I had told this story years ago but it might be worth a revisit. We had a Bombay patient who was a frequent flier for decades. She was the propositus in Levine's seminal study back in 1955. After he had pretty much figured out how the blood bank universe operated by studying her and her family, he made the tactical error of telling her that her blood was so precious that people should pay her whenever they took it. So she gave everyone grief for the morning CBC. You could forget about autologous donation. Eventually she realized that if she needed blood, there were not a lot of options, and started to donate her own. She was not a great autologous donor, running a 9 and change hemoglobin and having bad veins. The above posts mention looking at these patients' siblings; if one looks at our patient's pedigree (in a lot of BB texts) you'll see she had twin sisters who were also Oh. They never seemed to be available to donate, though.

Whenever she needed surgery, no one seemed to inform her surgeons about the potential transfusion difficulties. So it always fell on us. One time a surgeon told me, "OK, no problem, we'll be extra special careful" which I found very disturbing. Shouldn't that be the standard of care for everyone? Would you do a crappy, careless job on me because I'm a run of the mill O Pos?

Good luck with you all with these patients!

2 hours ago, Dr. Pepper said:

One time a surgeon told me, "OK, no problem, we'll be extra special careful" which I found very disturbing. Shouldn't that be the standard of care for everyone? Would you do a crappy, careless job on me because I'm a run of the mill O Pos?

I'll be honest, that made me laugh out loud.

45 minutes ago, goodchild said:

I'll be honest, that made me laugh out loud.

And I do hear it on rare occasion now. What are they thinking!!!

In the USA, all AABB accredited IRLs (Immunohematology Reference Laboraotories) and American Red Cross IRLs are members of the American Rare Donor Program (ARDP). This program has over 45,000 Rare Donors registered from over 88 member centers. If your blood supplier is not a member of the ARDP,  your facility can access the program by sending a sample for evaluation to a member. If there are no member centers in your area, the Penn-Jersey American Red Cross can be a "portal" to the ARDP. After a sample is submitted and tested, Penn-Jersey will access the ARDP for the non-member hospital or blood center. Ninety four percent of the time, units are found.  In very complex cases, there may be no blood available. If the blood is not avaiable in the USA, then the ARDP, as a member of the World Health Organization (WHO) International Rare Donor Panel(IRDP), can request blood internationally after several qualifying steps are taken (prove no blood in USA, eligible sibling donors have been tested, MMA performed, patient and physician give permission). The WHO IRDP is managed by the International Blood Group Reference Laboratory headquartered in Bristol, UK under the direction of Nicole Thornton. No patient should be without the blood they need to survive, although some are very very rare with very few identified donors in the world [e.g. Rhnull, En(a-), Ko, Co(a-b-)] and that makes it difficult to supply lifesaving blood.

Sandra Nance, Senior Director, American Rare Donor Program, 1- 215 451 4362

Thanks for that Sandra.

Yes, we required a couple of units of Rh_null recently, and had to import one from France and the other from Japan, but Tooting is actually, and overall, a net exporter.

Thank you everyone for your feedback!