At the end of April this year, Dr Veena Shenoy and her team at the Department of Transfusion Medicine at the Amrita Institute of Medical Sciences (AIMS), Kochi, handled the case of a five-year-old patient from Gujarat who had suffered a serious fall and was in need of surgery. Dr Veena looked at the child’s reports and saw something which she had until then only seen in medical textbooks and journals: P null phenotype.
“The hospital in Surat got the child’s sample tested from the New York Blood Centre and she was then brought to Kerala for further treatment,” Dr Veena tells TNM.
Report in hand, the associate professor and head of the Transfusion Medicine department thought about the challenge ahead. “But we had to do it,” she says on a phone interview from Kochi.
What is ‘P null’ phenotype?
The very rare blood group ‘P null’ phenotype or ‘pp’ hit the headlines in 2018 when a team of doctors at the blood bank in Manipal’s Kasturba Medical College identified it in a patient for the first time in the country.
Human blood, she elaborates, consists of major groups like A, B, O, Rh and minor groups like Kell, M, N, P and so on. “We always talk about the major blood groups and do cross-matching only for them. In specific cases, when people develop antibodies against some antigen because of transfusion or transplantation, we’re required to consider matching the minor blood groups too,” Dr Veena explains.
Dr Veena Shenoy
“This case was rare,” she continues, “because while a majority of people have the minor blood group P, this patient didn’t (thus the name ‘P null’). So, she formed an antibody that reacts against the P antigen – meaning, she will have a reaction against whichever blood we cross-match with hers. Thus, she had to be given blood that was P null as well.”
She reached out to the team at Kasturba Medical College but the donor’s major blood group, disappointingly, didn’t match the five-year-old’s. Dr Veena says she wasn’t sure whether they would find a donor. “We did autologous blood transfusion (wherein the patient’s own blood is collected and used for treatment) for a surgery in May. But we couldn’t continue that as her haemoglobin wasn’t picking up. We wanted more blood for one more surgery and had to find a donor.” The team also decided to wait for the child to recuperate.
A pan-India search
By July, many NGOs and volunteer organisations such as Blood Donors Kerala joined the quest to find a donor. A message requesting for blood donors went viral on social media at the beginning of the month – MP Shashi Tharoor’s tweet on the same was liked 35,000 times. “With social media, things started moving faster,” says Dr Veena. It would, later, play a crucial role in the hunt.
Meanwhile, the hospital’s team got in touch with international rare blood donor panels and registries. “We contacted the New York Blood Centre, the American Rare Blood Donor Program and Japanese Red Cross Society. One unit of blood was available but the problem was that it was frozen, and in India we don’t have the facility to process frozen RBC (blood),” she explains.
But almost 1,500 km away in Mumbai, a doctor at ICMR’s National Institute of Immunohaematology came across the viral message. “Dr Swati Kulkarni at the institute, who had seen the message, informed us that there was a ‘probable donor’ in Nashik, Maharashtra,” says Dr Veena.
“We contacted the donor and he was willing to travel almost 100 km from his village to donate the blood. With the help of Arpan Blood Bank in Nashik – which arranged the donor’s local conveyance due to the lockdown – and specifically Dr Shashikant Patil at the bank, our patient’s blood was cross-matched with the donor and found to be a match,” Dr Veena says. The ongoing COVID-19 pandemic had disrupted connecting flights, but she says they arranged for a courier service to collect the blood in a temperature controlled environment and transport it safely back to their centre.
Her relief is palpable even today. “We were all engrossed in the case, we were very happy when the child finally found a matched blood,” she says. “Our staff at the hospital’s blood bank, especially my colleague Dr Linda, got enquiries about the case 24/7, from every nook and corner of the country during this period. So many people, including doctors from other fields of medicine, wanted to know about the blood group.”
Although the search for a blood donor has come to an end, the child remains under treatment.
The way forward, Dr Veena adds, is to create a centralised rare donor registry in the country – similar to those in Western countries – in which rare donor details are well documented and which anyone can contact in times of similar emergencies. “Transfusion medicine specialists should focus on getting rare blood donor details together in one place,” she says.
Anu Prabhakar is an independent journalist based in Mumbai.