Dear Sir,
The incidence of Bombay phenotype blood group has been reported to be around 0.01% in various studies1. The absence of a national rare blood donor programme2 similar to the ones available in the USA3 and Europe4,5 and the de-centralised nature of blood transfusion services in India make it extremely difficult to organise blood for individuals with these rare blood groups when needed.
The Sankalp India Foundation is a non-profit organisation, which has been running a rare blood group network (www.bombaybloodgroup.org) with the voluntary participation of blood banks, individuals with Bombay blood group (BBG), specialists in transfusion medicine and volunteers. The national network aims at making rare blood available when needed, promoting use of alternatives to transfusion, as well as building a rare blood group donor registry and preventing wastage of blood. We would like to share our experience with running the network from 1/07/2012 to 31/03/2014. We created a customised web-based application for the network. Individuals with BBG were invited to enrol. Blood banks were asked to post the availability of BBG units. Hospitals, blood banks and patients’ families were asked to post blood requests. Trained volunteers coordinated the network and ensured that adequate provisioning of blood was done for every patient.
From 1/07/2012 to 31/03/2014, 117 BBG-positive and 16 BBG-negative donors registered on the network, out of which 49% were willing donors from nine different states. Blood banks reported the availability of 40 units. Of the 40 reported units, 14 expired, mainly because the blood banks communicated their availability within a week of the date of expiry.
Requests were received from 11 states and 35 districts. The state-wise distribution of donors enrolled and blood requests received is shown in Figure 1. Requests for 170 units of blood for 81 different patients came through this network. These included 115 units requested for immediate transfusion and 55 units for standby. Help was offered to 95% of requests and 100 units mobilised, of which 50 were donated whereas the other 50 were found off the shelf. Every unit of blood that was collected was subjected to mandatory tests for human immunodeficiency virus, hepatitis B, hepatitis C, syphilis and malaria to prevent transfusion-transmitted infections in the recipient. Figure 2 shows the distribution of demand and the supply of blood units.
Figure 1.
State-wise distributions of donors enrolled and requests received.
Figure 2.
Distribution of demand and supply of blood units.
The most common reasons for blood transfusions were delivery and surgery, each accounting for 20% of the requests, followed by anaemia, which accounted for 16% of all requests.
Pre-donation screening of donors for BBG was encouraged in blood donation camps organised by the Sankalp India Foundation and one donor was detected. It was found that some donors had donated blood several times before they were detected as having BBG. In all 14 units were collected in various blood banks without it being known that the unit was BBG. This highlights the need to screen blood donors for BBG prior to donation.
The rare blood group network has been successful in enrolling donors, providing them a platform for interaction and enhancing their participation in voluntary blood donation from all over the country. The network has enabled blood banks to make optimal use of the units available on the shelf. The network has been effective in providing much required help and assistance to patients for blood requests that came from different parts of the country. It thus also helped in promoting the conservative use of allogeneic blood. Our experience presents a novel, effective and much needed mechanism to manage very rare blood groups2.
Footnotes
The Authors declare no conflicts of interest.
References
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