Do you have a Ro blood type and don’t know it?

One of the biggest challenges NHSBT (National Health Service Blood and Transplant) faces is a need for more Ro blood group donors.

You usually will not know your blood type or subtype until you have given blood for the first time. You may be walking around with a Ro blood subtype and not even know it. During our latest interview, we discussed blood transfusions. Some individuals, such as those with Sickle Cell, require regular transfusions and need extensive compatibility testing. They must be matched using the ABO group system and Rh group, which your genes determine. For the ABO blood group system, you can be either A, B, AB, or O blood group, and you can be either Positive or Negative for the Rh blood group system.

Individuals with the O-Negative blood group are known as universal donors and may donate their blood to anyone. The other blood groups require some form of compatibility between the donor and recipient blood. The Ro subtype is a blood group with a specific combination of genes. Only 2% of donors (NHS Blood Donation, 2023) who gave blood last year have the Ro subtype, resulting in a shortage in the Ro blood. Demand for Ro subtype blood increases by 10-15% annually. This subtype is approximately ten times more prominent within the BAME (Black, Asian, and Minority Ethnic) community than those from a white ethnic background.

We had the privilege to interview Wisdom Musabaike, the Assistant Director of Red Cell Immunohematology for NHSBT. We asked him to explain what his role entails, his opinions on how we could tackle the shortage in the Ro blood group and how we could increase the number of donors from the BAME community.

What is your specific role within the red cell immunohematology department?

Wisdom previously worked in what he described as ‘the best children’s hospital in the world’ at Great Ormand Street Hospital. In January this year, he joined NHSBT as the Assistant Director for Red Cell immunohematology, a branch of biomedical science focusing on blood groups and red cell antibodies to ensure patients get safe and matched blood. Wisdom explained that Karl Landsteiner discovered the blood groups in 1901, and after much research over the years, more is known apart from the most common blood groups: A, B and O, followed by the Rh blood group system.

Wisdom’s work entails supporting transfusion labs in hospitals with more complicated cross-matches. He leads a team of more than 200 staff and oversees seven Red Cell immunohematology laboratories in the UK and a reagent manufacturing unit in Liverpool. The following is a typical hospital scenario: There can be patients that go into the hospital, and they require blood because they receive regular blood transfusion; or they could have gone for surgery, have bled, and need a top-up transfusion so that they would require blood. For this example, Wisdom further explained that the hospital would do the blood grouping and would identify the right blood for the patients by doing a crossmatch. If everything goes well, the patient has a blood transfusion. However, some patient cases are more complicated because they have rare blood. So, in those instances, they will send the samples to NHSBT, and they send those samples to Wisdom’s department, which is called Red Cell Immunohematology. Their job is to support hospitals find matching blood in the more complicated cases. In terms of numbers, Wisdom explained that their department receives about 80,000 referred samples or cases from hospitals in a year.

Why do you think there is a shortage of Ro blood donors within BAME communities?

Supply and demand are two main reasons for the shortage of Ro blood donors. There has been an increase in the demand for people who require Ro blood. This has been driven by the rise in the number of people receiving regular blood transfusions. Those that receive regular blood transfusions often live with Sickle Cell Anaemia, which is a genetic condition that results in red cells that are rigid and sickled-shaped. They require regular blood transfusions to reduce the number of sickle cells in the blood and replace them with healthy red blood cells. Sickle Cell Anaemia is the fastest-growing genetic disorder (NHS Blood and Transplant, 2022) in the UK, resulting in pressure on the blood supply in the United Kingdom.

Most people who live with Sickle Cell are from black heritage background and have the Ro subtype. This results in a higher demand for the Ro subtype. We must give Ro blood to regularly transfused Ro patients because if the blood type is not matched as far as possible, there is a risk of producing antibodies. These are antibodies attack the red cells, which cause them to haemolyse (where the red cells break down and no longer function).

