Harnessing the potential of blood donors negative for high prevalence Rh antigens: A database initiative for thalassaemia care

Abstract

Background and objectives

With increasing life expectancy and prevalence of thalassaemia, it has led to a greater need for safe blood, yet the current supply from voluntary donors is insufficient to meet this demand. Thalassaemia recipients face a significant risk of alloimmunization because of repeated exposure to foreign red cell antigens. Study aims to determine high prevalent Rh antigen negative donors in western India donor population along with what percentage of these donors are willing to become dedicated voluntary donors for thalassaemia patients. Study also aims to examine factors influencing their willingness and challenges faced in mobilizing dedicated donors.

Method

700 whole blood donors from western India, following screening for inclusion & exclusion criteria as per Drugs and Cosmetic Act (DCA) 2020 amendment guidelines & were sero-negative for transfusion transmitted infections were enrolled for the study. Red cell phenotyping was performed using Conventional Tube Technique (CTT) for “D”, “C”, “E”, “c”, “e” and “K” antigen using known antisera. Donors that were “C” AND/OR “e” antigen negative were contacted telephonically and were counseled and motivated for becoming voluntary blood donors. Statistical analysis assessed correlation between donation frequency, donor’s occupation and education.

Result

Among 700 donors, 96.6% (n = 676) were males and 3.4% (n = 24) were females. The most predominant blood group was B > O > A > AB. Rh(D) antigen was present in 91.44% (n = 640) and absent in 8.6% (n = 60). Prevalence of other Rh antigens is as follows: “e” (99%) > “C” (85.4%) > “c” (59.1%) > “E” (18.0%). Only 1.15% had “K” antigen positive. The commonest Rh phenotype R₁R₁ (DCe/DCe) was expressed by 40.57% (n = 283), and the least common r″r (cE/ce), r″r″ (cE/cE) and r′r′ (Ce/Ce) was found in 0.14% (n = 1), respectively. ‘C’ negative, ‘e’ negative, ‘C’ and ‘e’ antigen negative donors constituted 14.8% (n = 104) with 93.2% (n = 97) C-antigen negative, 1.92% (n = 2) e-antigen negative and 4.8% (n = 5) both “C” and “e” antigen negative donors. The commonest phenotypes among C-antigen and e-antigen negative donors were rr (50%) and R_zR₂ (1.94%) respectively. Likewise, the most common phenotype amongst both C- and e-antigens negative donors was R₂R₂ (3.84%). 61.5% of the donors agreed to enroll for voluntary blood donation following telephonic invitation, while 6.8% of them refused permanently. Approximately, 3.9% of the blood donors were willing to donate blood only when needed and 27.8% of them could not be contacted.

Conclusion

Creating a database of voluntary donors with known phenotype, especially who lack very common antigens like “C” and “e” and are willing to become dedicated, regular voluntary donors for thalassemic patients can ensure timely administration of safe blood. One of the major challenges for this noble initiative was lack of awareness which can be circumvent effectively with proper counseling efforts.