The document discusses the rare Bombay blood group (hh phenotype) which lacks the H antigen and highlights the challenges faced by the Sankalp India Foundation in managing blood requests for this group. With an estimated prevalence of 1 in 17,000 individuals and specific difficulties in detection and availability, the foundation recognizes the need for better screening practices and donor engagement. Recommendations include mandatory screening at blood collection, improved logistical support, and crisis management protocols to optimize blood donation and usage.

1. Our Experience With Bombay
Blood Group
Sankalp India Foundation®

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

6. Where are the blood requests coming from?

8. Our Experience
of Relevance to Blood Banks

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.

12. Managing Bombay Blood Group

14. WWW.BOMBAYBLOODGROUP.ORG

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

20. Recommendations: Donors
• Connect and network
• Keep hemoglobin high
• Screen all family members – whether they can
donate or not!

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 . .

22. Questions

23. Thank you 