Trends in Blood Product Utilization at a Military Hospital in the Sahel (2021-2024)

Blood transfusion is a key aspect of the resuscitation of wounded casualties, yet blood product availability is often limited in low-resource conflict settings. Burkina Faso is a low-resource conflict setting in the Sahel region of West Africa. In Burkina Faso, the National Blood Transfusion Center (Centre National de Transfusion Sanguine; CNTS) is currently the only authorized institution to provide oversight for blood products, yet its coverage is insufficient. The current security context, characterized by widespread effects from terrorism including conflict-related injuries, leads to a constant strain on military health facilities which must meet increasing needs for blood products. This study aimed to examine the evolution of blood product utilization at Captain Halassane Coulibaly Military Hospital (l'Hôpital Militaire Capitaine Halassane Coulibaly; HM-CHC) over the past four years.

We conducted a retrospective observational study over a 48-month period from January 2021 to December 2024. The study population consisted of patients who had received a blood transfusion at HM-CHC regardless of sex, combatant status, or clinical indication. We examined variables including patient demographics, indication for transfusion, injury characteristics among trauma patients, and blood product utilization.

Four hundred thirty-five patients received at least one transfusion with a total of 1,405 units transfused. The median age of the patients was 38.3 years. War wounds including ballistic trauma and injuries related to improvised explosive devices (IEDs) were the most common indications for transfusion 85.3% (n = 371). Between 2021 and 2024, the average number of blood products used per transfused patient increased from 2.55 to 3.53 units. Packed red blood cells were the most frequently used, accounting for 93.2% of transfused units (n = 1,309).

Over the past four years there has been an increase in blood product utilization at HM-CHC. This may reflect both increasing awareness of the importance of blood as part of resuscitation of the wounded, as well as increasing need for blood products due to the volume and acuity of casualties. Further research is required to understand the relationship between supply and demand for blood products at other treatment facilities in the study setting. Operationalization of a separate entity for blood transfusion within the military medical system of Burkina Faso may allow for self-sufficiency in supplying military medical units with blood products. In addition, the introduction of whole blood and freeze-dried plasma to address cold chain constraints, particularly closer to the battlefield, may improve casualty care in the study setting.