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effectiveness of transfusion [2, 21, 22]. According to the World Health Organization’s (WHO) report, there is a remarkable difference in the use of blood transfusion in different hospitals, clinical specialties, and between different teams in a specific area, which leads to the inappropriate use of blood and blood products [22]. To benefit from transfusions therapeutic value, it is important to study recipients’ demographics, such as age and sex and clinical conditions like ward and transfusion inducing clinical findings in forecasting the demand for blood transfusion in particular settings [6, 23], and to devise blood transfusion needs, particularly in resource-limited areas where there is scarce blood supply [23, 24]. It is always wise to consider that blood is an expensive and scarce resource [11], so that appropriate clinical use of blood and blood products, avoiding unnecessary transfusions, and use of simple transfusion alternatives are some of the strategies of WHO blood transfusion service (WHO/BTS) [25] advocated. Therefore, blood should be appropriately transfused to treat a certain condition in clinical practice [21] by ensuring that “Is blood transfusion necessary in this patient? If so, “ensure right blood, for the right patient, at the right time, at the right place” [8]. A review document reported by Giuliano G. indicated that appropriateness of transfusion practices should systematically mean that “blood components are transfused only when there is evidence for potential benefit, there are no valid alternatives, safe and quality products are available, and risks and benefits are carefully assessed before the decision to transfuse are made” [26]. Besides, overall transfusion safety is not only on the side of correct blood collection, product preparation, and administration but also on the ability of correct interpretation of this clinical intervention needed [27]. With this regard, researchers suggested that 5 to 58% of blood transfusions carried out were estimated to be “unnecessary or inappropriate” [27, 28]. Several study reports indicated that a large number of surgical blood transfusion over-orderings, and blood utilization practices ranging from only 5% to 40% [29]. Likewise, estimates in developing countries also indicated that 40% to 70% of transfused patients showed gross over-ordering [30]. In South Africa, 7–10% of annual blood wastage was reported because of over-ordering [31], and the blood utilization rate in India was found to be 28% [32], in Kuwait, 13.6% [33], in Ethiopia 43.6% [34], and in Nigeria 69.7% [35]. Even in trauma patients, less than 50% of blood utilization was reported in 2004 by Olatunji et al. [36].Boral Henry in 1975 was the first to use the determination of cross-match-to-transfusion (C/T or C:T) ratio for evaluation of blood utilization and reservation [34, 37]. This C/T ratio has to be within the index value of 2:1 or 2.5:1 [30, 34, 37], although WHO lets this range as 3:1 to be ideal for surgical patients [22]. The probability of blood transfusion (TP%) with a considered value of >30% to be is expected desirable. Meaning that at least 30% of cross-matched blood needed a transfusion, with any figure less than this number being said to be unjustifiable [30, 37] or in surgical procedures blood usage, less than 30% would be included under the category of group and screen [22]. Another threat to the judicious use of this scarce resource is failing to use components of blood instead of whole blood. Although people usually donate whole blood, it is rarely given as a transfusion in modern medical practices [38]. Blood transfusion history in Africa is assumed to be introduced beyond the “life-saving” role [17, 39–42] of the procedure. It is mainly associated with the acceptance and spread of modern technology of medicine, reported as started in 1921 [7] and 1940 according to WHO’s report, which became more important during the 1980s following the emergence of HIV/AIDS [7, 43, 44]. The Ethiopian Red Cross Society (ERCS) was the pioneer for the establishment and organization of blood transfusion services in Ethiopia and founded the first blood transfusion center in 1969 in Addis Ababa. The service later expanded as a network covering some major hospitals in the country [45, 46] and reverted to government-owned activity in 2010 after it is handed over to the Federal Ministry of Health (FMoH). Currently, there are 25 blood banks strategically positioned across all regions of the country to ensure access to safe and adequate blood supply, based on the nationally proposed regional blood bank services organogram [46]. Globally, of 80 million (in 2011) [47] to 118.5 million approximate units (in 2020) [48] of blood donated each year, only 40% collected in high-income countries, however only 2 million units in sub-Saharan Africa, in contrary; demand for blood transfusions is excessive in the later

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