For Bengaluru-based Shridhar BS, finding out he was of the HH positive blood type was something of a wake-up call. While the 58-year-old was always keen on donating blood, he realised the responsibility he had when he discovered he was one of the few thousand people in the world to belong to the Bombay blood group.
And on Tuesday, Shridhar fulfilled his responsibility once again by travelling all the way to Vellore in Tamil Nadu, on very short notice – all to save the life of a 35-year-old stranger who had the same rare blood group as him.
Shridhar is part of the network of the few Bombay blood group donors in India, and got to know about a requirement in Vellore.
The patient, Saimhadri Polaki, was working as a construction supervisor in Visakhapatnam. Originally from Odisha, when Saimhadri first fell sick and needed blood, he was given O positive – the blood type which many HH positive people are wrongly identified with – in a hospital in Paralakhemundi on the Odisha border near his hometown.
Saimgadri’s friend and caretaker, Srinivas, narrates that after receiving O positive blood units, Saimhadri’s condition deteriorated. “Once the doctors figured out about his rare blood group, we moved him to Vizag and then here to CMC Vellore,” Srinivas says.
By that time however, his haemoglobin had dropped to a critical 5 g/dL and his platelet count was also dropping.
Srinivas says they had been trying to find donors through Facebook and Whatsapp groups, when a Mumbai-based group put them in touch with Shridhar. “As soon as we talked to Shridhar, he immediately booked tickets and came to CMC Vellore to donate one unit of blood. He acted really fast,” says Srinivas.
On Tuesday morning, Shridhar left for Vellore to donate blood, and was back home the same night.
Bombay blood type is often not recognised
Like Saimhadri, Shridhar too believed for a major part of his life that he was O positive.
It was only in 2002, when he had gone to donate blood at a blood donation camp that he got to know he never had O positive blood type.
“The doctors there called me back, and gave me a card certifying that I was of the Bombay blood group. They told me to keep the card with me at all times, in case I was ever in an emergency and would need blood,” Shridhar says.
He explains that this mix-up happens because in the initial testing, the H antigen’s presence is not ascertained.
The master antigen H, which is present in all blood groups, is needed to generate A, B, AB and O antigens. But when the antigen H is absent from the cell and only its antibody is present in the plasma, it leads to the occurrence of the rare HH blood group.
“The problem now is that people don’t even know the Bombay blood group exists. There is no option on official forms too. Once, when I had gone to get my driving license renewed and wrote Bombay blood type on the form, they gave the license back to me with that section left blank,” Shridhar shares. “Now you tell me, if I am in an accident and need blood, if they don’t run proper tests, they will just end up giving me O positive blood units.”
This fear is something Aditya Hegde, another Bengaluru based man who has HH negative blood type, also had. He had told TNM earlier, “This is such a rare blood group. I wonder what would happen if I am in a situation where I need blood.”
And perhaps that’s why people like Aditya and Shridhar never shy away from doing their bit.
Shridhar has donated blood 48 times so far, and has often travelled to cities like Coimbatore, Hyderabad and Chennai, among others, to answer a call for requirement of the Bombay blood type.
Many times, the recipient is a pregnant woman; he has also donated blood to cancer patients.
Struggles of belonging to a rare blood group
Sometimes, the requirement is so acute that Shridhar gets calls for blood requirement for a surgery, months in advance. Since one is only allowed to donate blood once in three months, Shridhar often has to turn down calls, because he’d have donated blood less than three months ago.
When asked if he follows up on the people he has donate to, he says, “Usually patients themselves stay in touch with me. I once gave blood to a 6-month-old girl from Nagpur who had a serious heart condition a few years back. She still calls me every year for New Year’s, and her parents brought her to my son’s wedding last year. It was really nice and moving.”
“I am thankful that now we have a network of recognised Bombay blood type donors, thanks to Sankalp (a blood bank) and social media groups and sites specifically for this rare blood group. While I would have donated blood anyway, the sense of duty because I have this rare blood type, is stronger now,” Shridhar adds.
Shridhar donating blood
Meanwhile the struggle is far from over for Saimhadri.
Now identified as belonging to the HH positive blood type, Srinivas says that the cost for his treatment has also gone up exponentially. “At CMC they told us the tests would cost Rs 30,000, but now they’re charging Rs 63,000. They have diagnosed it as a rare blood disorder similar to thalassemia, and they’re saying that treatment will cost Rs 15 - 20 lakhs,” he rues.
Srinivas adds that he will take Simhadri back to Vishakhapatnam, hoping that treatment will be available covered under the Andhra Pradesh state government’s health insurance scheme. “We are not sure if treatment can happen over there. We will have to see. He still needs two more units of blood, and he will continue to need more blood in this condition. We are looking on social media to find more donors.”
What is the Bombay blood group?
First discovered in Bombay (now Mumbai) in 1952, this is an extremely rare blood group.
Red blood cells (RBCs), white blood cells and the plasma come together to form blood groups.
On their surface, RBCs carry markers, with which the plasma interacts. While RBCs have antigens, the plasma has antibodies.
The antigens can be A or B or both. If the RBCs have antigen A, the plasma will be the B antibody or the other way round. These determine if the blood type will be A, B or AB. If the RBCs have neither antigen A nor B, the plasma has antibodies of both, and the blood type then is O.
There is another variable called the Rh factor which determines the ‘positive’ or ‘negative’ marker in the blood type. If the RBCs have Rh factor on their surface, the blood type would be positive. If the Rh factor is absent, the blood type would be negative.
It is the interaction between the RBCs and the plasma which sets apart a blood type and is important for a robust immune system.
Where does the HH blood type come in then?
There’s a master antigen H, which is present in all blood groups. This antigen is needed to generate A, B, AB and O antigens. But when the antigen H is absent from the cell and only its antibody is present in the plasma, it leads to the occurrence of the rare HH blood group.
The HH blood type is a result of extensive inbreeding in close-community marriages which limit the gene pool. It is therefore possible that people with the Bombay blood group have common ancestral roots.