- The Washington Times - Thursday, January 17, 2019

Blood banks are struggling amid a national decline in donations, especially for rare blood types — a situation that has spawned a global search for donors for a 2-year-old cancer patient with an extremely rare type in Orlando, Florida.

Last year, Zainab Mughal was diagnosed with neuroblastoma, an aggressive cancer that arises from nerve cells in babies and young children. She will need many blood transfusions throughout her treatment, but Zainab’s blood is missing a key immune-system component — the Indian-B antigen.

She can receive only type A or type O blood that also is missing the antigen, a condition so rare it is present in only 4 percent of people who are of purely Pakistani, Indian or Iranian descent.

A rare blood type typically is found in one case per 1,000 people. A very rare type is found in one case per 10,000 people. Zainab’s type is considered extremely rare.

“It’s shining a spotlight on the need for a diverse blood supply and how important that is around the country and really around the world,” said Susan Forbes, vice president of marketing and communications for OneBlood, a nonprofit based in South Florida that works to find rare blood donors. It made Zainab’s story public to the world.

“We need to have people from all ethnic groups donating, because genetics play a role in finding compatible blood for specific patients,” Ms. Forbes said.

Between 2011 and 2015, blood donations across the U.S. declined by more than 4 percent, according to the most recent federal statistics.

Racial and ethnic minorities are underrepresented among blood donors. Whites far outpace other racial groups, representing about 75 percent of the donated blood supply. Blacks make up about 5 percent of the blood donor registry, and Hispanics about 3 percent.

Blood primarily is classified by the major antigens and antibodies in it, with the types being A, B, AB or O. It is further classified by the presence (positive) or absence (negative) of the Rh(D) antigen.

But other antigens, antibodies, proteins and materials further individualize blood, especially along racial and ethnic lines. There are an estimated 600 different antigens, any one of which can make receiving donated blood either slightly worrisome or impossible.

Donated blood that doesn’t match a recipient’s antigens can stimulate an immune system attack against it.

“The diversity of the donor population is the bottom line for the foreseeable future,” said Dr. Louis Katz, chief medical officer at America’s Blood Centers, the largest network of nonprofit blood centers in North America.

Dr. Katz said increasing donation rates among minority groups has been a long-running challenge, complicated by the same social factors that contribute to these groups being underrepresented in most areas of medicine.

“You become a blood donor when you’re well-integrated in your community, generally have enough time to go in and donate If you’re poor, minority or ethnic minority, it’s not the top of the list of things that occupy your time to be a donor,” he said.

In Zainab’s case, OneBlood so far has found four donors — two from the U.S. and two from the U.K. — and hope to find a total of seven to 10 donors: One person can donate blood every eight weeks. The staff is sifting through tens of thousands of emails from people all over the world who believe they may be a match.

In a surprising twist, Ms. Forbes said two people who reached out as a possible match for Zainab were discovered to have the Bombay blood type: Their blood is missing the H antigen and is so rare it’s present in about one-in-10,000 Indians but only one-in-1-million Europeans.

“So when a person comes along — and they will — who has the Bombay blood type and needs a blood transfusion, that’s two more people that are now in the American Rare Donor Program that will be able to help a future patient who has that blood type,” Ms. Forbes said.

The American Rare Donor Program is a joint venture between the American Red Cross and the American Association of Blood Banks that keeps a database of rare blood donors for patients in need.

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