(P-BB-47) Improving Blood Availability in Blood Deserts of LMICs through Implementation of Civilian Walking Blood Banks: Conclusions from an International Working Group.

Background/Case Studies: Low- and middle-income countries (LMICs) are facing a critical shortage of banked blood. Innovative strategies are urgently needed to ensure the availability of safe and timely blood transfusions in low-resource settings. Civilian Walking Blood Banks (CWBBs) have emerged as a promising strategy to provide emergency blood transfusions in austere civilian setting environments. A WBB is a just-in-time transfusion process that utilizes available blood, whether banked or collected from a donor, for emergency transfusions after screening for transfusion-transmissible infections (TTIs) using rapid diagnostic tests (RDTs) and cross-matching. CWBBs have benefits of rapid mobilization of blood units, on-demand availability in remote areas, and reliance on fresh whole blood for effective treatment of life-threatening hemorrhage.

Study

Design/Methods: Five international experts in transfusion medicine, surgery, public policy, and industry convened for the Innovative Blood Transfusion Strategies for Blood Deserts in LMICs Radcliffe Seminar. Over an eight-week period, the group conducted workshops, literature reviews, three group and two individual interviews. The discussions aimed to outline current applications of WBBs, identify barriers to successful implementation of this strategy, and develop recommendations on large-scale implementation and adoption of WBB in the civilian setting.

Results/Findings: Walking blood banks have been used successfully in military conflicts, natural disasters, and the COVID-19 pandemic but not explored extensively in civilian settings. Successful implementation of a WBB requires supplies, such as validated TTI testing kits, cross-match kits, and blood bags, as well as haemovigilance protocols and donor engagement. Coordination across healthcare authorities, medical providers, laboratory technicians, regional blood banks, and community agents is needed to streamline the CWBB process. Key barriers include legal and regulatory challenges around the safety of RDT testing and the use of fresh whole blood for transfusion. More research is needed to validate the use of RDTs in this setting, and to develop guidelines on appropriate, safe CWBB use, including context-specific best practices. Advocacy efforts should focus on creating policy that not only optimizes the safe application of CWBB, but also bolsters the existing blood banking system.

Conclusions: Rigorous research, implementation, and policy advocacy are needed for successful implementation of CWBBs in settings without reliable access to blood for transfusion. Provided recommendations can support the integration of CWBB into national health systems as a supplementary contingency measure to save numerous lives during emergencies.

Importance of research: CWBBs are a promising contingency strategy for emergency blood transfusions, reducing mortality in facilities where no laboratory-screened blood is available. Blood deserts exist and traditional blood banks are inadequate to meet global needs. Experts identified key components, barriers, and recommendations for CWBB implementation. This study aims to identify next steps for facilitating CWBB implementation in low- and middle-income countries.