When his blood group changed
When his blood group changed
Vijay Gopichandran
Mr. Moorthy was a cheerful young man with a very active social life. His family comprising of his wife and two sons were living a normal rural life in their village. Moorthy's father had been an agricultural laborer, but he worked hard to educate Moorthy till the 12th standard. After schooling, Moorthy had worked in several mechanic workshops in the nearby town repairing two-wheelers and cars. He had started his own mechanic shed recently and he was doing a good job with his own set of loyal clients. Moorthy was a happy man and had an excellent sense of humor. He would laugh and joke at every little opportunity. He would instantly bring life to every get together of friends.
Being a socially conscious and active man, Moorthy regularly donated blood every three months. He has been donating blood from the time he was 28 years old. He is now 36 and counting at least 3 donations a year, he must have donated at least 24 times, thus saving the lives of 96 different patients. Moorthy took his regular blood donations seriously and it was a noble action for him. In fact, if he went without donating blood for a period of more than 4 months, he would remark to his wife that he "felt heavy" and needed to donate soon.
It was this happy, normal, enthusiastic, young man who sat in front of me at the clinic last Sunday. He seemed to be in distress. The AYUSH practitioner whom he had come to see, referred him to see me as "he had a peculiar problem". I asked Moorthy what the problem was and he started narrating the events of the past 2 days.
"Doctor, I donate blood regularly. I am O negative blood group. They say O negative blood can be given to anyone with any blood group. So I make sure that I donate blood regularly. The day before yesterday, I went to the government blood bank to donate blood. As usual, they collected blood. I felt happy that I gave blood and I returned home. Yesterday, someone from the blood bank called me and said that I need to come back to the blood bank because there is a problem. I went there yesterday and they told me that I am not O negative blood group. I am O positive. They referred me to Chennai GH and asked me to go there to get this tested."
After completing this narration, Moorthy asked me if there is an explanation for this. He was perplexed that his blood group had changed. He asked me, "Doctor, does a person's blood group change like that?"
To be very honest, I had never heard of changing blood groups. I had no clue how to answer him. For gaining a better understanding of the blood group phenomenon, I will explain briefly how it works. The Red Blood Cells that we all have in our blood, has several proteins on its surface called antigenic proteins. There are three of them which are very important in determining the blood group of a person. These are A antigen, B antigen and D antigen. If A, B, and D antigen are present, the person belongs to A, B, and Positive blood groups respectively. If both A and B antigens are present they belong to the AB blood group and if neither is present they belong to the O blood group. This is an oversimplified version of how the blood groups work. In Moorthy's case, he lacked the A and B antigens and so he was O group. Also, he initially lacked the D antigen and was called negative, but subsequently he was said to be D antigen positive. This was the confusion.
I discussed this with my colleagues who were there at work and they had no idea about this either. We had to find an answer to explain this phenomenon to Moorthy. Before going into the process of discovery of blood group changes, I must explain why Moorthy was in so much distress over this matter. Blood group is a matter of identity. Just like how signature, finger printing, iris scans etc. are all biometric indicators of one's identity, blood group is also understood to be a person's identity. Moorthy has been believing over the past 8 years that he had O negative blood group. Not only this, he was a proud blood donor. He also believed that being O negative he was a universal donor and so his blood could be used for anyone without any difference. All these matters were important to Moorthy as a matter of identity and purpose in life. Now suddenly he was being told that his blood group has changed. Moorthy is a smart man and so he understood that a change in blood group is not a normal thing. He asked me, "Doctor, the blood group is entered in our Driving Licence as an identity. This means that it is a permanent thing, right? How can it then change?" To Moorthy, the blood group meant more than just a set of alphabets. He was worried and confused and sat there in a state of distress.
