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Bombay Blood Group
Context:
In a groundbreaking medical achievement, doctors at MIOT International in Chennai successfully performed a kidney transplant on a patient with the extremely rare Bombay blood group.
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- The procedure was performed by MIOT International, Chennai, a hospital with two decades of experience in cross-blood transplants.
- This was the first recorded case of a cross-blood kidney transplant for a Bombay blood group patient.
What is Bombay Blood Group?
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- Discovered in 1952 by Y.M. Bhende in Mumbai.
- Distinguished by the absence of the H antigen, which is the foundation of the ABO blood group system.
- Individuals with this blood group cannot receive transfusions from ABO blood groups, including O-type, which contains the H antigen.
- Occurrence rates:
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- 1 in 4 million globally.
- 1 in 1 million in Europe.
- 1 in 10,000 in Mumbai.
Background
- A 30-year-old male underwent a kidney transplant in mid-2024.
- The patient had the extremely rare Bombay blood group (HH), which made it nearly impossible to receive organs or blood transfusions from anyone without the same blood type.
- His mother, who did not have the Bombay blood group, was willing to donate a kidney, posing an unprecedented medical challenge.
Clinical Challenges in the Transplant
- The primary challenge: The recipient’s immune system would reject the donor kidney due to incompatible blood types.
- The team used the Japanese-developed double filtration plasmapheresis (DFPP) technique, first applied by MIOT in 2010 for ABO mismatched kidney transplants.
- Key steps taken by doctors:
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- Identification of Anti-H antibodies: Unlike ABO transplants, the patient’s anti-H antibodies had to be measured and managed.
- Use of Monoclonal Antibody Injection: To deplete B cells responsible for antibody production.
- Antibody Titration: The team measured and titrated anti-H antibody levels to a safe concentration, though no standard cut-off existed.
- Plasmapheresis & Immunosuppressive Therapy:
- Plasmapheresis was used to remove harmful antibodies.
- Intravenous immunoglobulin (IVIG) was administered to further suppress antibody activity and prevent rejection.
- Regular Antibody Monitoring: Conducted every alternate day to determine the safest point for transplantation.
- Emergency Blood Stocking: The team sourced Bombay blood group units as a precaution but did not need them.
Successful Transplant and Recovery
- The transplant was successfully performed with no rejection or complications.
- The crucial first two weeks post-surgery, typically decisive for organ rejection, were uneventful.
- Six months post-transplant, the patient resumed normal life and activities.
Medical and Scientific Significance
- The case study was published in Kidney International Reports, documenting the breakthrough for future reference.
- The success provides hope for other Bombay blood group patients requiring organ transplants.
- It establishes a new frontier in transplantation science, proving that with meticulous planning and advanced medical techniques, the impossible can become possible.
