Characterization of the Allogeneic Blood Supply and Demand Deficit in Surgical Patients in Malawi

In 2003, the Ministry of Health established the Malawi Blood Transfusion Service to streamline blood collection and management. However, the availability and timely distribution of blood products for surgical patients is unknown. This study characterizes the supply and demand deficits in blood products for surgical patients in this setting.

We conducted a prospective cohort study at Kamuzu Central Hospital, Lilongwe, Malawi, from October 2024 to May 2025. We captured patient demographic data and information on the date of request, the units, and the type of requested blood product. We also stratified patients by hemoglobin level, categorized as >7 or ≤7 g/dL.

Among the 826 patients with a blood transfusion request analyzed, the median age was 44 (range, 32-56). The initial mean hemoglobin level for these patients was 8.3 ± 2.37 g/dL. The groups with hemoglobin levels >7 or ≤7 g/dL had a supply-demand deficit of 243 units (21%) and 185 units (22.6%), respectively. A greater proportion of patients with hemoglobin levels ≤7 g/dL were transfused (88.6% versus 75.6%) and received, on average, more units 3 (2-4) versus 2 (1-2) P < 0.001. We found that hemoglobin level and surgery status impact the odds of transfusion. Logistic regression predictive probability modeling showed that as hemoglobin levels rose, the probability of transfusion decreased.

In this study, we demonstrate a significant blood supply-demand deficit of 21.7% in a surgical cohort. Patients with severe anemia (hemoglobin ≤ 7 g/dL) were more likely to receive a transfusion than patients without; however, this cohort had a larger blood supply-demand deficit.