly trained in counselling donors.³
• Donors with rare and negative blood types should be kept in reserve, and blood should only be drawn when needed.³
• By promoting single donor platelets through apheresis based only on demand, platelet concentrate/RDP waste can be prevented.³
• Strict adherence to the donor selection rules and appropriate donor screening will reduce the amount of such units collected from the donors, preventing their disposal.¹³
• By properly interrogating donors about the time between their last meal and donation, lipemic discards can be reduced.⁶
• Blood that is inappropriate for transfusion because the anticoagulant used in the bag and the volume of blood collected do not match. This kind of collection typically takes place at blood donation camps. It can be avoided by choosing healthy donors carefully, encouraging donors, and providing phlebotomy personnel with sufficient training.¹⁹
• Current guidelines that highlight voluntary blood donation as a more effective and dependable source are supported by higher waste among replacement donors compared to voluntary donors.⁸
• It is advised that blood be collected using double- or triple-filtered bags and that all donors, including those with increased haemoglobin, have their haemoglobin levels tested. Blood bags from these donors should be labelled to create an appropriate product in the processing unit if these bags are not accessible.²⁰

At the level of blood centre and technical process

• Issue units strictly on a first-in, first-out (FIFO) basis.³
• Whole blood unit collection can be minimized since it has limited demand.³
• To reduce the chances of damage and leakage, the blood bag should be placed in a plastic bag before immersing it in lukewarm water.¹³
• Larger or better-equipped storage, software to track stock and forecast use, and use of those data to target donors of the groups and quantities actually required all support optimal use of blood.¹³
• Platelet additive solution, specialised storage bags and cryopreservation can lengthen the usable life of platelets, and preparing platelets on demand cuts expiry.⁶
• Continuous staff training, supervision of component separation and automated separators can limit red-cell contamination of plasma. Red cells carrying platelet contamination can still be used for patients of the same blood group within 24 hours of separation.⁶
• Collecting into CPD bags with an additive solution extends the storage period of red cells.⁶
• Storage equipment should be calibrated and validated, with electronic temperature monitoring and an audible alarm. Automatic SMS alerts to the blood-bank medical officer or technical supervisor allow quick action and help prevent storage-related loss.⁶

Inventory and information management

• Inexpensive and easy interventions such as educational outreach, print and digital messaging, and improved transportation and component identification modalities can have a prompt and dramatic impact on reducing blood wastage, concerning both cost and resource savings.⁶
• Surplus components can be sent to other licensed blood centres, and surplus FFP to fractionation.⁶
• Donor recruitment, collection and component separation can be adjusted to hospital demand, and the best stock levels of red cells, platelets and FFP can be reviewed daily.⁶
• Continuing education for technical staff in standard procedures for collection, processing, storage, internal transfer and transport, together with FIFO issue and regular audit by the hospital transfusion committee, helps reduce technical faults.⁶
• Machine-learning models that use real-time clinical data have shown promise for forecasting transfusion needs and reducing unnecessary reservations, but they require validation in resource-limited settings.²¹
• Platelet overproduction can be curbed by changing the type of bags used at donation and by making longer-lasting products, such as cryoprecipitate, from triple-bag collections.²⁰

At clinician interface

• A maximum surgical blood ordering schedule (MSBOS) aligns the number of cross-matched units with the likely transfusion need for each procedure. It serves as a guide for surgeons, anaesthetists and the transfusion service without overriding clinical judgement.²¹
• Issuing red cells to the ward one unit at a time limits over-requesting, ordering errors and repeated rewarming. Transporting components in insulated containers or cool bags with a portable thermometer keeps them from prolonged exposure to room temperature.¹⁴
• Physicians and residents should be trained in the indications, use and handling of blood components to minimise bedside wastage.²²
• Clinicians should return any issued unit not used within 30 minutes, keeping it cold and sterile. Red cells and platelet concentrates returned within that time may be restocked.²²
• Packed red cell and platelet concentrates can be taken back to blood bank if received back within 30 minutes of issue.²²
• Plasma should not be thawed until transfusion is confirmed. If thawed plasma is ordered but not transfused, it may be stored at 2-6 °C and reissued with priority within 24 hours.²²
• Avoiding unnecessary type-and-screen (T&S) or type-and-cross-match (TC) requests: a growing body of evidence suggests that many operations do not need either test, which adds cost and ties up blood, a stretched resource.²¹

