How a rare blood type is challenging India

Indians are far more likely to test positive for the Bombay Blood Group than those living in the West because of the higher prevalence of marriage between blood relations, reports Samanth Subramanian.

An Indian student donates blood on National Voluntary Blood Donation Day in Hyderabad on October 1, 2013. Noah Seelam/AFP Photo

NEW DELHI // A month after Swapna Sawant donated blood for the first time 10 years ago, a local hospital phoned her with an alarming message.

“We need to tell you some facts about your blood,” said a doctor at the Bhakti Vedanta Hospital in Mumbai. “Meet us urgently.”

Recalling the incident, Ms Sawant, who was 21 at the time, said she was scared.

Her father was not home, so she went with a friend to see the doctor who had phoned.

“But then the doctor said that I had a rare blood group, the Bombay Blood Group,” she said. “I heard that, and I was so relieved.”

According to academic statistics, roughly 1 in 17,000 people in India test positive for the Bombay Blood Group, a type that falls outside the regular A, B, O and AB groups and which was discovered by scientists in Bombay – now Mumbai – in 1952.

Ms Sawant’s blood type does not affect her daily life in any way, but her doctor warned her to be cautious. If she ever needed a blood transfusion, it would be difficult to get the right type.

Worse still, said Rajat Agarwal, a volunteer with the Sankalp India Foundation, a Bengaluru-based NGO, many people with the Bombay Blood Group never find out, and when they need a transfusion, their blood type could be incorrectly diagnosed as O.

A mistaken transfusion can destroy the recipient’s kidneys or even prove fatal, which is why Sankalp and another NGO, the Mumbai-based Think Foundation, maintain registries of people with the Bombay Blood Group, hoping to call upon them during emergencies.

Both NGOs work extensively in the field of blood donation. The Think Foundation was set up to help children with thalassaemia, a group of inherited blood disorders affecting haemoglobin production, said its vice president, Vinay Shetty. But along the way, realising the need to network with hospitals, donors and doctors to help Bombay Blood Group patients, the NGOs began to keep registries of these individuals.

“Even four years ago, it would only be hospitals in the big cities who would be calling us and giving us the details of a newly discovered Bombay Blood Group individual,” Mr Agarwal said. “Now, though, even district hospitals in the remote corners of India are calling us.”

Each NGO’s registry has about 150 names, although not everyone on the list is willing or able to donate blood. Mr Agarwal and Mr Shetty estimate that they each have 50 viable donors – barely sufficient to keep up with the one request per week that they get on average for blood of this type.

The Bombay Blood Group was discovered by accident, when a patient from a railway accident was brought to the Seth Gordhandas Sunderdas Medical College. While testing for the patient’s blood type, a team led by Dr YM Bhende found that the patient’s red blood cells were clumping in an unusual manner, indicating a previously unknown blood group.

Three months later, a patient with a stab wound displayed a similar type of blood. “Then the doctors ran a deliberate screening, testing hundreds of people over eight months, and they found a third person with the same blood group,” said Girish Vyas, who joined the college as a postgraduate student just a couple of years after these tests, and who worked with these doctors on the Bombay Blood Group.

Dr Bhende and his team published their discovery in the medical journal Lancet in 1952.

Dr Vyas, now 81 and living in San Francisco, said further research has since established that the Bombay Blood Group occurs relatively more in India than in the West “because of consanguineous marriages (between blood relations). Some communities have a practice in which a man can marry his maternal uncle’s daughter.”

Such practices help propagate the gene that encodes the blood group, Dr Vyas said.

In Europe and the United States, the Bombay Blood Group occurs in one person in a million, or perhaps even more rarely.

Even six decades after the discovery of the Bombay Blood Group, it is often overlooked in blood screenings. Mr Agarwal said a greater awareness of the type had to be spread within the medical community before screenings started to test routinely for the group.

Its rarity presents massive challenges. In one case, a little girl in Hyderabad had a negative version of the Bombay Blood Group – five times rarer still than the positive type.

“The doctor said we needed four units of blood,” Mr Agarwal recalled. Fortunately, the surgery for which the blood was needed was not urgent.

“It took us eight months to track down four such donors who could give blood,” he said.

Mr Shetty’s NGO once flew Bombay type blood to a patient in Dhaka, Bangladesh. The cost of transporting blood by air can be anywhere between 1,500 (Dh87.8) and 3,000 rupees per unit, and is frequently borne by the NGOs.

However, both NGOs operate mainly within a relatively small area: Sankalp mostly in south India and the Think Foundation mostly in Mumbai and its environs. Their presence in the north of the country is relatively weaker.

Mr Shetty said a nationwide registry and blood bank was needed to find more potential donors and get them to donate.

This is the best way to save lives, he said.

“Blood donation is not about having a list of donors, but ensuring that the blood is already there in the bank.”