Background: Blood system deficiencies contribute significantly to preventable surgical mortality in low- and middle-income countries (LMICs). Timely access to safe blood remains a critical quality indicator for emergency care, yet systemic gaps in availability, timeliness, and safety monitoring persist across resource-limited settings. Methods: A mixed-methods design combining a PRISMA-ScR scoping review of LMIC literature (2000–2025) with retrospective analysis of emergency surgical cases requiring transfusion at AIC Kijabe Hospital, Kenya (January–December 2025). Data sources included the Hospital Management System (HMS), manual chart review, and laboratory/blood bank registries. Primary outcomes were blood availability and timeliness; secondary outcomes included mortality, complications, and system performance indicators. Results: This study evaluated blood system performance at Kijabe Hospital through a retrospective review of 2025 operative data, in which 15% of procedures were emergencies and 56 patients required emergency blood transfusion, complemented by a scoping review of LMIC literature, revealing critical systemic weaknesses likely contributing to adverse outcomes. In 2025, Kijabe Hospital performed 9,491 surgeries, of which 1,457 (15.4%) were emergencies. 56 patients (median age 35 years; 53.6% male) requiring emergency blood transfusion were included, primarily for surgical (60%), obstetric (29.1%), and trauma (23.6%) indications. Blood was unavailable at the initial request in 26.5% of cases, with a median time to availability of 1.25 hours; 44% of cases had missing data for this critical metric. The system relied entirely on in house stock (84.0%) and family replacement donors (28.0%), with no emergency voluntary donor mobilization. Key documentation gaps included missing clinical indications (28%), hemoglobin values (16%), and cold chain monitoring (46%). In-hospital mortality was 29.5%, 40.4% of patients experienced complications, and 57.1% required ICU admission. A scoping review of 64 studies confirmed consistent LMIC patterns: 15–35% stockout rates, 40–80% dependence on family replacement donors, 2–6 hour median delays correlating with adverse outcomes, and incomplete safety monitoring. Conclusions: Systemic weaknesses in blood availability, donor systems, timeliness, and documentation at Kijabe Hospital mirror broader challenges in LMICs. Evidence-based interventions, including emergency voluntary donor registries, standardized documentation systems, maximum delay thresholds, and enhanced safety monitoring, may support efforts to reduce preventable surgical mortality in resource-limited settings.
Dieudonné A Lemfuka (Thu,) studied this question.