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Australia’s ethnic face is changing, and so are our blood types

It’s often said that no matter who we are, “we all bleed red”. But although our blood may be the same colour, we’re as individual on the inside as we are on the surface. Just like our background determines the way we look, where we come from is one of the major factors that influences the make up of our blood.

About half of people living in Australia today were either born overseas, or have a parent born overseas. This increase in the diversity of our population leads to a corresponding diversity in the people who need medical treatment – and their blood types.

We need a broad mix of ethnicities in our donor pool to meet the needs of patients with rare blood types. Providing the right blood and blood products for an ethnically diverse population presents an evolving challenge for blood collection agencies around the world, including here in Australia.


Read more: Blood groups beyond A, B and O: what are they and do they matter?


People from diverse backgrounds tend to be underrepresented in donor populations. While Australians born overseas account for roughly one-third of the population, they account for only one in five blood donors.

This limited diversity in our pool of donors creates challenges in identifying blood matches for transfusion to patients with rare blood types.

The link between your blood group and where you come from

Blood types consist not only of the commonly recognised groups such as A, B and O, but also include more than 300 other variants. Each of these variants is a marker on the surface of our red blood cells, and is known as an “antigen”.

Our blood type is inherited from our parents. Like other inherited characteristics such as skin and hair colour, the frequency of blood types in a population shift in response to stresses in the environment (known as “selection pressure”).

For example, in parts of the world where malaria thrives, the proportion of the population with various blood types has altered over time to make people less prone to infection.

So this effect has more to do with where you and your ancestors lived than your ethnic group. One blood type, known as Duffy null, is much more frequent in Africans in Africa than in African-Americans, possibly because African Americans are no longer exposed to the malaria parasite.

In short, one reason we have different blood groups is to improve our chances of fighting disease.


Read more: How our red blood cells keep evolving to fight malaria


Who needs specially matched blood?

Most transfusions of red cells are matched for the commonly recognised ABO and Rh blood groups (the Rh group is the one that gives you the “positive” or “negative” in your blood type).

If someone receives a transfusion of blood that doesn’t match their own type, their body may recognise the transfused blood as foreign, and develop antibodies to try and destroy the “invader”. Their body will keep making these antibodies, which can then interfere with future transfusions.

Most healthy people are eligible to donate blood. From shutterstock.com

Some patients need specially matched red cells for transfusion. This means on top of being matched by ABO and Rh type, the donor’s blood is matched to make sure it doesn’t contain blood group variants that aren’t present in the recipient’s blood. This is more difficult to achieve.

There are three groups of patients who need specially matched blood:

  1. patients who have already developed antibodies because they have had a transfusion of blood that is not fully matched in the past
  2. patients who may have developed antibodies to blood group antigens, but other conditions or drug treatments make it hard for their doctors to test for antibodies
  3. patients who need to have many transfusions throughout their life, so doctors want to avoid the development of blood group antibodies.

Patients who may need to have multiple transfusions throughout their life include those with disorders affecting the blood such as sickle cell anaemia, thalassemia major and myelodysplasia.

Thalassemia is most common in people of African, Middle Eastern, Asian, Indian and Mediterranean descent. Sickle cell anaemia affects these ethnic groups and also people of Hispanic descent.

Which groups are most in need in Australia at the moment?

There are so many different blood group antigens, combinations of even the most common blood group types are found in only a small proportion of donors, making it difficult to provide blood fully matched for a particular patient.

In addition, as our patient population becomes more diverse, there is a greater need for blood types that are rare in a Caucasian population.

Ultimately, the distribution of blood groups that we collect from our donors should reflect the distribution of blood groups required by patients who need transfusion.


Read more: Explainer: what's actually in our blood?


Blood centres in many countries have introduced a variety of campaigns to attract a broader donor group.

At the Australian Red Cross Lifeblood, we are interviewing donors from diverse backgrounds to learn more about their experiences in donating blood. Our goal is to build a donor panel that represents the diversity of the broader Australian community.

The benefits are not only for the patients and the health system – research suggests participating in blood donation facilitates social inclusion among migrant communities.

Dr Alison Gould, Scientific Communications Specialist for the Australian Red Cross Lifeblood, co-authored this article.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Authors: 
Tanya_Davison

A/Prof Tanya Davison

A/Prof Tanya Davison

A/Prof Tanya Davison is National Donor Research Manager at Australian Red Cross Lifeblood. In this role she leads a multidisciplinary team of researchers who are investigating ways to improve the recruitment and retention of blood donors, as well as maintain the health and wellbeing of Australians donating blood.

