Sankalp India Foundation(r)'s experience with management of Bombay Blood Group shared at the 2nd Annual Conference of Indian Society of Transfusion Medicine, Bangalore on 15th September 2013. Visit www.sankalpindia.net / www.bombaybloodgroup.org
2. Bombay Blood Group?
• Do we all know about it?
• Individuals with the rare Bombay
phenotype (hh) do not have H antigen the
antigen which is present in blood group O
• As a result, they cannot make A or B
antigen on their red blood cells.
• They have anti-H in the plasma and
consequently
– They can donate RBCs to any member of the
ABO blood group system
– but they cannot receive any member of the
ABO blood group system's blood
3. Prevalence
• No comprehensive study done to show
prevelence.
• Estimates for the nation say 1 in 17,000
individuals with high prevelence in Andhra
Pradesh, Tamil Nadu, Karnataka, Maharashtra
and Gujarat – even up to 1 in 4500 in some
areas.
4. Sankalp Emergency Wing
• This team of Sankalp India Foundation works
to ensure that the people who don’t find
blood from the blood banks are helped
• Works on the corner cases of blood
transfusion medicine and extremely rare
blood group requests
• Been handling Bombay Blood Group Requests
for 5 years now.
5. How many requests did we manage?
• Does not include
requests where
we did not help.
• 1 patient counted
as 1 request.28
56
68
118
Total Requests Total Blood Units Requested
Bombay blood group requests
2011-12 2012-13
9. Situation with Detection
• We are not detecting as many BBG as we should
• Not everyone is doing enough Bombay Blood
Group(BBG) tests. Bombay blood group donors
donated several times before being detected and
informed.
• Testing at time of issue it is futile as it leads to
wastage.
• If you are doing components then you are likely
to miss Bombay blood group. Red cells are
compatible and plasma rarely used.
10. False Detection
• Within 2012-13 we have had 5 instances of
incorrect detection of blood group followed by
wrong transfusions causing severe haemolytic
reaction and more complications.
• The patient ended up needing more units of
blood than what would have been required
initially.
11. Problems with Availability
• With 10 units required each month Sankalp pushed the
limits to ensure that each willing donor and each
donated unit was used optimally. Following issues were
observed:
– Several small lists of Bombay Blood Group donors were
being maintained. Sub-critical mass leading to staggered
availability.
– There were attempts to reserve the donors for donations
for specific institutions
– The good donors, who donated regularly were being called
by everyone – emotional blackmail was rampant!
– Remaining units post procedures were not being utilised.
16. Awareness and Education
• Sankalp Patrika shares experience with
Bombay Blood Group every month -
education cum sensitisation.
• All Sankalp blood donation drives has pre-
screening of donors for Bombay blood group
– 1 donor detected
• Media and mass publicity
17. Cold Chain and Logistics
Minimum discomfort to donor.
Minimum cost to patients.
• Temperature controlled logistics for 4, 8 12, and
more than 12 hours.
• Resolution of regulatory and legal requirements
fro transfers .
• Liaison with airlines and blood banks nationally.
• Consideration for poor patients
• Crisis management protocols
18. Aggressive use of alternatives
• Family screening locally
• Use of EPO
• Autologous donations wherever applicable
• Intra-operative blood salvage
• Double red cell donations (not yet used)
• Move to better centres – conservative
procedures and better equipment
19. Recommendations: Blood Banks
• Do BBG test at screening stage for donors
• Communicate collection of BBG immediately
• If unutilised intimate network
• Share donor details
• Learn proper packaging and transportation
essentials
21. Recommendation: Authorities
• Make Bombay Blood Group screening at time
of collection mandatory.
• Make it mandatory for airlines to transport
Bombay Blood Group Units – Possibly free of
charge.
• Come up with a clear policy for national and
international transfer of blood and leave
regulation in the hands of just 1 department.
• Provide facility for cryopreservation – But . .
