Regional
Rare Donor program: Kuwait Central Blood Bank
Reem Ali Al Radwan
Blood Administration Services, Kuwait
Marwa Hamed Aly Ibrahim AlSayed
Kuwait Central Blood Bank, Kuwait
Hanan AlAwadhi
Blood Administration Services, Kuwait
Kuwait Central blood bank (KCBB) is part of Blood Transfusion Administration Services (BTAS) working under the umbrella of Ministry of Health. It is the overall organization responsible for national blood transfusion services. KCBB is an AABB accredited center for donor center activities, blood transfusion activities, immunohematology reference laboratory activities and molecular testing.
Immunohematology Reference Laboratory (KCIRL) is part of the Blood Transfusion Administration Services, which provides patient and donor immunohematology testing for government, private and military hospitals in Kuwait. KCIRL function within a highly specialized area of the blood banking community, providing an essential service to patients who have very specific serologic complexities and/or need rare blood components.
- Specialized laboratories were established to provide immunohematology services for the patients and build up our rare donor program since identification of rare donors is a critical factor in establishing a rare donor registry. Several measures have been implemented to identify rare blood donors as follows: • In 2009, Donor Panel Laboratory was established. This laboratory routinely carry out programs of typing RBC antigens serologically in large numbers of donors (around 1000 donors monthly). This provides information of the phenotypes of the donor population and secure the ability to maintain a stable and sufficient daily inventory of antigen negative RBC units registered in our data management system for the more common antibodies. In addition, detecting rare donors with high frequency antigens i.e U, k, Kpb, Lub, Lu3, Jk3. A library of these rare donors is maintained that contains information such as their antigenic profile and demographic information for recruitment once needed.
- In 2016, Molecular laboratory started using bloodChip IDXT for molecular testing, it detects k, Kpb, Jsb, U, Dib, Hy, Jo, Coa, Yta, Lub for high frequency antigens. In addition to some of the rare variants e.g. RHCE*ce,733G, RHCE*ceAR, GYPB*S_null (IV5+5t), GYPB*S_null(230T). Since the resources of rare antisera are limited, thus identification of rare blood donors is more dependent on molecular testing. In addition to the use of Innotrain Fluogene RBC verify extend, which was newly introduced in May 2024. This will help in detection of KNa, LWa and Vel negative donors.
- In 2018, we started performing antibody screening for all donors using IH-500. Since some very rare blood types may be found because of the presence of ‘naturally occurring’ antibodies such as anti-H in donors with Bombay phenotype, anti-Ge2 in donors with Ge: -2, 3, 4 (Yus type), anti-PP1Pk in donors with p phenotype.
- In addition to donor selection from family members, especially siblings, of patients immunized against high-prevalence antigens. Since in cases of a single antibody to a high-prevalence antigen, approximately one in four siblings will have the same rare blood group.
- Furthermore, all patients with antibodies against high frequency antigens who are eligible at a later date to be allogeneic donors are encouraged to donate for future needs.
In 2018 we started participation in American rare donor program (ARDP) as per requirement from standards for Immunohematology reference laboratories. This is through the annual submission of donors recognized as being rare following ARDP criteria.
According to ARDP, an individual is recognized as a rare blood donor when RBCs are negative:
- For high-prevalence antigens with an occurrence less than 1 in 1000
- For multiple common antigens: the donor must meet one of the following sets of criteria:
• Absolute IgA deficient (IgA of level ˂ 0.05 mg/dl). • RH variant alleles.
Table 1. Overview of rare donors in Kuwait
Finally, a rare donor program requires perseverance, patience, and long-term commitment, given that one cannot predict when rare blood will be needed. In order to improve rare donor program, it is necessary to put a heavy emphasis on continuous education, training and improving knowledge of technologists.
The importance level of services offered to patients with difficult samples by rare donor program should be promoted to prevent transfusion-related adverse effect. Thus, being part of a national program under the aegis of several agencies (International Society of Blood Transfusion and AABB) with active cooperation and mutual support increases the chances of finding a rare unit for a rare patient.
In the future, our challenge is to expand the recruitment and awareness of donors with different ethnic backgrounds to enlarge our database with other specificities of rare blood groups.
References
- Behrooz G., Mostafa M., Sima A. Challenges of Establishing a National rare donor program in Iran. IJHOSCR 2018; 12(3): 213-218
- Paccapelo C., Managing a rare donor programme: the immunohaematology laboratory perspective. Vox Sang. 2018; 13: 11-15.
