The Bombay blood type: A rare blood group in urgent need of database

Minu, 42, a resident of Raipur, Lakshmipur, had been diagnosed with cervical cancer. She desperately needed blood for a surgery.

A quick test revealed her to be O-positive. Two bags were arranged and on a Thursday, she underwent the operation.

Later on 20 January, when she needed another bag of blood, doctors at the Bangabandhu Sheikh Mujib Medical University (BSMMU) Transfusion Department conducted another blood test.

That's when a fatal error was discovered: Minu was not O-positive!

Her blood was identified as the hh, or the Bombay blood group a rare blood type.

The Bombay blood - named after its discovery in Mumbai (formerly known as Bombay) in 1952 by Dr YM Bhende - has an incidence of one in 4 million.

The result of Minu's blood test led to a mad scramble.

During the surgery, Minu's kidney failed. She was admitted to the ICU at the BSMMU on 21 January. 

Her family members took to social media to appeal to possible donors. The post went viral and two donors came forward. But it was too late. Minu lost her battle while under the knife on Monday.

While the Bombay blood group is one of the rarest in the world, a shared ancestry in the sub-continent means it has a higher incidence here in Bangladesh.

Even then, one in every 17,600 people in India or one in every 25,000 people in the world have this blood group. Bangladesh has no national database on how many people receive the blood in the country.

Since Minu's death, the BSM- MU has identified more than 30 people with the blood group.

Unique, expensive

The chemicals needed for correctly identifying the Bombay group are more expensive and only sometimes available, Dr Ashraful Hoque, assistant professor at the Blood Transfusion Department of the Sheikh Hasina National Institute of Burn and Plastic Surgery, told The Business Standard.

He said the chemicals expire in six months and are not available in all hospitals. The BSMMU, being a university, has more access to these chemicals.

"When we suspect a blood group to be Bombay, we send the blood to the BSMMU," he said.

Dr Ashraful Hoque said the blood group's unique feature is that it cannot be donated to other groups and nor can any other group donate to people with the Bombay blood type.

Therefore, it is necessary to create a blood database of this rare group, so that blood donation can be facilitated in emergencies, he said.

Like other rare blood groups, the Bombay type can be processed and kept refrigerated for up to seven years. Dr Ashraful said such an initiative should be undertaken.

Doctors said if someone has blood group A, the person has the antigen of type A and antibody of type B in their blood.

People with the AB group have both A and B antigens in their blood and no antibodies.

People with the O-type have only antibodies A and B and no antigens. However, what is not generally known is that all these groups also have an antigen H in the blood.

The H antigen is present in 99.9% of red blood cells.

In hh, there is a lack of the H antigen on the red cell membrane and anti-H in the serum. It fails to express any A, B or H antigen on the red cells or other tissues.

Dr Ayesha Khatun, professor, Department of Transfusion Medicine, BSMMU, who has worked with the blood group for a long time, told TBS that Bangladesh has 33% more positive blood groups. People should ensure their blood type is confirmed.

"If the blood grouping is done correctly, Bombay or OH can be determined initially. During blood grouping, if a positive blood group is found, those involved in transfusion and those with positive blood should be careful."

She also said she had proposed setting up a donor group with those with the Bombay blood type.

Professor Dr Syeda Masooma Rahman, consultant, Safe Blood Transfusion Programme, the Directorate General of Health Services, said, "Nationally, there is no database of how many people have the Bombay group blood. The demand of this group is very low; if the demand increases then the database will be created."

The saviours from Mumbai

On 21 May 2016, Kamruzzaman, a 25-year-old man was severely injured in a traffic accident. He was admitted to what was then Apollo Hospital in Dhaka with multiple fractures and displacement of the pelvis.

He required immediate orthopaedic surgery.

In this situation, urgent blood transfusion was needed and doctors found that his blood group was incompatible with the most common types.

Later, the BSMMU discovered that Kamruzzaman had the rare Bombay blood group.

The higher-ups of the plastic factory where Kamruzzaman was an employee began a search all over the city, calling every hospital and blood bank.

No one had heard of the blood group. Even leading blood banks in Bangladesh were caught unawares.

Thus began a frantic online and offline search which connected them to Think Foundation, a Mumbai-based NGO.

They found that there was a robust blood distribution network in India. Less than 400 people were known to have the Bombay blood group and only a few were traceable donors.

Finally, four people from Mumbai donated blood to save Kamruzzaman.

On 20 June, the blood arrived in the country and Kamruzzaman underwent an operation, after which he recovered.

Kamruzzaman was one of the lucky ones. Experts now urge steps so more such success stories can be replicated in the country.