Blood Component Utilization, Return, and Expiration Patterns across Four Teaching Hospitals in South Khorasan, Iran: A Multicenter Cross-Sectional Study

Abstract

Background: Efficient utilization of blood components is a major goal in transfusion medicine, particularly in healthcare systems facing rising demand and limited donor resources. This study evaluated patterns of blood component utilization, return, and expiration in four teaching hospitals in Birjand, South Khorasan, Iran.

Materials and Methods: This multicenter cross-sectional study was conducted over six months (September 2024–March 2025) in hospitals affiliated with Birjand University of Medical Sciences. Data on requests, issuance, transfusion, and return of blood components were extracted from blood bank and hospital information systems. In total, 622 requests and 10,295 issued units were analyzed. Utilization rate, return rate, and crossmatch-to-transfusion (C:T) ratio were calculated. The Kruskal–Wallis test was used to compare return rates among hospitals.

Results: The overall utilization rate was 97.54%, with a return rate of 2.46% and a C:T ratio of 1.05. Significant inter-hospital variability was observed (P < 0.0001). Razi Hospital accounted for 71.3% of returned units (return rate: 6.10%), while Iranmehr Hospital achieved near-complete utilization (0.02%). ICUs and CCUs represented over 75% of returns, and leukocyte-reduced red blood cells were the most frequently returned component (64.5%). A total of 261 units were discarded, mainly due to expiration (74.3%), with B+ showing the highest expiration frequency (19.9%).

Conclusion: Although overall transfusion efficiency was high, substantial variability in return and expiration patterns suggests that targeted, data-driven interventions may further reduce wastage and improve patient safety.