Importance of confirming Blood Group

Sankalp helpline gets a minimum of 3 to 4 Bombay blood group requests every month from all parts of the country. With such flowing requests and very few eligible donors available it has become very much a necessity to request donors to donate every three months and motivate more Bombay blood group donors who are not aware about the scarcity and need of this unit.

This time we got a case from a remote place in Davangere where the patient was diagnosed for kidney disorder and had to undergo dialysis. His hemoglobin was found to be less than 4g/dl and treating doctors insisted for a unit to be transfused before they began the treatment. The patient's sister was asked to arrange for one unit. She called majority of the blood banks and enquired for the unit only to hear a no from the blood banks.  When our volunteers received a call from her for this unit, we realised the panic state her family had been in the last two days. The hospital in Davangere had asked them to move to Mangalore as the unit was not available in Davangere. When they moved to Mangalore, it was the same story there too and the patient was moved back to Davangere.

Sankalp conducts blood donation camps in various colleges and IT companies throughout Karnataka. And during these camps we get many first time donors who are not aware of their blood groups. So, we requested the blood banks not only to do a basic blood grouping test but also to perform the H antigen test which is used to detect if the donor has Bombay blood group. This test is done if the donor is found to belong to O+ blood group in the basic blood group test. The presence or absence of H antigen determines if the donor belongs to O+ or Bombay positive. Bombay blood group lacks the H antigen. If the donor is found to belong to Bombay+, we explain to him / her the rarity of this blood group and make a request to him / her not to donate at the blood camp and donate only when there is a emergency.

We recently came across such a donor, Arun(name changed) in one of the camps. He had shown his full support and agreed to donate during any emergency. So when we got a request from Davangere, we initially tried to contact donors from Davangere and nearby districts but none of the donors were eligible to donate. So we tried to contact donors from Bangalore for donation. When Arun was contacted he immediately agreed to donate . We informed the patient's sister about the donor and they agreed to come down and collect the unit. 

Arun donated in the blood bank and the patient's relative came down all the way from Davangere with the patient's sample to collect the unit from the blood bank. But the blood bank claimed that the cross match test failed for the two samples.

What happened? The donor did go to the blood bank and donated the unit. As the donor was told he was Bombay positive, he informed the blood bank the same and donated. The blood bank collected the unit without any pre-donation blood group test. Later when the donors sample was matched with that of the patient, the cross match failed. This is because the donors blood group was not Bombay positive but it was O+. The patient side had to return back to Davangere empty handed and we had to immediately speak to other donor and get him donated so that the patient side could come down to collect the unit next day.

This scenario could have been easily avoided if the blood bank had initially checked for the donors blood group. But, the donors blood group had been detected as Bombay positive. There had been a mistake. One way to confirm if the donor belongs to Bombay positive is to perform reverse blood grouping test on the donors blood sample as a confirmatory test. Reverse typing is another method of testing the patient's blood for the presence of ABO antibodies. In this case the patient's plasma is mixed with known red blood cells in a test tube and checked for any coagulation. Because of the presence of H antibody in the Bombay blood group blood plasma, this sample will coagulate with A, B and O red cell sample.

If the above test was done when the blood bank informed the donor that he had Bombay blood group, we would have prevented the unnecessary trouble and tension the patients relative had to undergo in order to arrange for one single unit.

Wrong detection of Bombay blood group can cause unnecessary confusion among the donors and patient relatives. What if there is an emergency and the patient whose blood group is O+ was detected to be a Bombay blood group person. The patient side would have to struggle to get even a single unit even though we would have O+ units readily available in majority of the blood banks.

One such incident was during an urgent requirement of Bombay Blood Group unit for a thalassemia patient for whom we tried contacting several Bombay Group donors. Unfortunately most of them were either unavailable or not eligible. We kept the search on and finally managed to get a donor who readily agreed to donate. The donor came to donate along with his father as he was donating for the first time. Medical history, hemoglobin and general well-being everything was fine. But when the Blood grouping was performed we were shocked to know that it was not Bombay Blood Group. He was found to be O+. We got the group verified from another Blood Bank. Result was the same.

The patient initially claimed that around one and half years back he underwent a surgery and his blood group was found to be Bombay positive. The patient side had to take up an intense search to find one unit of Bombay positive blood group, even though multiple O+ units was available in the blood bank.

If you are associated with the blood banking community, we request you to

1. Ensure that reverse blood grouping test is done for every unit or donor / patient sample that is detected as Bombay blood group.
2. Ensure that every O+ patient / donor sample is further checked if it belongs to Bombay blood group in order to prevent wrong transfusion of O+ to Bombay blood group.
3. Ensure that the donors blood group is detected and confirmed to him / her before donation.

Sankalp Unit
Patrika Section