Transfusion medicine

Rare blood groups: a drop in the ocean

International collaboration is critical to providing transfusion support to people with rare blood groups.

Speaking at Blood 2018, National Red Cell Reference Manager at the Australian Red Cross Blood Service (ARCBS) Tanya Powley provided a case study of sourcing compatible blood from New Zealand for a patient in Sydney.

She said there were also cases when compatible blood for rare blood groups could not be sourced and ‘least incompatible blood with caution’ was issued.

Ms Powley told the limbic people might like to think it doesn’t happen but ‘least incompatible’ blood was sometimes a necessary option and there was a need to share the outcomes.

“We are very good at reporting and presenting papers when things go wrong. We are not very good at reporting when things go well. So, for example, you might have a particular antibody specificity and we can’t find compatible blood, and if you do a literature search there is very little published information about how clinically significant that antibody is because it is not very common.”

“But then when I email my international colleagues, I’ll get half a dozen experiences of what they have done. So the Rare Donors Working Party for the International Society of Blood Transfusion is trying to collate that information on a global level. One case in Australia is of little value, but when that’s combined with a dozen other cases internationally, then we’ve got a body of evidence.”

Transfusion medicine specialist Dr Philip Mondy agreed that sharing information on rare events was valuable for providing some objective evidence of the likely risk.

“People have been reluctant to report that we did what we could and it was alright,” he said.

Because many of the rare blood groups such as Jk(a-b-) clustered in families and ethnic groups, targeted recruitment and screening and family studies were part of the strategy for building a panel of rare blood group donors.

But there were challenges such as the theoretical risk of inadvertently exposing recipients to a donation from someone who may be a lost family member.

“So when family members provide a directed donation, we do have great policies around that including the need to irradiate the blood to remove the risk of GVHD.”

“But when we want people to be in our donor panel, not for a particular patient, the donor we are going to call on could be a relation and we are not going to know that.”

“There would be protection from that in the routine processing of the blood because it is leucodepleted, and the accepted way of preventing transfusion GVHD is to irradiate the blood,” Dr Mondy added.

He said there were some sensitivities in Australia about asking people for their ethnicity.

“We are increasingly using donor-directed information so we have a donor platform where people can self-report their information. That’s probably the place to do it because there is always going to be a concern about training your staff to ask about ethnicity or heritage.”

“We want this on a platform so the donor can fill in this information themselves at home. It’s important to capture this information as a way of improving our matching.”

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