Background:Blood transfusion is lifesaving for patients experiencing acute blood loss and severe anemia. In low- and middle-income countries (LMIC), availability of blood products impairs timely blood transfusion. A transfusion service (TS) is a clinical laboratory preparing blood products for patients. TS capabilities at the hospital level may contribute to preventable patient outcomes. We sought to learn more about the practices, capabilities, and challenges of TSs in LMIC . Materials and Methods: A cross-sectional survey explored hospital-level TS access to blood supplies, testing methods, policies, and structure. Surveys were administered in English, Spanish, French, and Russian, followed by a mixed methods analysis. Results: Responses (71) from 124 invitations comprised 50 TSs from 27 nations in low (4), low-middle (11), and upper-middle (12) income countries. Most LMIC TSs collected blood (36, 77%); only 11 (23%) relied on an external supply of blood products. Testing methods varied. The top reason for blood transfusion was adult anemia for non-malignant conditions (17, 15%). Blood transfusion delays (17, 57%) primarily involved inadequate blood supplies (15, 54%). Additional challenges involved educational access (8, 27%), financial models (4, 13%), or other barriers (8, 27%). Conclusions: This is the most-comprehensive survey into the status of hospital TSs in LMIC. Availability of blood products remains a dominant problem, requiring TSs to generate the facility’s blood supply. Blood shortages effect delays that are rarely reported as a patient-specific adverse event. Continued education and multi-disciplinary transfusion approaches were lacking. Safe and available blood transfusion extends beyond the TS, to governments and society. Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: The Children’s National Health System IRB provided ethical review for the protection of human subjects.
