Background: Despite blood being lifesaving, it is not always available when needed. Prolonged turnaround time (TAT) and unavailability of blood and its components impact negatively on patient care. At the Kenyatta National Hospital (KNH) medical wards, the current practices of blood and blood components transfusion and the existing gaps and challenges had not been studied. Objective: The main objective of this study was to determine the practices and document challenges associated with blood and blood components use in the medical wards at KNH. Significance of the study: Results from the study have documented the current blood transfusion practices, existing gaps and challenges in the provision of blood transfusion services, and will inform blood transfusion policy formulation at KNH. Methodology: This was a cross-sectional descriptive study carried out at the KNH medical wards and the blood transfusion unit (BTU) in KNH. Blood request forms of patients admitted in the medical wards and healthcare workers working in the medical wards and the BTU were enrolled in the study. A data collection sheet was used to obtain demographic, clinical and laboratory data from in-patient files. The units of blood components transfused and TAT were obtained from the in-patient file 7 days from the date of the request. An open-ended questionnaire was used to document the challenges experienced by healthcare workers. Results: One hundred and thirty-eight blood request forms and 203 healthcare workers were enrolled in the study. Packed red cells were the most frequently requested blood component (29.0%). The transfusion rate was 8.7%. The top five clinical indications for blood and blood components were neoplasms, disorders of blood and blood forming organs, upper gastrointestinal bleeding, infections and chronic kidney disease, in that order. The mean TAT was 2.2 days (SD1.9). The unmet blood demand was 78.9%. Notably, 59.4% of the requests weren’t issued with a single unit of blood. Unavailability and delays in getting blood for transfusion were the most frequently reported challenges by all healthcare workers. Conclusion: The blood transfusion practices in the medical wards were comparable to standard practices in the world. However, the unmet blood demand in the medical wards was very high, with unavailability of blood being the most frequently cited challenge by all healthcare workers.

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