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Background: Blood products are vital yet scarce medical resources. In teaching hospitals, inefficient transfusion practices often result in unnecessary waste, compromising both patient safety and healthcare costs. This study investigated the patterns and underlying causes of unused blood products at Imam Reza Hospital, a major tertiary center in northeast Iran, with the aim of delineating modifiable factors contributing to this issue.

Methods: This retrospective cross-sectional study was conducted at Imam Reza Hospital, Mashhad. Data were extracted from the Laboratory Information System (LIS) and the hospital’s dashboard for the period of March 2022–2025. Blood component reserve and return data for five large clinical departments were examined.

Results: Although the total number of returned units declined over time, the return percentage increased in the final year, indicating persisting inefficiencies. By department, Neurology and Gynecology exhibited the highest return percentages, while the Hematology-Oncology ward, Intensive Care Unit (ICU), and Emergency Department reported the highest absolute numbers of returns. Platelets were the most frequently returned product, whereas fresh frozen plasma had the highest relative return rate. The most consistently reported reason for returns was “Physician Decision / Order Canceled,” with returns due to “Patient Death” also showing a gradual increase over the study period.
Conclusion: Despite gradual improvements, systemic challenges—especially poor documentation, absence of digital monitoring tools, and knowledge gaps in transfusion handling—continue to undermine efficient blood product use. Implementing real-time dashboards, enforcing mandatory documentation, educating clinical staff, and adopting AI-based demand prediction tools could dramatically reduce waste and enhance transfusion practices.