Global definitions of rare donors

Abstract

Background A basic definition of a rare donor unit is that unit not available for the patient at the time of the transfusion need. However, there are some patients who required exquisitely phenotyped, even genotyped units, for optimal survival of transfused red cells. Often, the rare phenotyped unit needed is negative for an antigen of high prevalence, sometimes the type is less than one in 10 000 donors tested or even rarer. Further complications arise with consideration of ABO/Rh type or the concomitant presence of antibodies to common antigens. Another type of rare unit is one that is negative for multiple common antigens, which in combination make the donor difficult to find. Aims The availability of rare donor phenotypes or genotypes can vary amongst countries, but some types, e.g. Rhnull, are difficult to provide in nearly every country. The need for an organized approach to managing rare donor information was recognized long ago, with the ISBT establishing the concept of an International Rare Donor Panel (IRDP) in 19653. In 1968, the IRDP had 300 donors listed from 10 countries. In 1985, 500 donors from 22 countries were listed, and in 1991, 3000 donors. In 1998, 4000 donors from 24 countries were listed. The ISBT Working Party on Rare Donors member countries supports the continued replenishment of rare donors and provision of their units world‐ wide by continuing to identify and submit donors to the IRDP. The aim is to ensure rare blood units are available internationally when needed. Method The ISBT Working Party on Rare Donors presented data specific to their country at the 2012 Congress Working Party meeting on the topic of: What are the most difficult phenotypes to find? Results Identifying donors with rare types is important for provision of blood for patients with complex antibody challenges. From the international perspective of the Working Party Members, the most difficult to provide is Rhnull, listed by 11 of 17 reporting countries (65%). D– – was listed by seven countries at 41%. Ko and U‐ were listed by 6 at 35% and Di(b‐), Ge‐, Hr/HrB‐, Lan‐ at 21%. The complete data is listed in Vox Sanguinis Science Series publication from this Regional Congress. From an international perspective, if there were more donors of these types, more patients could receive the treatments they need. While massive screening might be one way to find rare donors, it may be more effective to track the sibling of patients with rare types, and engage all that are found to be rare types to be blood donors. Summary Each country's rarest types should be known to all blood centers. When a patient needing this type is identified, it will be known that there might be delays or challenges in getting the blood. The ISBT Working Party on Rare Donors works to ensure that all countries with rare donor activities have their donors listed on the IRDP, so that rare blood units are available internationally.

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