Outdated blood transfusion system poses risks for East Asians: study < Hospital < Article

It has been pointed out that the Korean blood transfusion system needs to be improved to reflect the genetic and racial characteristics of East Asians, including Koreans.

Experts point out that the current blood transfusion standards and blood type classification system are insufficient because some of them are designed based on the blood type distribution of Westerners.

The current blood transfusion standards and blood type classification system are insufficient because some of them are designed based on the blood type distribution of Westerners, according to Professor Cho Deok of the Department of Diagnostic Laboratory Medicine at Samsung Medical Center. (Courtesy of Samsung Medical Center)

A team of researchers led by Professor Cho Deok of the Department of Diagnostic Laboratory Medicine at Samsung Medical Center called for such improvements in a study that analyzed blood type characteristics by region worldwide.

Professor Lim Ha-jin of the Department of Diagnostic Laboratory Medicine at Chonnam National University Hospital and Yoon Se-hyo, a trainee doctor at the Department of Pathology at Harvard Medical School, jointly conducted the study.

They found that East Asia, which includes Korea, Japan, China, and Taiwan, has a relatively high proportion of AB blood types and extremely low RhD negativity, unlike Europe, the Middle East, and Africa. In East Asia, the proportion of AB was 5-12 percent, and RhD-negative was 0.1-1 percent, compared to 3-8 percent and 11-19 percent, respectively, in Europe, indicating apparent regional and ethnic differences in blood group distribution.

The researchers emphasized the need for different blood transfusion systems in different countries rather than simply interpreting this as a difference in blood type distribution.

The researchers pointed to the fact that in Europe, “type O RhD-negative blood,” a universal blood type that can be used immediately without blood type testing in emergencies, is easy to obtain, while in Korea, “type O RhD-positive blood,” is in short supply and must be used.

This is not without risk, even if it is used exceptionally for patients in life-threatening emergencies with massive blood loss.

“We have a blood donor registration program to secure RhD-negative blood. However, in a crisis, including Covid-19, it can be difficult to get enough blood,” the researchers said. “We need to develop a more stable supply system and consider a more predictable and precise system for exceptional use.”

Blood typing also showed apparent genetic and racial variations. Compared to Europe, the Middle East, and Africa, cis-AB, which is relatively common in Koreans and Japanese, can be misdiagnosed as AB on some automated machines developed in the West and popularized in Korea, the researchers reported. Without further testing, transfusion of AB-type red blood cells to a cis-AB patient can lead to hemolysis due to antigenic antibody reactions and should not be overlooked.

The researchers noted that the same is true for “Asian-type DEL. ” This blood type is thought to be absent in Westerners and found only in Asians. The problem is that existing tests test negative for RhD and cannot accurately detect Asian-type DEL without testing for the RHD gene. Although few people with this blood type have RhD antigens, their blood can cause adverse reactions when transfused into RhD-negative patients.

“RHD genetic testing should be performed on donors classified as RhD-negative to ensure safe transfusion,” the team said.

A similar story follows for red blood cell antibody testing. Antibodies to Mi a or Di a antigens are also frequently found in East Asia, but most commercial antibody screening kits developed in the West cannot detect them. The team added that acute hemolytic reactions and fetal neonatal hematologic disorders have been reported both domestically and internationally.

“It is necessary to introduce blood group genetic testing methods and red blood cell non-predictive antibody panels specific to East Asians and to improve the precision donor-recipient matching system for rare blood group carriers,” Professor Lim said.

Professor Cho said, “This study shows that the existing Western-centric transfusion standards cannot be universal. In the era of globalization, each country needs a specialized transfusion system that accommodates ethnic diversity in healthcare.”

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