You must have heard about blood groups like ‘A’, ‘B’, ‘O’ and ‘RH’. Apart from these, there are some rare blood groups as well. But now a new blood group has been found in India, its name is CRIB.
‘C’ in CRIB means Cromer (i.e. CH) which is one of the total 47 blood groups, ‘I’ means India and ‘B’ means Bengaluru. In simple words, this is a blood group which has been found in a woman near Bengaluru.
This blood group is so rare that during the heart surgery of this 38-year-old woman, the doctors did not even follow the common procedure of keeping one or two bottles of blood ready in advance in case a transfusion is needed.
This is because the experts were not able to identify the blood group of the woman.
11 months after the incident, Dr Ankit Mathur remembers the day of the surgery and heaves a sigh of relief. The surgery was successfully completed without any blood transfusion.
Dr Ankit Mathur is the additional medical director of Rotary-TTK Blood Centre, Bengaluru. He was an important contact for the doctors of Kolar’s RL Jalappa Hospital. The woman was advised surgery in this hospital due to a heart problem.
Dr Ankit Mathur told BBC, “The woman’s blood group was not matching with any other blood group. We tested it by mixing it with other blood groups but it was reacting every time.”
He said, “After this, we started searching for it in her family itself. We took blood samples of 20 family members. Everyone cooperated with us. Still, no one’s blood could match her blood.”
After this, the next option was to send the blood sample to the International Blood Group Reference Laboratory (IBRGL) in Bristol, UK.
This is the same laboratory where blood samples from all over the world are sent to check whether they match with other blood groups or not. This is just like blood samples from different parts of South India are sent to Rotary-TTK Blood Center in Bengaluru and PGI in Chandigarh in North India.
Dr Ankit Mathur said, “It took them 10 months to do a complete analysis of it. In February-March, they sent their reply that the patient’s blood has a unique antigen. After this, this information was sent to the International Society of Blood Transfusion (ISBT). Here there are experts of Red Blood Cell Immunogenetics and Terminology Group. They approved the name CRIB.”
It was officially announced in the 35th conference of ISBT held in Milan, Italy in June this year.
A person’s blood group depends on the genes of his parents. So was there any problem in the genetic structure in this woman’s case?
Dr Mathur says about this, “We thought that at least one member of the family would have this antigen, but we found that no one in the family had it.”
Antigens are a type of protein that is found everywhere in the body.
Dr Mathur says, “Whenever something is formed in the body, its complete information or coding comes from both the parents. Half the information comes from the father’s genes, and if there is any deficiency in it, it is completed by the mother’s side. Similarly, if there is any deficiency in the gene from the mother’s side, it is completed by the father.”
“But in this case, only half the information is present. This is the reason why their blood group is completely different. In this case, that antigen is chromer.”
Dr Ankit Mathur said, “So far there were 20 antigens in the Cromer blood group system that have been identified. CRIB has now become the 21st antigen of this system.”
Nothing is safe for patients like this woman patient from Kolar in any emergency situation.
If a person does not have these proteins and is given blood transfusion in the normal way, then his body considers it a foreign element and produces antibodies to destroy it.
Dr Ankit Mathur says that there is no option in such a case, “unless we find someone within the family whose blood group is also CRIB type.”
He says that in such cases “the other option is that the doctor collects the patient’s own blood before surgery so that in case of emergency, the patient can be given the same blood. This is called autologous blood transfusion.”
Autologous blood transfusion is not an uncommon procedure. This type of procedure is commonly adopted in patients with rare blood groups.
The case of the CRIB blood group is no different from the rest of the 47 blood group systems, which have 300 antigens. But only ABO and RhD blood groups are matched for transfusion.
Dr Swati Kulkarni, former deputy director of ICMR-NIIH (National Institute of Immunohaematology), Mumbai, gives the example of the rare Bombay blood group or HH, discovered in 1952 by Dr YM Bhende and Dr HM Bhatia.
“People who have the Bombay phenotype do not have the A and B antigens, just like the O group, but they cannot receive blood from the O blood group,” she told the BBC.
The Bombay blood group is a rare blood group, with a prevalence of one in a million people worldwide. However, in Mumbai, the rate is said to be one in every 10,000.
This blood group was discovered in 1952 by Dr. YM Bhende and Dr. HM Bhatia. In India, it is found in relatively more people.
Dr. Ankit Mathur says, “The situation is the same in the case of the female patient from Kolar, she cannot take blood from anyone but she can donate blood to others. As people with Bombay blood group can do.”
Dr. Swati Kulkarni says, “Apart from CRIB antigen in Bombay blood group and Cromer blood group system, Indian blood group system has also been discovered in India. It was discovered by ICMR-NIIH in the year 1973.”
Dr. Swati Kulkarni says that NIIH is trying to make a list (register) of rare blood donors at the national level.
This will be a database which will have information about donors with rare blood groups, so that it can be made available to patients in a systematic manner soon.
She says that this register will be especially helpful for those patients who have already developed several types of antibodies and need a matching blood group.
This kind of register becomes even more important in situations where red cell alloimmunization and negative blood antigens are needed (when the body’s immune system starts producing antibodies to fight a foreign element).
A low immunization rate of 8 to 10 percent has been found in thalassemia patients. In such cases, the patient has to be given blood transfusions repeatedly.
Dr Swati Kulkarni says, “In the general population, the probability of antibody formation in patients requiring transfusion is about one to two percent. The incidence of alloimmunization and the rate of formation of blood group antigen may vary in different ethnic groups.”
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