In terms of supply, many donors within the United Kingdom do not have Ro subtypes, resulting from most blood donations from people of white ethnic groups. There are many factors resulting in a need for more donations from BAME communities. Wisdom explained why he had only recently donated blood for the first time; he felt giving blood was not something that had crossed his mind as a priority, and it took some effort to make time to donate for the first time. However, he expressed that many people would be willing to donate, but blood donation advertisements do not reach them. They must be made aware of the importance of donating blood, especially if they have the Ro subtype. From Wisdom’s experience, blood donation was never fully promoted or advertised to him, delaying his decision to donate.

Some sections of society, including people in the BAME community, fear donating blood due to mistrust of the system or perceived social exclusion, causing less people coming forward to donate blood. You can draw comparisons between the fear of donation and the recent COVID-19 vaccination; this results from a general misunderstanding, such as what blood donations are, why they are essential and why we should donate. Wisdom mentioned how some religions may discourage people from donating or receiving blood transfusions, or people are unclear of their respective religion’s rules surrounding blood donation and, therefore, choose not to donate.

How would you tackle the shortages of donations of the Ro subtype blood groups, especially from those in BAME communities?

Wisdom explained that people are not coming forward to donate Ro blood because they may not be aware that they are carrying this rare blood. He gave himself as an example of this scenario, explaining that he was only made aware of his own rare blood type once he went to donate for the first time in March 2021, since this information is not readily available. His idea is to spread the word on this, targeted at local communities like scout groups, football and sporting events, and religious gatherings, and other social events. Like many others, he believes people would donate if they knew that just a little of their blood could save someone’s life.

Our final takeaways from the interview with Wisdom led us to believe that quite a substantial percentage of people within the BAME community do not come forward to donate blood purely because they have never been effectively made aware of the the importance of it. Misinformation is one of the leading causes that need to be overcome. The best way to start this is by targeting the younger generation and improving their views on why blood donation is essential, especially those with a rare blood type. After reading this we hope you have learnt the importance of knowing your blood type and that you can help by registering to become a blood donor.

References:

NHS Blood Donation (2023) Ro blood [online] Available at: https://www.blood.co.uk/why-give-blood/demand-for-different-blood-types/roblood/#:~:text=Subtypes%20are%20important%20if%20you,donors%20have%20the%20Ro%20subtype [Accessed 20 Jul. 2023]
NHS Blood and Transplant (2022) Record demand for blood donations to help sickle cell patients prompts urgent call for more donors of Black heritage. [online] Available at: https://www.nhsbt.nhs.uk/news/record-demand-for-blood-donations-to-help-sickle-cell-patients-prompts-urgent-call-for-more-donors-of-black-heritage/#:~:text=%E2%80%9CSickle%20cell%20disease%20is%20the,vital%20to%20treat%20this%20disorder. [Accessed 20 Jul. 2023]

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2% of the (mainly white) UK population have the antigen combination that is described as “R0”, (that should be a subscript zero, the NHSBT campaign brand is “Ro” from the pronounciation used by haematologists). However, the black population have a higher prevalence than the white pop and that’s all that stat means, not “If you have this antigen combination then you must have black ancestry”.

Scroll down to the “Rh phenotypes and genotypes (UK, 1948)” table at https://en.wikipedia.org/wiki/Rh_blood_group_system and then scroll down to D+ C− E− c+ e+ (RhD+) in the first column. Now look across at the % column and you can see where the general pop % figure comes from.

The Rh blood group system “extended antigen” combination of D+ C− E− c+ e+ occurs at about 2% in the white pop but at about 40% (?, think that fig is correct) in the black population. Conversely the Rh antigen combination of D-C− E− c+ e+ occurs in 15% of the white population but at a much lower rate in the black population, because it is common in the white population to be RhD negative and that is a very common antigen combination amongst whites who are Rh neg, but that doesn’t mean that black people who are Rh negative and with that antigen combination have white ancestry.

Our ancestry influences the prevalence of our red cell antigen combinations in our populations not our red cell antigens are a marker for the world locations of our individual ancesters.

NB R0/O is not “rare”. The accepted stats definition of a “rare blood donor” is 1:1,000 and that is the definition used by the scientific side of NHSBT, unfortunately their public interface copywriters haven’t read the brief and indulge in misleading hyperbole. See, https://www.isbtweb.org/isbt-working-parties/rare-donors.html

Wisdom’s Rh antigen combination is not “rare” in the general UK population, but is less common, and in the black population it is common. That’s the issue, that the UK donor pool cannot currently meet the treatment needs for those with sickle cell disease (nor the requirement for B blood for those with thalassemias).

