By PPH Foundation

When a mother experiences postpartum haemorrhage (PPH), the urgency is visible in the delivery room. Healthcare workers move quickly to control bleeding, stabilise her condition and determine whether she needs a blood transfusion. Less visible, but equally important, is the work happening in the blood transfusion laboratory, where donated blood is tested and compatibility is established before it can be safely issued for transfusion (World Health Organization, 2010).

PPH can cause rapid and severe blood loss, making timely access to appropriate blood components an essential part of emergency obstetric care. However, having blood donations available does not automatically mean that suitable blood is ready for a particular patient. Laboratory professionals help ensure that the blood selected is compatible with the recipient and that the required safety checks have been completed (World Health Organization, 2010; World Health Organization, 2025).

The process begins with correct patient identification and a properly collected blood sample. Laboratory staff establish the patient’s blood group, screen for clinically significant antibodies and perform compatibility testing, including crossmatching when required. Donated blood also undergoes screening for transfusion-transmissible infections under established blood safety procedures. These safeguards help reduce the risks associated with incompatible transfusions and infected blood, while supporting clinicians in making urgent treatment decisions (World Health Organization, 2010).

For a woman bleeding heavily after childbirth, these procedures must be completed within a system that balances safety with speed. Delays can arise when blood stocks are inadequate, samples are incorrectly labelled, testing capacity is limited or communication between the clinical team and the laboratory is poor. Emergency protocols, clear communication and adequate staffing are therefore essential. Where immediate transfusion is necessary, clinicians must follow established emergency-release procedures and clinical protocols to avoid unnecessary delays while maintaining patient safety (World Health Organization, 2010; World Health Organization, 2025).

Research in Kenya illustrates the importance of strengthening the entire transfusion chain. A 2024 study examining blood and blood-component use at the Kenyatta National Hospital maternity unit found that postpartum haemorrhage was the most common indication for transfusion among the women studied, accounting for 34.5% of transfusion indications. The study also found that the need for blood and blood components was not fully met: 65.4% of participants had their needs met, while the deficit in blood units ordered was 12.4%. The researchers concluded that shortages affected both the number of units and the types of components required (Wakoli et al., 2024). These findings highlight the importance of adequate supplies, effective laboratory services and coordination between maternity units and blood banks.

Prof Julius Ogeng’o, a professor at the University of Nairobi and a Co-Lead of the EndPPH Initiative, has also emphasised the need for better coordination in blood access. Speaking about the Rural Outreach and Mobilization Initiative for Network Growth (ROAMING Blood) initiative, he said: “All hospitals who subscribe to the network will be able to reach out just by a click of a button to get blood, saving patients.”

ROAMING, which stands for Rural Outreach and Mobilization Initiative for Network Growth, is part of PPH Foundation’s efforts to strengthen access to blood through a connected network of blood services (PPH Foundation, 2025). Although the initiative addresses access to blood across the health system, connecting hospitals and blood suppliers must go hand in hand with reliable testing, compatibility checks and safe distribution. A network can help hospitals identify where blood is available, but laboratory procedures remain essential in determining whether a unit is suitable for the patient who needs it.

A 2025 Cochrane review examining the transfusion of blood and blood products for the management of postpartum haemorrhage found that evidence on the effects of different transfusion strategies remains uncertain. The authors concluded that the available evidence was insufficient to draw firm conclusions about several important maternal outcomes (Williams et al., 2025). This highlights the need for careful clinical assessment, appropriate protocols and further research, rather than assuming that one transfusion threshold or approach will suit every emergency.

Preventing avoidable maternal deaths therefore requires investment beyond blood donation campaigns. Laboratories need trained personnel, dependable reagents and equipment, quality assurance systems, adequate blood stocks and effective communication with maternity and emergency teams. Hospitals must also maintain clear procedures for requesting, testing, issuing and transporting blood, including arrangements for emergencies outside routine working hours. Evidence from referral hospitals in Kenya has identified gaps in the quality and timeliness of PPH care, reinforcing the need to strengthen the systems that support emergency response (Clarke-Deelder et al., 2023).

When a mother is losing blood, the laboratory may be out of sight, but its role is central to safe care. Every correctly identified sample, compatibility test and timely release of suitable blood contributes to the clinical team’s ability to respond. Strengthening this often-unseen part of maternal healthcare is an important step towards ensuring that women experiencing postpartum haemorrhage receive safe, appropriate blood when they need it most.

References

1. Clarke-Deelder, E., Opondo, K., Achieng, E., Garg, L., Han, D., Henry, J., Guha, M., Lightbourne, A., Makin, J., Miller, N., Otieno, B., Borovac-Pinheiro, A., Suarez-Rebling, D., Menzies, N.A., Burke, T., Oguttu, M., McConnell, M. and Cohen, J. (2023) ‘Quality of care for postpartum hemorrhage: A direct observation study in referral hospitals in Kenya’, PLOS Global Public Health, 3(3), e0001670. Available at: https://doi.org/10.1371/journal.pgph.0001670.
2. PPH Foundation (2025) PPH Insights. October 2025. Available at: https://endpph.com/assets/media/newsletter-docs/1765523441336950.pdf.
3. Wakoli, E., Gwako, G., Owende, P., Ogutu, O., Odongo, E. and Karanja, J. (2024) ‘Prevalence and pattern of blood and blood component utilization at the Kenyatta National Hospital maternity unit in 2022–2023: A cross-sectional study’, Journal of Obstetrics and Gynaecology of Eastern and Central Africa, 36(1). Available at: https://doi.org/10.59692/jogeca.v36i1.164.
4. Williams, C.R., Huffstetler, H.E., Nyamtema, A.S., Larkai, E., Lyimo, M., Kanellopoulou, A., Robertson, L., Choi, L. and Alwy Al-Beity, F.M. (2025) ‘Transfusion of blood and blood products for the management of postpartum haemorrhage’, Cochrane Database of Systematic Reviews, 2, CD016168. Available at: https://doi.org/10.1002/14651858.CD016168.
5. World Health Organization (2010) Aide-mémoire for national health authorities and hospital management: Clinical transfusion process and patient safety. Available at: https://www.who.int/publications/i/item/WHO-EHT-10.05.
6. World Health Organization (2025) Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage. Geneva: World Health Organization. Available at: https://www.who.int/publications/i/item/9789240115637.
7. Image by DC Studio on Magnific</a>