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

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).

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.

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. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study was funded by a grant from the Gillian Reny Stepping Strong Center for Trauma Innovation. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee of Strathmore University gave ethical approval for this work. IRB of Mass General Brigham gave ethical approval for this work. Ethics committee of the National Commission on Science, Technology, and Innovation gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data produced in the present study are available upon reasonable request to the authors