Blood Bank Service : An Experience at Newly Established Birat Medical College and Teaching Hospital , Tankisinuwari , Morang , Nepal

Introduc on Blood bank service facility of blood collec on, storage and dispatching began from 19 June 2016 in the new blood bank and transfusion service unit, at Birat Medical College & Teaching Hospital, Tankisinuwari, Morang, Nepal, with the support of Nepal Red Cross Society. As the supply of blood is finite, the inappropriate use of blood transfusion units and its component in the world exist, hence there is a need to monitor and regulate these services.


Objec ves
The objec ve of this stud now and iden fy different blood y is to k groups and its u liza on pa ern to meet the demand for future preparedness and to iden fy the total blood unit, which are being, replaced back.

Methodology
This retrospec ve study was conducted at BMCTH, Tankisinuwari, Morang for component dispatches from 19th June, 2016 to19th February, 2017.Requisi ons for whole blood requirement for pa ents from various departments were reviewed regarding the department request, the whole blood requested and whether being replaced, blood group and socio-demographic profile.

Results
Out of 193 transfusion units dispatched, 28 pa ents were male and 165 pa ents were females respec vely B posi ve blood groups were most common, followed by A posi ve, O posi ve, AB posi ve, both AB and O nega ve respec vely.The largest numbers of requisi ons were from Gynecology and Obstetrics ward in the hospital, while 22 requisites were from other health centers.Majority of the requisi ons were for 51-60 years age group from the local district Morang.The total number of blood units replaced were 38, out of which 5 for males and 33 for females respec vely.

Conclusion
B posi ve was the predominant requested blood group, with Gynecology and Obstetrics ward demanding the most requests, among 51-60 years age group from Morang district.The total blood units being replaced were very less in number with some requisi on forms, which lacked essen al details.

INTRODUCTION
The blood transfusion units and the individual blood components have become an integral part of pa ent management in modern medicine.It can be vital and life saving procedures when given appropriately.In Nepal, the Nepal Red Cross Society (NRCS) began to provide ins tu on based Blood Transfusion Service (BTS) through the Department of Pathology at Bir Hospital (1964).The first BTS was established as Laxmi Blood Bank in 1966, with the purpose to ensure an adequate, safe and mely supply of blood and blood products to meet the transfusion requirements of the people of Nepal in an equitable and affordable manner.Blood bank service facility of blood collec on, storage and dispatch began from 19 June 2016 in the new blood bank and transfusion service unit, at Birat Medical College and Teaching Hospital, Tankisinuwari, Morang, Nepal.It is established under the supervision of Nepal Red Cross Society of Eastern Region, Nepal.Like drugs, the blood and its component have property, which may cause the adverse reac ons in the recipients, though they are important part of 1 the pa ent management treatment protocols.Therefore, the physicians should be alert regarding the proper use and indica on for reques ng the blood transfusion units and its components.Further of which, the unwanted and unnecessary exposure and misuse of the blood transfusion recipient to numerous infec ous as well as other noninfec ous complica ons is prevented.So, the and con nual regular audi ng on proper usage of blood transfusion units and its components is mandatory.This in long term would help to track down the appropriate blood transfusion units and its component u liza on pa ern and to set up the of perfect guidelines in all the blood using special es.Among such, the exact updates and proper audi ng proves to be a useful management applica on for the jus fica on of appropriateness and efficacy of blood and its component 2 transfusion therapy.Not only this, but this could be a key factor of the quality assurance programme providing the necessary informa on for improving the blood transfusion 3 medicine prac ce.In view of high rate of inappropriate use of blood and its component services around the world, there is a need to monitor and regulate these services.The objec ve of our study is to iden fy the mode of blood u liza on pa ern to meet the demand for future preparedness.And also to iden fy those blood units, which are being replaced.

METHODOLOGY
The study is retrospec ve and conducted at Department of Pathology, Birat Medical College and Teaching Hospital, Tankisinuwari, Morang, Nepal.For this study, all the required informa on and data from 19 June 2016 to 19 February 2017 were retrieved from the main registra on record book of the Blood Bank Service Unit of Nepal Red Cross Society (NRCS) at Birat Medical College and Teaching Hospital.Among these, the requisi ons for requiring whole blood for the pa ents from various departments were reviewed regarding the department request, the number of whole blood requested and whether the blood was replaced back, blood group and socio-demographic profile (age and gender) for the above period.Descrip ve sta s cal analysis was done.

RESULTS
The present study was conducted for 193 transfusion blood units dispatched for different various blood groups over a period of 8 months from 19 June 2016 to 19 February 2017.Out of total 193 transfusion units, 28(14.51%)pa ents were male and 165 (85.49%) were females (Figure 1).Out of the blood groups units being dispatched, B posi ve were most common of 74 (38.35%) followed by A posi ve of 55 (28.50%), O posi ve of 49 (25.38%),AB posi ve of 13 (6.74%) and of AB nega ve and O nega ve as 1 each respec vely (Table 1).The largest numbers of requisi ons for 95 transfusion units were from Gynecology and Obstetrics ward, followed by General Surgery, Internal Medicine and ENT ward for 30, 11 and 2 transfusion units respec vely (Table 2).Fi y five requisites were from other hospital outside the Birat Medical College and Teaching Hospital.Majority of the requisi ons were for 51-60 years age group from the local district Morang followed by neighboring district Sunsari.The total blood units replaced were 38, out of which 5 units were from males and 33 units were from females.

