{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T01:01:11Z","timestamp":1793494871460,"version":"4.5.0"},"reference-count":48,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2022,2,15]],"date-time":"2022-02-15T00:00:00Z","timestamp":1644883200000},"content-version":"unspecified","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,1,14]]},"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Blood transfusion is life-saving for patients experiencing acute blood loss and severe anaemia. In low-income and middle-income countries (LMICs), low blood donation rates and unavailability of whole blood and blood components (blood products) impairs timely blood transfusion. To fulfil patient-specific blood orders, a hospital blood transfusion service (HBTS) receives orders from a prescriber for blood transfusion, tests and prepares blood products for the patient. This study sought to describe the current state of LMIC HBTS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>A cross-sectional survey explored LMIC HBTS access to blood products, testing methods, policies and structure. Surveys were administered in English, Spanish, French and Russian, followed by a mixed-methods analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>HBTS within LMICs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>From among 124 public and private facilities invited to participate, we received 71 (57%) responses. Of these responses, 50 HBTS from 27 LMICs performed on-site blood transfusions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Most LMIC HBTS perform blood collection to generate blood products for their patients (36\/47, 77%); few relied exclusively on an external supply of blood products (11\/47, 23%). The primary reason for blood transfusion was adult anaemia for non-malignant conditions (17\/112, 15%). Testing methods varied by gross national income per capita. Blood transfusion delays to patients were common (17\/30, 57%) attributed to inadequate blood inventories (13\/29, 45%). Other barriers included lack of regular clinician education about transfusion (8\/29, 28%) and sustainable financial models for the HBTS (4\/29, 14%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This survey describes the status of HBTS in diverse LMICs, illustrating that the availability of blood products remains a principal problem, requiring HBTS to generate its own facility\u2019s blood supply. Currently, blood shortages are not reported as a patient-specific adverse event making systematic tracking of delays in transfusion difficult. These findings highlight areas for further exploration related to the lack of available blood inventories for transfusions at HBTS in LMICs.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-055017","type":"journal-article","created":{"date-parts":[[2022,2,15]],"date-time":"2022-02-15T12:39:36Z","timestamp":1644928776000},"page":"e055017","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":42,"title":["Status of hospital-based blood transfusion services in low-income and middle-income countries: a cross-sectional international survey"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5090-0328","authenticated-orcid":false,"given":"Linda S","family":"Barnes","sequence":"first","affiliation":[{"name":"Doctor of Public Health Leadership, University of Illinois--Chicago, Chicago, Illinois, USA"},{"name":"American Association of Blood Banks, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Stanley","sequence":"additional","affiliation":[{"name":"Quality Focus, Moraga, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan M","family":"Bloch","sequence":"additional","affiliation":[{"name":"Pathology, Johns Hopkins Medicine, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica B","family":"Pagano","sequence":"additional","affiliation":[{"name":"Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina S","family":"Ipe","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quentin","family":"Eichbaum","sequence":"additional","affiliation":[{"name":"Pathology, Immunology and Microbiology | Medical Education and Administration, Vanderbilt University Medical Center, Nashville, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvano","family":"Wendel","sequence":"additional","affiliation":[{"name":"Hospital Sirio Libanes Blood Bank, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Indrikovs","sequence":"additional","affiliation":[{"name":"Pathology, Northwell Health, Manhasset, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Cai","sequence":"additional","affiliation":[{"name":"Stanford Health Care, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan","family":"Delaney","sequence":"additional","affiliation":[{"name":"Pathology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,2,15]]},"reference":[{"key":"2025101813090460000_12.2.e055017.1","unstructured":"WHO . World health organization model list of essential medicines. Mental and Holistic Health: Some International Perspectives, 2019: 119\u201334."},{"key":"2025101813090460000_12.2.e055017.2","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/j.hoc.2015.11.011","article-title":"Problems and approaches for blood transfusion in the developing countries","volume":"30","author":"Roberts","year":"2016","journal-title":"Hematol Oncol Clin North Am"},{"key":"2025101813090460000_12.2.e055017.3","first-page":"e606-e615","article-title":"The global need and availability of blood products: a modelling study","volume":"6","author":"Roberts","year":"2019","journal-title":"Lancet Haematol"},{"key":"2025101813090460000_12.2.e055017.4","unstructured":"World Health Organization (WHO). . Global status report on blood safety and availability 2016. 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Towards a safe and sufficient blood supply in sub-Saharan Africa. 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Towards 100 % voluntary blood donation a global framework for action. 123, 2010."},{"key":"2025101813090460000_12.2.e055017.32","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.tmrv.2015.02.003","article-title":"Transfusion medicine in sub-Saharan Africa: conference summary","volume":"29","author":"Dzik","year":"2015","journal-title":"Transfus Med Rev"},{"key":"2025101813090460000_12.2.e055017.33","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60696-6"},{"key":"2025101813090460000_12.2.e055017.34","doi-asserted-by":"crossref","first-page":"e323","DOI":"10.1016\/S2214-109X(14)70227-X","article-title":"Global causes of maternal death: a who systematic analysis","volume":"2","author":"Say","year":"2014","journal-title":"Lancet Glob Health"},{"key":"2025101813090460000_12.2.e055017.35","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.16-0735"},{"key":"2025101813090460000_12.2.e055017.36","unstructured":"World Health Organization . 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