Tanya is a psychologist, with a research background in mental health, and a particular interest in designing and evaluating psychological interventions to improve outcomes for individuals and lead to practice changes within health care systems.

Robert Flower

Prof Robert Flower

Prof Robert Flower

Prof Robert Flower leads our Product Safety team in Research and Development. His research focusses on product safety, with a particular interest in how genetic technologies can improve the matching of blood for patients.

A/Prof James Daly

A/Prof James Daly

A/Prof James Daly

A/Prof James Daly is our Medical Director of Pathology Services. He's a clinical and laboratory haematologist. FRACP, FRCPA 2005

Comments

I am lucky enough to be O neg and regularly donate blood and plasma in between whole blood donations. I always encourage my friends to donate but I have a couple of Latino friends who have been told that they cannot donate due to their ethnicity. I am yet to find a reason for this. Are you able to elaborate, please? Helen

Thanks Helen for asking this question. It’s great that you mix and match to donate both blood and plasma and that you encourage your friends to donate too! I’m sorry to hear of your Latino friends’ experience, and assure you that we don’t stop people donating simply because of their ethnic background. To make sure our blood supply is safe for patients, we do have some restrictions based around a person’s country of birth. For example, we don’t take whole blood donations from people who were born in, or had a blood transfusion in South America (no matter what their ethnic background). This is because there’s an increased risk of passing on Chagas disease, which is carried by insects and can be present for many years without showing symptoms. Chagas kills more people in Latin America each year than any other parasitic disease and is transfusible through red cells. The good news is that your friends may still be able to donate plasma! The best thing to do is ask them to phone 13 14 95 to check, and you can let them know how simple it is to donate plasma instead.

Very interesting information! I am a first fleet descendant, and there isn't much ethnic diversity in my family tree, so this article was really enlightening. I have a question a bit off topic...I have given my A- blood regularly in the past, until about 5 years ago, when I started medication for Complex-ptsd. I am medication free now, and wonder how long I need to wait to give blood again? Thankyou

Hi Dee I'm glad you enjoyed the article! To find out when you're eligible to donate again, the best thing to do is call 13 14 95, and have the name of your medication handy. We can help you work out when you can donate, as well as make an appointment for you.

In Giving blood over the last 35 years it has been very satsfying to know I have been helping others to not only live but to enjoy as close a life to 'normal' for those with 'abnormal' life conditions. All of us have a responsibility in sharing what we can when we are healthy and able. One day we may need to be on the receiving end and we too will be thankful for those who make time to give for others benefit. Give generously! :)

Hi Rob Thanks for being such a regular donor, and for encouraging others to join you.

As a prior donor mentioned I first gave blood in the 1970s but as I worked the last 40 years of my career as an operating theatre scrub nurse, the advent of the Aided epidemic in the 1980s saw me stop donating blood until I retired 2 years ago. I felt the chance of cross infection via adverse events such as needle stick injury in my work was too high so chose not to donate. However one of the first things I did following retirement was to start donating blood again and I very happy to do so. As a previous respondent mentioned I have seen many occasions when blood transfusions have made the difference literally between life and death.

Hi Diane Thanks for sharing your story, and your obvious concern for patient safety. That's a real focus for us as well, and we're proud that Australia has one of the safest blood supplies in the world. It's wonderful that you have returned to donate now that you've retired, and I hope you have many healthy years of donating ahead of you.

I agree with Michel's comment, I had no idea that my father's Mediterranean ethnicity (born in Cyprus) could increase his risk of being born with Thalassemia, which I actually found out through the Red Cross Blood Bank around 30 odd years ago when I was donating and was found to be anemic. Further tests found I had Thalassemia minor, inherited from my father. I had no idea about this blood disorder. I only recommenced donating nearly 2 years ago, but plasma every 2 weeks and currently into my 42nd donation. Finding out about this disorder has been informative for both me, ensuring I keep my diet healthy. I think tracing donors family traits on the questionnaire is an excellent idea as I was informed that my blood group was more common for my father's ethnicity, B+, and less common for Caucasian ethnicity, again learning about blood groups and where the different groups originate from was very interesting. I have 3 children, one of whom is B+, the other A+ and my youngest is AB+, so I feel very unique to have 3 different blood groups within our family.

