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We all know we should donate
blood, but probably don't as much as we
should. Every year almost 5 million
Americans need blood transfusions and
would likely die without them.
Approximately 32,000 pints of blood are
used each day in the United States for
people who lose blood during operations
or from traumatic injuries. Others need
blood transfusions because of ongoing
illness like sickle-cell anemia where
they all need transfusions throughout
their lives. The network of blood
donation and transfusion in any country
is a hugely vital part of keeping sick
or injured people alive and well. This
wouldn't be so complicated if we all had
the same type of blood, but we don't. And
some of us have such rare blood types
that any injury, any procedure, or any
accident can be life-threatening.
Imagine your blood was so rare and so
unique that should you get hurt, almost
no one else in the worlds donated blood
would be able to save you. So rare and so
valuable that your identity needs to be
concealed to keep a never-ending stream
of requests for it at bay. So rare that
scientists would do almost anything to
get their hands on a pint of it to study.
For the people who have the rarest blood
type in the world, Rh null this is their
reality. It's the world's most dangerous
blood type to have because only 43
people in the world are discovered to
have it. Meaning if you get hurt,
basically no one else's blood would be
compatible with yours. Injuries that
would be serious but treatable for
everyone else would probably be fatal
for you. Most of us have probably heard
of the usual blood type system, or even
know our own blood type. O+, AB-,
A+, O-. This
classification determines who we can
donate blood to or receive it from. There
are a total of 33 different
classification systems recognized but
most people only need to worry about the
two most common ones, the ABO and Rh
systems. The ABO system classifies blood
based on the presence of antigens,
antigen A and antigen B. You can have one or the other, both, or neither. Antigens are
glycoprotein markers embedded in the
cell membrane and help your immune
system to distinguish between your
body's own cells and foreign cells like
viruses or bacteria. In an A blood type
the A antigen is found on the blood cell
itself and an A or anti-B antibody is
found in the blood serum. In a B blood
type a B antigen is found on the blood
cell and a B or anti-A antibody is
found in the serum. Blood type AB has
both A and B antigens on the blood cells
and neither of the corresponding
antibodies against them in the serum. And
blood type O has neither antigen on the
cells but has antibodies A and B in the
serum. When blood is donated, the red
blood cells are separated from the
plasma where the antibodies are located
through a process called blood
fractionation. This ensures that only the
red blood cells get donated and not
their corresponding antibodies since
that would cause an adverse reaction in
the recipient. Your immune system will
produce antibodies against any blood
antigens you don't have in your own
blood. Therefore a person with type A
blood that receives B blood would have
an ABO incompatibility reaction. The
anti-B antibodies present in the
patient's blood would agglutinate
with the B antigens on the donated red
blood cells making the blood cells clump
together and block small blood vessels.
The immune system would then attack the
new blood cells and destroy them. It's
rare for this to happen but if it does
it is serious and potentially fatal.
Transfusion is considered safe as long
as the serum of the recipient does not
contain antibodies for the blood cell
antigens of the donor. So this is why if
you have type AB blood you're a
universal recipient - you don't have
either of the antibodies that would
attack A or B donor blood. However this
also means you can only donate blood to
other people who have A B blood. If you
have type O blood you're universal donor.
You can give your blood to a
A B or O without triggering their
immune system. But this is also why
people with O blood can only receive
Type O blood.
However there are other antigens that
need to be accounted for beyond the ones
and the ABO system before donating or
receiving blood safely. This is where the
rhesus system comes in. The rhesus, or Rh
system, is the second most significant
blood group system. These are the most
important antigens with the most
significant one being the D antigen.
Although there are lots of other Rh
antigens RH-D is the most significant
because it's the most likely of the Rh
antigens to produce an immune response.
Depending on whether the RH-D antigen is
present, each blood type is assigned a
positive or negative symbol. People who
are Rh-D negative can only receive Rh-D negative
blood. But people who are Rh D+ can
receive either Rh D positive or Rh D negative
blood. The negative blood types,
A negative, B negative, AB negative, and O
negative are more rare than their
positive counterparts. And while the D
antigen is the most important one in the
Rh system there are a total of 60 other
Rh antigens making it the largest of any
of the blood classifications. And while
these eight blood types are the most
common way of describing our blood, each
of these eight types can be subdivided
much further. There are millions of
varieties, each classified according to
the exact antigens that coat the surface
of our red blood cells. To know your
exact blood type you'd have to write it
out antigen by antigen.
