In a rare and complex Cross Blood Transplant a 30-year-old woman with the extremely rare ‘Bombay’ (hh) blood group underwent a successful kidney transplant in India.
About Cross Blood Transplant
- Definition: A cross-blood transplant involves transplanting an organ from a donor with an incompatible blood group to a recipient.
- Challenges: Such transplants require specialized desensitization protocols to prevent rejection.
- Techniques Used: Plasma exchange therapy and immunosuppressive treatments help lower antibody levels and improve graft acceptance.
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ABO Blood Group System
| Blood Type |
Antigen on RBCs |
Antibody in Plasma |
Can Receive From |
Can Donate To |
| A |
A |
Anti-B |
A, O |
A, AB |
| B |
B |
Anti-A |
B, O |
B, AB |
| AB |
A and B |
None |
A, B, AB, O |
AB |
| O |
None |
Anti-A, Anti-B |
O |
A, B, AB, O |
Bombay Blood Group and Related Challenges
- Rarity: Occurs in 1 in 10,000 Indians and 1 in a million people worldwide.
- It was first discovered in Mumbai in 1952 by Y.M. Bhende.
- Medical Challenges: People with this blood group lack the H antigen, making them incompatible with all standard blood types, including O-negative.
- H antigen: It is a fundamental precursor structure found on the surface of red blood cells (RBCs).
- It serves as the building block for the ABO blood group system.
- Specific enzymes (glycosyltransferases) modify the H antigen to form different blood groups.
- For example in blood group A the H antigen is converted into A antigen by the A enzyme.
- Finding compatible donors is extremely difficult, complicating blood transfusions and organ transplants.
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Exceptional Cross Transplant and Its Significance
- India’s First Bombay Blood Group Kidney Transplant: The successful kidney transplant took place at Jaslok Hospital, Mumbai.
- Medical Complexity:
- The patient initially misdiagnosed as O blood group was later identified as Bombay blood group (hh).
- Since Bombay blood group patients cannot receive organs from common donors, the mother (a B-positive donor) stepped forward.
- Advanced immunological protocols were used to modify the immune response before transplantation.
- Key Solutions in the Transplant:
- Specialized pre-transplant desensitization protocols were implemented.
- Rare blood donor registries were used to secure compatible blood products.
- A multidisciplinary medical team managed immunological and surgical risks.
- Significance:
- First such recorded case in India and one of the few worldwide.
- Highlights the importance of accurate blood typing in organ transplantation.
- Demonstrates how medical advancements can overcome complex immunological barriers.
This groundbreaking transplant marks a major medical milestone, showcasing the potential of precision medicine and advanced immunotherapy in overcoming rare transplant challenges.
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