Preventing overfilling of blood bags to reduce clot formation and improve donor safety

BACKGROUND AND OBJECTIVES: Overfilling of blood bags is common in low-resource settings, causing clot formation, donor and recipient risks and blood wastage. This study assessed overfilling prevalence and evaluated a low-cost intervention to mitigate it. MATERIALS AND METHODS: We conducted a prospective study across six blood banks in Kano, Nigeria, weighing 131 blood bags and examining clot formation in 688 consecutive units. A simple, manual measuring and mixing (MeMi) device was developed and implemented to prevent overfilling. RESULTS: Before intervention, 129/131 blood bags (98.5%) exceeded the 612 g upper limit (mean: 711 g; range: 560-888 g). Systematic assessment revealed macroclots in 72/688 bags (10.5%; 95% confidence interval [CI]: 8.18-12.76). After MeMi use, 658/723 bags (91%) met the target weight (500-612 g), while 2 were overweight (629 g, 639 g) and 63 underweight (265-499 g). Clot incidence dropped to 1.9% (95% CI: 0%-5.1%). CONCLUSION: Overfilling of blood bags poses serious safety concerns in low-resource settings. The MeMi device provides a practical, low-cost mechanical solution without needing electricity. Locally producible for ~€15, it significantly reduces overfilling and clotting. This improves safety for donors and recipients. Its simplicity and affordability make it highly scalable across regions like sub-Saharan Africa.