Luckily for most of us many of the
antigens we have don't affect our
ability to receive or donate blood
because pretty much everyone else also
has them. For example more than 99.9%
of people carry the antigen
called Vel. So for most of us donating
blood to one another we wouldn't need to
worry about this antigen as it wouldn't
trigger an immune response. But for every
5,000 people there's one person
who does lack the Vel antigen who
shouldn't receive blood from the other
4,999. Their immune system recognizes the
Vel antigen as foreign and if given
Vel positive blood they could have
kidney failure and possibly die. But
doctors do screen for as many of these
variants as possible to make sure to
find the best match for a blood
transfusion. But sometimes this best
match isn't really possible and this is
why the rarer your blood the harder
things get. The world's rarest blood type,
Rh-null is called Rh-null because it has
none of the 61 antigens present in the
Rh blood system we previously discussed.
It is rare enough to have a few of the
antigens in the Rh system missing from
your blood but the chances of missing
them all are astronomically small.
Doctors call it the golden blood because
for anyone who has any type of rare Rh
blood type, missing a few antigens here
or there, the Rh-null blood can be
accepted where other more typical blood
types could not be. It has enormous life
saving capabilities but for those who
have it it can be a curse. Most of us
likely take for granted that if we get
hurt the nearest hospital will be able
to sort us out. But if you're one of the
few with Rh-null blood life is
inherently more dangerous. You can't
receive blood from anyone else except
the 42 other people that exist who have
been found to have the same blood type.
And of the people known to have it only
a handful of them are active donors and
they're spread across the world. And the
logistics of shipping blood around the
world are stupidly complicated.
Bureaucracy and paperwork can hold
things up at the borders, which can
create a myriad of issues. Fresh blood
has a shelf life of four weeks and it
has to be stored at four degrees Celsius,
which is challenging during
transportation, especially to remote
areas. This means that any holdup at
customs can render the blood unusable.
And some countries have very restrictive
rules in regards to importing blood. The
UAE for example won't accept any blood
into the country that isn't from the
Gulf states. These types of logistics and
bureaucracy make it very hard for
someone with rare blood to get a
transfusion, especially in a sudden
emergency when they need the blood fast.
For one Swiss man with Rh-null blood, this
meant as a child, he couldn't go to
summer camp or do outdoor sports because his
parents feared he could get an injury
with no ability to get a blood
transfusion. As an adult he can't travel
to countries without modern hospitals.
The only realistic way he can navigate
this danger is to continuously donate
blood to himself,
meaning twice a year he donates blood to
keep on reserve in case he ever needs it.
And he can't really donate much more
than that because Rh-null blood also comes
with some adverse effects. The Rh
antigens that most of us have are
thought to play a role in maintaining
the integrity of the red blood cell
membrane. Red blood cells which lack Rh
antigens have an abnormal shape and an
increased osmotic fragility. This means
that red blood cells break down quicker
than they should resulting in a
hemolytic anemia. This can lead to
fatigue, shortness of breath, and jaundice
and thus makes frequent blood donation
impossible. And because only a handful of
people with this rare blood ever donate
it, this places a large burden on those
who do when someone else needs this type
of blood. Because Rh-null blood can be
donated to anyone with a rare
combination of Rh negatives in their
blood type, every once in a while they
may get an urgent call to donate. The
Swiss man we mentioned before once had a
call that a newborn baby was in dire
need of his type of blood. To save the
baby's life he would need to make his
way to the donation center. This meant
taking a taxi to Geneva and taking time
off of work, none of which is allowed to
be reimbursed due to the blood donation
laws in some parts of Europe. He was able
to help in this instance, but quickly
realized that the cost and burden of
donating his valuable blood would
ultimately fall on him. Anyone with this
rare type of blood is given the gift of
being able to help someone at a time of
need, an ability to help where no one
else can. It probably feels pretty
amazing to know you've played a part in
saving someone's life. But this also
comes with the unfortunate burden of
being, in a sense, on call for your entire
life, should the need for your blood
arise. This poses an interesting ethical
question. It's up to you to donate blood
at a moment's notice, whether you're in a
client meeting, at your own wedding, or on
vacation. At what point does your moral
obligation to help someone else in need
begin and end? But for every person who was
otherwise doomed without this donated
blood, the importance of it obviously
can't be overstated. And this serves as a
reminder that hospitals around the world
rely on the good deed of blood donation
to save lives, whether your blood is rare
or not. Since the very first blood
transfusions in the 1800s
they have saved millions of lives and
played a vital role in shaping our
modern world. In times of peace they've
saved citizens from unfortunate
accidents and in times of war have saved
the lives of countless wounded soldiers.
During World War II
the American Red Cross flew almost two
hundred thousand pints of whole blood
from the US to the Allied forces in
Europe. More than fifty thousand pints of
blood were needed for the soldiers
fighting during the D-day invasion of
Normandy alone. The level of coordination
needed for the collection and transport
of this much blood is astounding, and you
can learn more about logistics like this
in Real Engineering's new "Logistics of
D-Day" series available exclusively on
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