Exploring intraoperative autotransfusion in a blood desert: A single-centre study in Turkana County, Kenya

Blood unavailability contributes to morbidity and mortality in low- and middle-income countries (LMICs). Intraoperative autotransfusion (IAT), a technique to obtain and re-transfuse blood lost during surgery, presents a safe alternative during shortages. Despite increased device development, limited research has outlined the need and potential impact of IAT in LMICs. Our study aims to quantify and characterize IAT-eligible surgical cases in Turkana County, Kenya.

Researchers followed surgical cases with pooled, uncontaminated blood loss over 500 mL (IAT-eligible) at a regional referral hospital across 2 weeks in January 2025. Data on blood loss, transfusion and clinical status were collected via direct observation and chart review. A matched retrospective review of hospital and county referral records was completed from January to December 2024.

Nine of 90 surgical cases in the 2-week prospective period were IAT-eligible. Blood loss ranged from 550 to 3500 mL, and diagnoses included splenic injury, ruptured uterus, perineal tears, caesarean section and femur fracture. Retrospective review identified 53 of 1779 surgical cases as IAT-eligible: 24 ruptured ectopic pregnancies, 10 splenic injuries, 9 uterine ruptures, 3 chest injuries and 7 blunt abdominal traumas. Among 321 county-referred surgical cases, 42 (13%) were IAT-eligible.

At a rural Kenyan hospital, IAT-eligible surgeries compromise 3%-10% of surgical cases and 13% of county-level referrals. Ruptured ectopic pregnancy and splenic injury were the most common IAT-eligible conditions and potential high-yield targets for implementation. IAT may present a useful adjunct to improve blood availability in hospitals facing shortages.