DISCUSSIONS
This retrospec ve study describes the different pa erns of blood u liza on along with the prepara on in future for the demand of different blood groups in the Birat Medical College, Tankisinuwari, Nepal along with other nearby and surrounding health centers.A study conducted by 4 Venkatachalapathy and Das concluded the importance of periodic review of the blood and its component usage pa ern in hospital.According to the study, introducing, implemen ng and establishing the appropriate plans and policies guidelines for use of various blood transfusion units and blood components definitely help to decline the improper use of blood units and its components.Not only this, but instead it will ensure the availability of the blood transfusion units and its component to other pa ents who has emergency requirement of such components.Also, many pa ents suffering from unwanted blood transfusion related reac ons can be saved as well.Likewise, our study also demonstrates the very ini al status and figures of the newly established blood storage, collec on and dispatch centers.In addi on, being confined to the ter ary care medical college and teaching hospital with almost all exis ng departments of medical educa on, the future demand and use of such blood and its components would increase in number.The result of our study revealed more numbers of female than male pa ents from Morang district followed by Sunsari district demanding the whole blood.This has definitely linked to the higher numbers of pa ents demanding the blood were from Obstetrics and Gynecology departments followed by the General surgery and other wards respec vely in ours hospital and nearby geographical areas.Among which, the maximum age group of the pa ents were fi h and sixth decade of life.
The recorded data showed that 55 requisites of blood units were from the pa ents belonging to other health centers besides Birat Medical College and Teaching Hospital.This ul mately becomes a useful tool in making the different blood transfusion related strategy and policies for future preparedness and ac on.In another way, we can also predict from the result about the vulnerable age group, geographical areas and the type of diseases having the exact indica on of blood transfusion.
Similarly, our study concluded that majority of blood group dispatched was B posi ve out of total 193 blood units being dispatched followed by A posi ve, O posi ve, AB posi ve, O nega ve and AB nega ve respec vely.This sort of the internal audit data not only helps in tracing out the exact use and preparedness for future demand of the individual blood units, but also can play a vital func on for quality control mechanism.These facts in detail have been prescribed and proved in the studies done by McCullough J and Steeper TA et Brandia K et al and Joshi GP et al has the common conclusion, sta ng about the easy and appropriate use of blood transfusion units and the blood components is on a high demand for its easy availability of sophis cated blood banking services.Thus, the blood bank should be regular enough for upda ng and fulfilling the requisites of this vital and life saving products.Moreover, it should be able at first to access, track, evaluate and even change if necessary the exis ng plans policies and systems of demanding the blood transfusion units or the blood components.
Considering these facts of the blood and its component being one of the life saving product, the blood bank should always try to maintain the replacing blood units a er delivery or dispatching of each blood units.So that the blood units storing in the blood bank is always maintained for each and every demand of it.Similarly, our study showed the result of minimal number of blood units being replaced a er dispatching of each blood units.Out of 193 total dispatched blood units, 33 female replaced only 38 blood units and male replaced 5.Such tendency of replacing the dispatched blood units in the blood bank should be increased, so that every demand and requisites for blood units would be fulfilled to overcome any life threatening situa ons demanding the use of blood and its components.Likewise, our study showed that, some of the requisi on forms demanding such blood units even lacked the necessary and important details.This was one of the unwanted findings we came across our study.
In another way, we can interpret that the necessary details about the pa ents iden fica on regarding the full name, age, sex, proper address, blood group (if already known), total blood units required, clinical or working diagnosis if possible etc. should be clearly men oned in every such blood units requisi on form.
Finally, we might achieve more favorable result if up grada on of blood storage and other facili es are considered at the blood bank which requires dealing with more inventories.A so ware based system for monitoring stock and predic ng the u liza on is mandatory.Genera ng a list of donors who can be used at the me when blood shortage and to avoid unavailability would be a great step for regular supply of such blood units.In addi on, regular educa on programs related to such ma er of improving the performance of any related staffs would be a posi ve step towards increasing the trend of using the blood transfusion units and the individual blood components appropriately.

CONCLUSIONS
B posi ve blood unit was the predominant requested blood units by Gynecology and Obstetrics ward at this ins tute making the most of requests.The total replaced blood units Kafle SU et al Original Research Article were very less in number.Some requisi on forms lacked essen al details.Finally, these results could be useful for es ma ng and planning the requirements for our newly established Blood Bank to meet the demand in future.

LIMITATIONS OF STUDY
Study was concluded with only data available from the registra on record book maintained at the blood bank service at Birat Medical College and Teaching Hospital.

Table 2 : Requests from Departments (n = 193) Department Number
5,6al and Silver H and Tahhan HR et al.According to them, the regular data updates and working upon it of the individual blood bank is proved to be an important aspect of the quality control mechanism in any blood bank, which is same as that in any other ins tu ons or organiza ons.Studies done by