BLOOD TRANSFUSIONS

AREN’T WE ALL THE SAME UNDER THE SKIN?

During my early hospital practice years, I distinctly remember two unusual patients with massive gastrointestinal bleedings who needed immediate blood transfusions. 

One of them was a Jehovah ‘s Witness. He absolutely refused a blood transfusion for religious reasons. I told him, ”blood is life, how can any religion be against life?” It made no difference for him. He could not survive without a blood transfusion and he eventually died.

The second patient was a black man who insisted on having a “black blood” transfusion. At the time, I didn’t understand what he meant. I took it literally and told him, “We are all the same under the skin. There is no such thing as black blood. Everybody’s blood is red.”

At the time, all that I knew about blood was that the donated blood is carefully screened for any abnormalities and any infectious diseases (viral, bacterial, parasitic, fungal) before blood donations are accepted by the blood banks. Additionally, before a transfusion, the patient’s blood would be typed and cross-matched against any available blood by the hospital staff before it was transfused.

And there are eight (8) types of blood: A, B, AB, O and each blood type with Rh Factor positiveor negative status.

Bloodtypes (groups) are genetically determineddepending on the different combinations of protein and sugar molecules on the surface of every red blood cells (RBC).  RBCs are strongly antigenic.If blood types do not match, or if the wrong blood type is transfused, it triggers a very strong immune reaction with the patient, causing fever, Anaphylaxis, Shock, even death. The other antigenic components of the blood are due to white blood cells (WBD), platelets and the serum of the blood.  These antigens could create minor blood compatibility problems for transfusion.

The International Society of Blood Transfusion lists at least 360 known antigens in the blood. In addition, there are different and very rare blood types called, Indian B and Big E.

Later on, in my hospital practice I learned that blood is racially and ethnically specific. Much of the variance in blood types have been driven by the evolutionary adaptation of survival depending on the environment (microbiotic, geographic,available food sources, etc.) that people have lived in. For example, sickle cell anemia developed in Africa, to protect people against malaria epidemics. 

Much of the variance of the blood types have been driven by evolutionary selection by bacteria, viruses and parasites. Consequently, it has been scientifically established that there are ethnic or racial division of blood types. Now, I know better when my patient requested black blood.

In conclusion, even though our blood is the same color, we are not the same under the skin. A successful bloodtransfusion depends on thesameness of the blood. Blood is very strongly antigenic. It is still unknown if blood transfusions could cause long term many immune reactions. Blood transfusions should be considered liquid organ transplants.It should never be abused. It should only be used in life- and- death situations always with clear cut indications.