Governance, audit and quality improvement

• Clear communication with clinicians, and issuing group-compatible units rather than defaulting to group O, limits wastage of group O positive and negative stock.⁶
• Continuous monitoring of wastage with corrective and preventive action (CAPA) aimed at root causes in collection, processing and storage has been shown to reduce wastage.²³
• Proper management of blood, self‑audit of blood and blood components discarded rate, and understanding reasons for discarding in blood bank will reduce unnecessary wastage of blood and blood components.⁶
• Every institution should have an active transfusion committee that sets rules for prudent use of blood, since the discard rate is itself a quality indicator.¹⁰

Patient Blood Management (PBM)

PBM is a patient-centred, systematic and evidence-based approach that aims to improve outcomes by managing and conserving the patient's own blood while promoting safety and patient empowerment.²⁴

 Hospital PBM programmes have been associated with shorter stays and lower blood use, and the resulting savings may offset programme costs. In one cost-benefit analysis, savings exceeded costs in about two-thirds of simulated repetitions.^24,25

By reducing demand and over-ordering, PBM complements measures that target discards directly.

Three pillars of PBM

1. Comprehensive detection and management of anemia.
2. Prevention and reduction of avoidable blood loss, including hospital-acquired anemia from unnecessary blood loss.
3. Optimization of the patient’s individual physiological capacity to tolerate of anemia.²⁵

Figure no 1: Three Pillars of PBM (Patient Blood Management)

Table no 3: Reported Effect of Intervention on Blood Components Wastage

Table no 3 summarizes the reported effects of different interventions on blood component wastage, including targeted multicomponent stratergies, a dedicated transfusion team, the Maximum Surgical Blood Ordering Schedule (MSBOS) and audit based corrective action, which reduced wastage across setting.

Future Perspectives

1. Standardized definitions and reporting: A consensus definition of wastage with a stated denominator, reported separately by component, cause and stage, is a prerequisite for comparison between centres and countries. A minimum national dataset for blood centres and hospitals would support benchmarking.
2. Stronger study designs: Future work should move from single-centre retrospective studies to prospective, multicentre and controlled designs, including interrupted time-series and stepped-wedge implementation trials, with follow-up long enough to show whether reductions are sustained.
3. Complete economic evaluation: Studies should capture direct and indirect costs, including donor time, recruitment, recollection, disposal, and the opportunity cost of a unit unavailable when needed, and report them in a single currency, price-year adjusted for inflation and purchasing power. Cost-effectiveness and return-on-investment analyses of individual interventions are needed.
4. Evidence from low- and middle-income settings: Research in replacement-donation systems, district hospitals and private facilities, and on the effect of moving towards voluntary non-remunerated donation, would make recommendations more transferable.
5. Digital tools and forecasting: Barcode or radio-frequency tracking, electronic issue, real-time temperature monitoring, and machine-learning forecasting (especially for platelets) need validation for accuracy, cost and feasibility in resource-limited blood banks.
6. Product innovation and supply-chain cooperation: Extended-shelf-life products, platelet additive solutions, on-demand component preparation and redistribution of near-expiry stock between hospitals deserve prospective evaluation, with safeguards against creating shortages.
7. Integration with Patient Blood Management: PBM programmes should be evaluated using combined outcomes (wastage, utilisation, stock-outs, patient outcomes and cost), with clinical pharmacists and transfusion committees involved in anaemia management, blood-loss minimisation and audit.
8. Governance and quality systems: Routine publication of wastage indicators, linkage with haemovigilance data and periodic external audit may sustain improvements and allow benchmarking.

CONCLUSION

Blood is a limited resource that depends on donors, and avoidable wastage has clinical, ethical and economic consequences. Wastage can occur at any stage from donor selection to administration, and many of its causes are preventable, including reactive screening and donor reactions, excess stock, inappropriate ordering, cold-chain breaks, failure to return unused units in time, and technical errors in collection and processing. Reported rates vary widely, and part of that variation probably reflects differences in definitions and denominators rather than true differences in performance.

The cost of wastage extends beyond the purchase or processing cost of a unit to include disposal, staff time, transport, storage, recollection and the opportunity cost of a unit that is unavailable when needed, but these indirect costs have been only partly quantified. Published evidence suggests that better inventory control, FIFO practice, maximum surgical blood ordering schedules, dedicated transfusion teams, staff and clinician education, and audit-based corrective action can all reduce wastage, and patient blood management offers a framework that brings them together. Future research should prioritise standard definitions, prospective multicentre designs, full economic evaluation and low- and middle-income settings, where every donated unit matters most.

FUNDING

None

ETHICAL STATEMENT

Ethical approval was not required because this is a literature-based review.

CONFLICT OF INTEREST

The authors declare no conflicts of interest.

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