The Local Initiative For Emergency Blood (LIFE-Blood) Study: A mixed-methods, single center exploration of civilian walking blood bank need, feasibility, and safety in a low-resource blood desert

Abstract Background Billions live in blood deserts, regions where there is effectively no access to blood transfusions. Lodwar County Referral Hospital, set in a rural, low-resource area in northwestern Kenya, is one such blood desert. A walking blood bank is a point-of-care system of emergency transfusion when banked blood is unavailable. The objective of this study was to evaluate the need, feasibility, and safety of a walking blood bank to address blood unavailability in a low-resource, civilian setting. Study Design and Methods This was a mixed method study. Blood need was determined through chart review from April to July 2022. Feasibility was evaluated through qualitative interviews with hospital stakeholders. Safety was established by comparing diagnostic performance of rapid diagnostic testing to standard-of-care assays for transfusion transmitted infections (HIV, HBV, HCV, syphilis). Results Stockouts occurred 40 of 126 days (32%). Stakeholders acknowledged blood was frequently unavailable and it was sometimes necessary to perform emergency transfusion using rapid tests to screen blood in order to save a life, despite uncertainty over their performance to detect transfusion infections. Overall transfusion infection prevalence in donors was 5.4%. Rapid testing had a 99.2% (p=0.01) negative predictive value when compared against standard-of-care laboratory-based tests. Discussion A walking blood bank using rapid testing may serve as a stopgap measure to address the extensive burden of hemorrhagic shock and severe anemia in the world’s lowest resource, civilian settings, where patients and their providers struggle without timely access to blood through a blood bank.