Audit of Blood Component Utilization and Request Appropriateness in a Tertiary Care Hospital: A Cross-Sectional Study

Abstract

Background: Blood components, packed red blood cells (PRBCs), fresh frozen plasma (FFP), and platelet concentrates (PCs), are finite resources whose inappropriate use compromises patient safety and depletes inventory. Structured audit of transfusion practice underpins sound hemovigilance, yet its application across Indian tertiary centers remains inconsistent. This study quantified the appropriateness of blood component requests and mapped component-wise and departmental variation. Methods: A six-month retrospective cross-sectional audit (July-December 2025) was conducted at a tertiary care hospital blood bank. All blood component requests (n=8,752) were reviewed by two postgraduate pathology trainees, with senior specialist adjudication of disagreements, against prespecified operational criteria adapted from National Blood Transfusion Council (NBTC) India, British Committee for Standards in Hematology (BCSH), and American Association of Blood Banks (AABB) guidance. The crossmatch-to-transfusion (C:T) ratio was calculated for PRBCs, and request appropriateness was compared across departments using the chi-squared test, with Fisher's exact test where expected cell counts were small and Benjamini-Hochberg correction for multiplicity; proportions are reported with 95% confidence intervals (CIs). Results: Of 8,752 requests, 6,202 (70.9%; 95% CI: 69.9-71.8) met appropriateness criteria, and 29.1% did not. FFP requests showed the lowest appropriateness (35.2% not meeting criteria), followed by PRBC (28.7%) and PC (21.6%). The overall PRBC C:T ratio was 2.1:1. Request appropriateness varied significantly across departments (χ²=161.3; df=6; p=3.2×10⁻³²), with Oncology (82.2%) and ICU/Critical Care (81.1%) showing the highest crude rates and Obstetrics and Gynecology (64.1%) and the heterogeneous "Others" group (63.3%) the lowest; these comparisons are unadjusted for component mix and within-patient clustering. Hemoglobin above threshold, FFP requested for volume support without documented coagulopathy, and missing clinical justification were the leading documented reasons among requests not meeting criteria. Conclusion: A substantial proportion of blood component requests, particularly for FFP, did not meet prespecified appropriateness criteria, and appropriateness varied markedly across departments and components. These findings support the consideration of a structured, recurring institutional audit-and-feedback program; the effect of such a program was not tested in this study.