Golden blood: The rarest blood type in the world
Introduction:
The real scenario of Blood transfusion:
We all know we should donate
blood, but probably don't as much as we should. Every year almost 5 million
Americans need blood transfusions and would likely die without them. Approximately
32,000 pints of blood are used each day in the United States for people who
lose blood during operations or from traumatic injuries. Others need blood transfusions
because of ongoing illnesses like sickle-cell anemia where they all need
transfusions throughout their lives. The network of blood donation and
transfusion in any country is a hugely vital part of keeping sick or injured
people alive and well. This wouldn't be so complicated if we all had the same type
of blood, but we don't. And some of us have such rare blood types that any
injury, procedure, or accident can be life-threatening. Imagine your blood was
so rare and so unique that should you get hurt, almost no one else in the world’s
donated blood would be able to save you. So rare and so valuable that your
identity needs to be concealed to keep a never-ending stream of requests for it
at bay.
Rh null, the world’s most dangerous blood type:
So rare that scientists would do
almost anything to get their hands on a pint of it to study. For the people who
have the rarest blood type in the world, Rh null this is their reality. It's
the world's most dangerous blood type to have because only 43 people in the
world are discovered to have it. Meaning if you get hurt, basically no one
else's blood would be compatible with yours. Injuries that would be serious but
treatable for everyone else would probably be fatal for you. Most of us have
probably heard of the usual blood type system, or even know our own blood type.
O+, AB-, A+, O-.
This classification determines whom we can donate blood to or receive it from. There ABO System is a total of 33 different classification systems recognized but most people only need to worry about the two most common ones, the ABO and Rh systems. The ABO system classifies blood based on the presence of antigens, antigen A and antigen B. You can have one or the other, both, or neither. Antigens are glycoprotein markers embedded in the cell membrane and help your immune system to distinguish between your body's own cells and foreign cells like viruses or bacteria. In an A blood type the A antigen is found on the blood cell itself and an A or anti-B antibody is found in the blood serum. In a B blood type, a B antigen is found on the blood cell and a B or anti-A antibody is found in the serum. Blood type AB has both A and B antigens on the blood cells and neither of the corresponding antibodies against them in the serum. And blood type O has neither antigen on the cells but has antibodies A and B in the serum. When blood is donated, the red blood cells are separated from the plasma where the antibodies are located through a process called blood fractionation. This ensures that only the red blood cells get donated and not their corresponding antibodies since that would cause an adverse reaction in the recipient. Your immune system will produce antibodies against any blood antigens you don't have in your own blood. Therefore a person with type A blood that receives B blood would have an ABO incompatibility reaction.
Figure: Cross-matching blood type
The anti-B antibodies present in
the patient's blood would agglutinate with the B antigens on the donated red
blood cells making the blood cells clump together and block small blood
vessels. The immune system would then attack the new blood cells and destroy
them. It's rare for this to happen but if it does it is serious and potentially
fatal. Transfusion is considered safe as long as the serum of the recipient
does not contain antibodies for the blood cell antigens of the donor. So this
is why if you have type AB blood you're a universal recipient - you don't have
either of the antibodies that would attack A or B donor blood. However, this
also means you can only donate blood to other people who have AB blood. If you
have type O blood you're a universal donor. You can give your blood to an A B
or O without triggering their immune system. But this is also why people with O
blood can only receive type O blood.
Figure: Different Blood type
However, there are other antigens
that need to be accounted for beyond the ones and the ABO system before
donating or receiving blood safely. This is where the rhesus system comes in.
The rhesus, or Rh system, is the second most significant blood group system.
These are the most important antigens with the most significant one being the D
antigen. Although there are lots of other Rh antigens RH-D is the most
significant blood type because it's the most likely of the Rh antigens to
produce an immune response. Depending on whether the RH-D antigen is present,
each blood type is assigned a positive or negative symbol. People who are Rh-D
negative can only receive Rh-D negative blood. But people who are Rh D+ can
receive either Rh D positive or Rh D negative blood. The negative blood types,
A negative, B negative, AB negative, and O negative are rare than their positive
counterparts. And while the D antigen is the most important one in the Rh system
there are a total of 60 other Rh antigens making it the largest of any of the blood
classifications. And while these eight blood types are the most common way of
describing our blood, each of these eight types can be subdivided much further.