Thanks Katrina It's good to hear you'd be happy to answer questions about your background on the questionnaire. Thanks so much for your plasma donations, they can be used in so many ways!! You'll be up to 50 before you know it.

Donation, including blood donation, is not very common for many countries, especially poor and totalitrian. For example there was blood donor campain in USSR but it was mostly workplace-oriented, using the idea "the whole workteam goes to donate blood - do not be a white crow!", and very few people donated blood by themselves as private persons. So it is not very realistic to rely on first-generation immigrants in this field. Second generation, grown and educated from kindy here, is much more prospective source - they inherited the same blood type as their ancestors have, but also got Australian habits and behaviour.

Thanks for your comment Anton! You're absolutely correct that attitudes towards blood donation are very different around the world. Our research team is working closely with community groups from many ethnic backgrounds to understand how we can make sure our blood supply matches the needs of Australian patients.

As blood type A is North European and B is Asian, I always thought that AUSTRALIA will be ( is not YET ! ) the AB country in the planet !! So HAPPPPPY to be helping, because I am a pleased AB - donor.

Hi Paloma- It's great that you're a happy donor. Did you know that your blood type would make you a fantastic plasma donor? Although the proportion of people with different blood types is differnt depending on where you come from, it's more complex than type "A" comes from Northen Europe and "B" comes from Asia (for example China has more type A than type B, and even more type O!). You're right that we will see a broader mix of blood types (not just A,B and O) as our population becomes more ethnically diverse. Keep up the great work!

One thing I find frustrating as a whole blood donor is the amount of times I am barred from donating because of my frequent travel overseas for work. I understand the Red Cross wants to eliminate blood borne diseases getting into their bloodstock but I think they have gone over the top in this respect. I suspect the information you use to pronounce SE Asian countries at risk of malaria is dated or at the least very indiscriminate in lumping whole countries into the "at risk" bag rather than just identifying regions of those countries where cases of malaria actually exist.

Hi Simon It can be very frustrating to be willing to donate, but be unable to. Did you know that you can donate plasma after visiting areas where malaria is present? This can be a great way to help save lives until enough time has passed to allow you to make a blood donation again. You can find out more on our website https://www.donateblood.com.au/eligibility/donating-after-travelling, or call 13 14 95

Interesting article regarding the blood type and other variants link to people background. I have been a regular donor of whole blood for a few years now and I can't recall being asked for my background. I'd be happy to provide this information (in a confidential way obviously). I know the pre-donation questionnaire is already quite daunting, especially for the first donation. However, it might be a good idea to add a few questions (perhaps non compulsory) about ethnic background and possibly history of places where previous generations of the donor had lived... If this helps supporting adapted blood supply?

Hi Michel Thanks for you observations and suggestions. We do currently ask our donors about their country of birth, but of course that doesn't always capture ethnic background. As you point out, our questionnaire needs to strike the right balance between providing the information we need to keep the blood supply safe, without being overwhelming. It's great to know that you'd be happy to share your ethnic background, and possibly many others would be too.

In my LinkedIn post I published this note some time ago: "Blood donations do not discriminate" https://www.linkedin.com/pulse/blood-donations-do-discriminate-dusan-baljevic I am very proud to be able to help somebody as I have seen plenty of suffering around me. Keeps spirit of chess term "gens una sumus" (we are one people). Those of us who have relatively good health are blessed and should help others.

Thanks Dusan for sharing your thoughts. Helping others is a great strategic move, and you can get a check in the process!

As a nurse in the operating room i see first hand the difference that giving blood products can make to the outcome of the procedure. Im an Australian born in Africa and am proud and honered to donate blood.

Hi Patricia It's great to hear that you give blood and also see the results of it in your work. Our life-saving work depends on yours!

I'm proud to be a blood/plasma donor. I started in the mid 1970's, but due to my work and international travel was unable to donaye for approx 20 years. Now 'am very chuffed to have my century of donations. Looking forward to the next 10 to 20, maybe more years of giving blood/plasma for our Aussies in need.

Thanks for your dedication Kaj! It's great that you've come back to giving blood and plasma after such a long break and I hope you have many healthy years of donation ahead.

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The information on this blog is presented by the Lifeblood’s Research and Development Team for the purposes of sharing general information and facilitating discussion about blood donation. It is not intended to be used or relied upon as medical advice. If you have a medical question, please consult your GP or health professional. For information on blood donation, or to find out if you’re eligible to donate, call 13 14 95.