Doctors, nurses, surgeons were constantly on standby during former US President Barack Obama's travels. The White House Medical Unit (WHMU) had to be ready to act in case of an unexpected illness or accident. Along with all the necessary things, they always made sure to have units of blood with them for emergency transfusions. The former president's blood type required this, as AB negative is the rarest of the eight major blood types in the general population, with a rate reaching only 1%.
If in Obama's case, immediate access to a blood supply was essential to his health, it's even more difficult for the fewer than 50 people on the planet with the Rh-null blood phenotype, also known as "golden blood."
The American Red Cross considers a blood type “rare” when it occurs in fewer than one in a thousand people. At about one in six million, Rh-null is the rarest of all and is characterized by the complete absence of all 49 Rh antigens on red blood cells. On the one hand, it is valuable, as it can be transfused to people with rare types, but on the other hand, it can be dangerous for the person who carries it, as they can only receive Rh-null blood.
Since its first discovery in 1961 in a woman in Australia, no more than 50 people worldwide have been identified with this unique blood type. Currently, those with this blood type depend on a small network of blood donors worldwide if they need transfusions, as only ten active donors are registered. Among them is 77-year-old Suzette Fourie from South Africa, who has donated more than 63 units of blood. She discovered her rare type after giving birth, when she needed the blood that ultimately saved her life. Since then, she has dedicated herself to donating blood to the South African Rare Donor Program. Local authorities have set up a freezing facility known as the “Rare Donor Archive” since the mid-2000s, which allows each unit to be stored for up to ten years and is available nationally and internationally. Authorities conduct studies when they identify a donor or patient with a rare blood type, as there is a one in four chance that the siblings of a person with a rare blood type will have the same gene.
What does it mean to be Rh-null?
A simple laboratory test is needed to determine what blood type someone has. To determine it, antigens are detected on the surface of red blood cells. So, if the A antigen is detected, the blood type is A, if B, the blood type is B, and so on. In addition, the Rh factor of the blood is examined, specifically, an antigen called RhD. If someone has RhD, the blood type is positive, otherwise it is negative. This is where “golden blood” comes into play. RhD is not the only antigen in the Rh system, as there are more than 50 different Rh antigens. However, people who are Rh-null do not have any of the Rh antigens.
Freezing and laboratory
“Golden blood” can be transfused to people with rare or multiple Rh antibodies, but it is very difficult to find a donor for them. In case a patient receives blood with different antigens, they will create antibodies to “attack” it. If this blood is transfused again, the patient’s life could be at risk. For this reason, those living with Rh-null have the option of freezing their blood and using it in case of planned surgeries, while experts recommend regular check-ups and preventive intake of iron or folic acid.
However, blood management is complicated, requiring proper storage conditions and ensuring that the unit is delivered to the patient who needs it in a timely manner. In addition, the possibility of low red blood cell counts complicates matters even further. These factors discourage storage, while most of them avoid a lifestyle that can be risky.
Scientists are trying to reproduce this strain in the laboratory. Among them is Professor of Cell Biology at the University of Bristol, Ash Toy, who, speaking to the BBC, explained that he and his team reproduced the Rh-null strain. However, as the publication points out, the use of gene editing techniques is controversial and subject to strict regulations, which makes it difficult to make this strain clinically available, which will have to undergo many clinical trials and controls before it is approved.
Meanwhile, the professor has founded a company that collects blood samples from people with rare blood types, with the hope of using them to create cell lines that can be grown in the lab to produce red blood cells indefinitely. This blood can then be frozen and stored in case of an emergency.