Life, death and rapid diagnostic tests in the world's blood deserts

Abstract

BACKGROUND AND OBJECTIVES: Millions of people globally reside in 'blood deserts', where systemic barriers prevent timely access to safe blood components. Lodwar County Referral Hospital (LCRH) in Turkana County, Kenya, is a district hospital lacking on-site testing capacity for transfusion-transmissible infection (TTI) screening, resulting in critical transfusion delays. We present three cases in which validated rapid diagnostic tests (RDTs) could have facilitated point-of-care donor screening and transfusion in life-threatening situations. PATIENTS AND METHODS: We present three cases of critically ill patients-two teenagers and an elderly woman-who presented to LCRH over the course of a single week. RESULTS: Each patient required emergent transfusions but experienced fatal delays along various points in the transfusion continuum due to the inability to rapidly screen available donor or banked blood for TTIs. CONCLUSION: These cases illustrate how delays in TTI screening can directly contribute to preventable mortality, even when blood is otherwise available. They highlight the urgent need for standardized, contextually appropriate emergency transfusion protocols that formally incorporate RDT use. Our experience suggests that such protocols may reduce transfusion delays, improve access to lifesaving blood and serve as a scalable model for improving blood access in rural and remote 'blood deserts' around the world.