Whites are not a good substitute for those with SCD having multiple transfusion treatment because the antigen matches need to be across many more antigens than the ABO and Rh extended antigens, (so that no clinically important antibodies develop). The next match is the K antigen in the Kell system, 92% of whites are K negative compared to over 99% of blacks, but then when we get to the antigen combinations of the Duffy, Diego and Kidd systems prevalence differs again and matches with the white donor population are more difficult.

Many more black people are blood group O than the general UK donor pool so increasing the black donor population is a win-win.

(I am a white Rh negative blood donor and my blood group is less than 1% of the UK pop but is still not “rare” in the accepted definition. One use of my red cell units is for sickle cell patients)

3 thoughts on “Do you have a Ro blood type and don’t know it?”

Stephanie gibbons says:

25th January 2024 at 1:42 pm

Hi there. My daughter’s blood type is A positive Ro. We are a white family. We were wonder if we may have black ethnicity in our family’s history, many thanks. Stephanie gibbons

1. Simonne Weeks says:
  
  28th January 2024 at 10:53 pm
  
  Thank you for your comment. Ro is more than 10 times more common in individuals from black African or black Caribbean ethnic backgrounds than in those from white ethnic backgrounds. So it is possible for your daughter to have Ro. You can find more information here https://www.blood.co.uk/news-and-campaigns/the-donor-magazine-summer-2017/a-very-special-blood-type/
  
2. Gerry says:
  
  31st January 2024 at 7:55 am
  
  2% of the (mainly white) UK population have the antigen combination that is described as “R0”, (that should be a subscript zero, the NHSBT campaign brand is “Ro” from the pronounciation used by haematologists). However, the black population have a higher prevalence than the white pop and that’s all that stat means, not “If you have this antigen combination then you must have black ancestry”.
  
  Scroll down to the “Rh phenotypes and genotypes (UK, 1948)” table at https://en.wikipedia.org/wiki/Rh_blood_group_system and then scroll down to D+ C− E− c+ e+ (RhD+) in the first column. Now look across at the % column and you can see where the general pop % figure comes from.
  
  The Rh blood group system “extended antigen” combination of D+ C− E− c+ e+ occurs at about 2% in the white pop but at about 40% (?, think that fig is correct) in the black population. Conversely the Rh antigen combination of D-C− E− c+ e+ occurs in 15% of the white population but at a much lower rate in the black population, because it is common in the white population to be RhD negative and that is a very common antigen combination amongst whites who are Rh neg, but that doesn’t mean that black people who are Rh negative and with that antigen combination have white ancestry.
  
  Our ancestry influences the prevalence of our red cell antigen combinations in our populations not our red cell antigens are a marker for the world locations of our individual ancesters.
  
  NB R0/O is not “rare”. The accepted stats definition of a “rare blood donor” is 1:1,000 and that is the definition used by the scientific side of NHSBT, unfortunately their public interface copywriters haven’t read the brief and indulge in misleading hyperbole. See, https://www.isbtweb.org/isbt-working-parties/rare-donors.html
  
  Wisdom’s Rh antigen combination is not “rare” in the general UK population, but is less common, and in the black population it is common. That’s the issue, that the UK donor pool cannot currently meet the treatment needs for those with sickle cell disease (nor the requirement for B blood for those with thalassemias).
  
  Whites are not a good substitute for those with SCD having multiple transfusion treatment because the antigen matches need to be across many more antigens than the ABO and Rh extended antigens, (so that no clinically important antibodies develop). The next match is the K antigen in the Kell system, 92% of whites are K negative compared to over 99% of blacks, but then when we get to the antigen combinations of the Duffy, Diego and Kidd systems prevalence differs again and matches with the white donor population are more difficult.
  
  Many more black people are blood group O than the general UK donor pool so increasing the black donor population is a win-win.
  
  (I am a white Rh negative blood donor and my blood group is less than 1% of the UK pop but is still not “rare” in the accepted definition. One use of my red cell units is for sickle cell patients)