The Problem
Blood loss is the leading cause of preventable traumatic injury-related death. Each year, an estimated 6 million people die from traumatic blood loss, and 90% of these deaths occur in low- and middle-income countries (LMICs), where access to blood products is severely limited. In contrast, patients who experience severe blood loss in well-developed trauma systems, such as the United States, have a much higher chance of survival due to ample blood supply, proper storage, and the accessibility of trained professionals who can begin transfusions immediately.
In many parts of the world, particularly LMICs, hundreds of millions of people live in “blood deserts” where the nearest blood bank may be hours away. In these areas, a lack of blood products can result in mortality rates from traumatic blood loss as high as 60 percent.
The Approach
To address this crisis, the United States military has designed an innovative solution known as a “walking blood bank.” In this model, blood donors are called upon in times of emergency, their blood is tested using point-of-care rapid diagnostic tests (RDTs), and healthy blood is immediately transfused to critically injured patients. While this strategy has proven effective in military settings, it is not widely understood or implemented in civilian healthcare. Paired with concerns about the risk of transmissible infections (such as HIV, Hepatitis, and Syphilis), the broader adoption of civilian walking blood banks (CWBBs) has been hindered, posing a challenge to scale this lifesaving approach.
Nakul Raykar, MD, MPH, a trauma and acute care surgeon at Brigham and Women’s Hospital, received the 2023 Stepping Strong Breakthrough Award to establish a formal protocol for a CWBB at Lodwar County Referral Hospital (LCRH), located in one of Kenya’s most remote and medically underserved regions.
With the support of the Stepping Strong Innovator Award, Dr. Raykar and his team found that sufficient blood was not available 40% of the time at LCRH, and limited blood screening capacity delayed infection testing for up to two weeks. The implementation of point-of-care RDTs revealed a 99.2% negative predictive value for transfusion transmissible infections, and frontline healthcare providers at LCRH learned how to design context-appropriate CWBBs tailored to the specific needs of their setting.
Building on the demonstrated need, safety, feasibility, and desire for a CWBB, Dr. Raykar is piloting an emergency transfusion protocol at LCRH. This will include evaluating the effectiveness of the CWBB model and assessing its potential for adaptation in other low-resource settings facing similar blood shortages. The Local Initiative For Emergency Blood Transfusion (LIFEBlood) Study aims to provide proof-of-concept and generate evidence-based recommendations for the wider adoption of CWBBs, to alleviate the global blood crisis.
What’s Next?
Leveraging the momentum from this research, Dr. Raykar’s team formed the Blood D.E.S.E.R.T. Coalition (Blood Delivery through Emerging Strategies for Emergency Remote Transfusion) to advance research, education, and policy initiatives aimed at making blood transfusions accessible in the world’s poorest settings.
To implement the CWBB at LCRH, Dr. Raykar’s team created two key working committees. The first includes prominent Kenyan officials focused on policy and advocacy, who have played a crucial role in navigating local political systems to gain approval for the CWBB model. The second committee is dedicated to documenting the project’s impact through filmmaking, capturing interviews with frontline healthcare workers who can speak to the severity of blood shortages and how a CWBB offers a vital solution.
The team’s lifesaving work has opened wider discussions on WBBs and other emergency transfusion strategies at major conferences including the Association for the Advancement of Blood & Biotherapies, the International Society for Blood Transfusion, and the Harvard Radcliffe Institute. To date, their findings have been published more than 10 times, including in The Lancet Global Health, further solidifying the significance of this model on the global health community.
