Demand for the blood type has coincidentally spiked at hospitals, but supply has been scarce. Each red blood cell has antigen over its surface, which helps determine which group it belongs to. For instance, in the AB blood group, both antigens A and B are found.
A will have A antigens; B will have B antigens. In hh, there are no A or B antigens. Globally, the hh blood type has an incidence of one in four million.
It has a higher incidence in South Asia; in India, one in 7, to 10, are born with this type. Dr Arun Thorat, in-charge of Maharashtra State Blood Transfusion Council, said this blood type is more common in South Asia than anywhere else because of inbreeding and close community marriages. Shared common ancestry among Indians, Sri Lankans, Pakistanis and Bangladeshis has led to more cases of hh blood phenotype in this region. To test for hh blood, an Antigen H blood test is required.
Often the hh blood group is confused with the O group. The difference is that the O group has Antigen H, while the hh group does not. There is no reported case in literature of a Bombay blood group from Nepal, and its prevalence in Nepalese population is unknown. Our primary concern in this case was the arrangement of blood for transfusion as she had placenta previa which put her at high risk for hemorrhage. We also anticipated difficulties at surgery and increased blood loss due to adhesions as she had history of myomectomy and endometriosis.
Autologous blood transfusion was planned due to unavailability of homologous blood of the same group. It is widely performed in scheduled operative procedures to avoid or reduce risks of homologous blood transfusion [ 7 ]. Priye et al. Three units of autologous blood was collected over three weeks and transfused in the postoperative period [ 8 ].
Autologous blood donation during pregnancy is not as commonly done as in nonpregnant since it can in itself lead to maternal and fetal complications like exaggeration of anemia in the mother, vasovagal symptoms, and fetal heart rate abnormalities.
Several studies have shown autologous blood storage during pregnancy to be relatively safe for both mother and fetus and to be feasible transfusion practice [ 9 ]. Others however proposed the need for reappraisal in obstetric patients [ 10 ]. Yamada et al.
Apart from iron supplementation and preoperative autologous donation, acute normovolaemic haemodilution and the use of cell salvage system are other alternatives to allogenic blood transfusion [ 12 ]. But due to unavailability of cell salvage system, we opted for autologous donation. This was a challenging case as we did not have any previous experience of the Bombay blood group and autologous blood transfusion in pregnant women. However, we successfully managed her with autologous blood transfusion with good maternal and fetal outcome.
This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors. Read the winning articles. Journal overview.
Academic Editor: Seung-Yup Ku. Received 01 Aug Revised 18 Nov Accepted 27 Nov Published 01 Dec Abstract The Bombay blood group is a rare blood type with an incidence of around one in a million. Discussion The Bombay blood group is a rare autosomal recessive phenotype within the ABO blood grouping system which occurs due to point mutation of the H gene that produces H antigen on RBCs.
Conclusion This was a challenging case as we did not have any previous experience of the Bombay blood group and autologous blood transfusion in pregnant women. Conflicts of Interest The authors declare that they have no conflict of interest. References Y. Bhende, C.
Deshpande, H. Bhatia et al. View at: Google Scholar R. Oriol, J. The patient's red cells were evaluated for the presence of the H antigen using commercial anti-H lectin Tulip Diagnostics, Goa, India and serum from a Bombay phenotype individual in-house.
The H antigen was not detected on patient's red cells. Further tests were performed to detect weak antigens and antibodies. Eluate was non-reactive with A cells and B cells, showing that there were no A and B antigens on patient's red cells. Furthermore, a saliva secretor test using hemagglutination inhibition was performed as described in the American Association of Blood Banks AABB technical manual, 17th edition.
Technical manual — American Association of Blood Banks. She was a secretor of ABH substances in saliva. A red cell antibody screen using a commercial three-cell panel was negative. She had no H antigen on red cells but secreted A, B and H substances in saliva. Based on these observations, her blood group was found to be AB para-Bombay phenotype AB h — secretor. The para-Bombay phenotype in Chinese persons.
Her biological sister's blood group was A 1 B RhD positive. H antigen expression on red cells is dependent on FUT1 the H gene. Bombay and para-Bombay phenotypes arise due to the homozygous inheritance of non-functional FUT1 genes hh allele.
Rossi's principles of transfusion medicine. Para-Bombay individuals may occasionally have A and B antigens on red cells due to passive adsorption of A and B blood group substances from plasma. Based on previous studies, the incidence of the Bombay phenotype in our population ranges from to , Indian J Hum Genet.
When compared to the Bombay phenotype, the para-Bombay phenotype is more infrequent, occurring in a ratio of
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