There are millions of varieties, each classified according to the exact
antigens that coat the surface of our red blood cells. To know your exact blood
type you'd have to write it out antigen by antigen. Luckily for most of us,
many of the antigens we have don't affect our ability to receive or donate
blood because pretty much everyone else also has them. For example, more than
99.9% of people carry the antigen called Vel. So for most of us donating blood
to one another, we wouldn't need to worry about this antigen as it wouldn't trigger
an immune response. But for every 5,000 people, there's one person who does
lack the Vel antigen and shouldn't receive blood from the other 4,999. Their
immune system recognizes the Vel antigen as foreign and if given Vel-positive
blood they could have kidney failure and possibly die. But doctors do screen
for as many of these variants as possible to make sure to find the best match
for a blood transfusion. But sometimes this best match isn't really possible
and this is why the rarer your blood the harder things get.
Figure: Blood type codominance
Rh-null:
Rh-null is called Rh-null because
it has none of the 61 antigens present in the Rh blood system we previously
discussed. It is rare enough to have a few of the antigens in the Rh system
missing from your blood but the chances of missing them all are astronomically
small. Doctors call it the golden blood because, for anyone who has any type of
rare Rh blood type, missing a few antigens here or there, the Rh-null blood can
be accepted where other more typical blood types could not be. It has enormous life-saving
capabilities but for those who have it, it can be a curse. Most of us likely take
for granted that if we get hurt the nearest hospital will be able to sort us
out. But if you're one of the few with Rh-null blood life is inherently more
dangerous. You can't receive blood from anyone else except the 42 other people
that exist who have been found to have the same blood type. And of the people known
to have it only a handful of them are active donors and they're spread across
the world. And the logistics of shipping blood around the world are stupidly
complicated. Bureaucracy and paperwork can hold things up at the borders, which
can create a myriad of issues. Fresh blood has a shelf life of four weeks and
it has to be stored at four degrees Celsius, which is challenging during transportation,
especially to remote areas. This means that any holdup at customs can render
the blood unusable. And some countries have very restrictive
The Dangers rules in regards to importing blood:
The UAE for example won't accept
any blood into the country that isn't from the Gulf states. These types of
logistics and bureaucracy make it very hard for someone with rare blood to get
a transfusion, especially in a sudden emergency when they need the blood fast. For
one Swiss man with Rh-null blood, this meant as a child, he couldn't go to summer
camp or do outdoor sports because his parents feared he could get an injury with
no ability to get a blood transfusion. As an adult, he can't travel to
countries without modern hospitals.
The only realistic way:
The only realistic way he can
navigate this danger is to continuously donate blood to himself, meaning twice
a year he donates blood to keep on reserve in case he ever needs it. And he
can't really donate much more than that because Rh-null blood also comes with
some adverse effects. The Rh antigens that most of us have thought to play a
role in maintaining the integrity of the red blood cell membrane. Red blood
cells which lack Rh antigens have an abnormal shape and an increased osmotic
fragility. This means that red blood cells break down quicker than they should resulting
in hemolytic anemia. This can lead to fatigue, shortness of breath, and
jaundice and thus makes frequent blood donation impossible. And because only a
handful of people with this rare blood ever donate it, this places a large
burden on those who do when someone else needs this type of blood. Because
Rh-null blood can be donated to anyone with a rare combination of Rh negatives
in their blood type, every once in a while, they may get an urgent call to
donate. The Swiss man we mentioned before once had a call that a newborn baby
was in dire need of his type of blood. To save the baby's life he would need to
make his way to the donation center. This meant taking a taxi to Geneva and
taking time off of work, none of which is allowed to be reimbursed due to the
blood donation laws in some parts of Europe. He was able to help in this
instance, but quickly realized that the cost and burden of donating his
valuable blood would ultimately fall on him. Anyone with this rare type of
blood is given the gift of being able to help someone in a time of need, an
ability to help where no one else can. It probably feels pretty amazing to know
you've played a part in saving someone's life. But this also comes with the
unfortunate burden of being, in a sense, on call for your entire life, should
the need for your blood arise. This poses an interesting ethical question. It's as much as you to donate blood at a second's observation, whether you are in a purchaser meeting, at your very own wedding ceremony, or on holiday. At what factor does your ethical duty to help a person else in need start and give up? But for every person who was otherwise
doomed without this donated blood, the importance of it obviously can't be
overstated. And this serves as a reminder that hospitals around the world rely
on the good deed of blood donation to save lives, whether your blood is rare or
not.
Conclusion
For the reason that very first blood transfusions in the 1800s, they have saved thousands and thousands of lives and performed an essential position in shaping our contemporary global. In times of peace they've saved citizens from
unfortunate accidents and in times of war have saved the lives of countless
wounded soldiers. During World War II the American Red Cross flew almost two hundred
thousand pints of whole blood from the US to the Allied forces in Europe. More
than fifty thousand pints of blood were needed for the soldiers fighting during
the D-day invasion of Normandy alone. The level of coordination needed for the
collection and transport of this much blood is astounding, and you can learn
more about logistics like this in Real Engineering's new "Logistics of D-Day".
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