{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T20:14:22Z","timestamp":1790367262985,"version":"4.1.0"},"reference-count":22,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2020,7,16]],"date-time":"2020-07-16T00:00:00Z","timestamp":1594857600000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,7,1]],"date-time":"2020-07-01T00:00:00Z","timestamp":1593561600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2020,7,1]],"date-time":"2020-07-01T00:00:00Z","timestamp":1593561600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Surgery and anesthesia are indivisible parts of health care, but safe and timely care requires more than operating rooms and skilled providers. One vital component of a functional surgical system is reliable blood transfusion. While almost half of all blood is donated in high\u2010income countries (HICs), over eighty percent of the global population lives outside of these countries. High\u2010income countries have on average 30 donations per 1000 people, and the average age of transfusion recipient is over 65. Most low\u2010income countries (LICs) have fewer than five donations per 1000 people, where maternal hemorrhage and childhood anemia are the most common indications for transfusion. In LICs, greater than 50% of blood is administered to children under 5 years of age. This study aims to snapshot, by survey, available resources for transfusion and then discusses the infrastructure and cultural barriers to optimal transfusion practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In January 2019, a 10\u2010question survey was sent electronically to physician anesthesiologists working in low\u2010 and middle\u2010income countries to examine resources and practice patterns for blood transfusion. Subsequent discussions illustrate obstacles contributing to low availability of blood products and illuminate infrastructure and cultural barriers preventing optimal transfusion practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Survey Results<\/jats:title>\n                    <jats:p>Acquiring whole blood takes hours. Clinicians wait days to receive packed red blood cells or platelets. Fresh frozen plasma is available but untimely. For many, protocols for massive transfusion are rare, and for transfusion, ratios are nonexistent. Complete blood counts take hours, and coagulation profiles are severely delayed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion of Infrastructure and Cultural Barriers<\/jats:title>\n                    <jats:p>With few voluntary, unpaid, donors and inconsistent supply of testing kits, donated blood is unsafe. Donors are seasonal for farming communities, endemic malaria areas, and student donors recruited through schools. Cultural beliefs fuel distrust. Transfusion specialists, concentrated in urban areas, see rural patients presenting late. Inadequate triaging and supervision jeopardize patients to shock. Inadequate blood storage leads to waste. Modeling systems from HICs fail to overcome hurdles faced by clinicians working with distinctive belief systems and unique patient populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00268-020-05461-x","type":"journal-article","created":{"date-parts":[[2020,3,10]],"date-time":"2020-03-10T14:04:35Z","timestamp":1583849075000},"page":"2094-2099","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Barriers to Effective Transfusion Practices in Limited\u2010Resource Settings: From Infrastructure to Cultural Beliefs"],"prefix":"10.1002","volume":"44","author":[{"given":"Alhassan Datti","family":"Mohammed","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care Bayero University\/Aminu Kano Teaching Hospital PMB 3452 Kano Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Papytcho","family":"Ntambwe","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care Unit Livingstone Central Hospital 2444\/244B, Highlands Livingstone Southern Province Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Maria","family":"Crawford","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine Stanford University Hospital 300 Pasteur Drive, Room H3580, MC 5640 94305 Stanford CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,7,16]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(15)60160\u2010X"},{"key":"e_1_2_15_3_1","unstructured":"World Health Organization(2017)Global Status Report on Blood Safety and Availability 2016.http:\/\/apps.who.int\/iris\/bitstream\/10665\/254987\/1\/9789241565431\u2010eng.pdf. 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July 2020","order":1,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 July 2020","order":2,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":3,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The article \ufffd\ufffd\ufffdBarriers to Effective Transfusion Practices in Limited-Resource Settings: From Infrastructure to Cultural Beliefs\ufffd\ufffd\ufffd.","order":4,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Each author attests that there are no conflicts of interest. IRB submission through Stanford University found this survey exempt from review.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}