I told Mr. Moorthy that I did not know anything about this problem. I have never heard of anyone's blood group changing like that. I reassured him that it is unlikely to be anything serious. I am not sure if I was even right in doing that. I promised to read up and find more information on this matter and get back to him. Moorthy left the clinic dissatisfied and still in distress. My colleagues and I started searching the literature to find out if anything like this has been reported before. Many of our friends and colleagues also helped in searching for the answer.
There could be two possible explanations for the phenomenon of changing blood groups. I will briefly describe them here. Firstly, there is a type of D antigen (the one that determines the positive or negative blood group) called the Weak D Antigen. Read more about this Weak D antigen here (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4922919/). The antigen is so weak that when tested it shows up as a negative group. However, during certain conditions of the body, it may show up as positive. This has been reported in the past and there have been situations where people have had inconsistent positive and negative blood groups results in testing. The reports say that the prevalence of this Weak D antigen is about 0.189%. In other words, only 2 in 1000 will have this form of weak D antigen. The second explanation is also interesting. There are some situations that have been shown to be associated with drastic changes in blood groups of individuals. Some infections of the blood such as infection with Cytomegalo Virus (CMV) have been shown to cause minor changes in expression of the antigens on the surface of the Red Blood Cells, causing a change in blood group. Also, cancers of the blood and bone marrow have led to changes in the blood groups. There are reports where patients had a change in blood group when they developed Acute Myeloid Leukemia (a form of blood cancer) but this reverted to their old blood group when the disease went into remission (cure). This reference can be read here. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5242122/). It has also been reported that when a patient undergoes a bone marrow transplant, there is a possibility of a change in the blood group.
So what does all this mean to Moorthy? I will have to sit with him during the next visit and talk to him that what he has is not something that is completely unheard of. I have to take him through the steps of how we can understand his condition further. A clear immunohematological testing to see if he has the Weak D antigen is the place to start. After that, we may have to look for alternative explanations. Moorthy's episode taught me the importance of certain small things that we take for granted in giving identity to individuals. My first reaction to his distress was, what is the problem? He is not having any pain or suffering. Why is he reacting like this to just a change in blood group? But then a deeper understanding of Moorthy and his life, helped me see how distressing it can be to have your identity completely changed. I will update this blog with what happened to Moorthy's tests and how we managed to get over this problem.
Vijay Gopichandran
Mr. Moorthy was a cheerful young man with a very active social life. His family comprising of his wife and two sons were living a normal rural life in their village. Moorthy's father had been an agricultural laborer, but he worked hard to educate Moorthy till the 12th standard. After schooling, Moorthy had worked in several mechanic workshops in the nearby town repairing two-wheelers and cars. He had started his own mechanic shed recently and he was doing a good job with his own set of loyal clients. Moorthy was a happy man and had an excellent sense of humor. He would laugh and joke at every little opportunity. He would instantly bring life to every get together of friends.
Being a socially conscious and active man, Moorthy regularly donated blood every three months. He has been donating blood from the time he was 28 years old. He is now 36 and counting at least 3 donations a year, he must have donated at least 24 times, thus saving the lives of 96 different patients. Moorthy took his regular blood donations seriously and it was a noble action for him. In fact, if he went without donating blood for a period of more than 4 months, he would remark to his wife that he "felt heavy" and needed to donate soon.
It was this happy, normal, enthusiastic, young man who sat in front of me at the clinic last Sunday. He seemed to be in distress. The AYUSH practitioner whom he had come to see, referred him to see me as "he had a peculiar problem". I asked Moorthy what the problem was and he started narrating the events of the past 2 days.
"Doctor, I donate blood regularly. I am O negative blood group. They say O negative blood can be given to anyone with any blood group. So I make sure that I donate blood regularly. The day before yesterday, I went to the government blood bank to donate blood. As usual, they collected blood. I felt happy that I gave blood and I returned home. Yesterday, someone from the blood bank called me and said that I need to come back to the blood bank because there is a problem. I went there yesterday and they told me that I am not O negative blood group. I am O positive. They referred me to Chennai GH and asked me to go there to get this tested."
After completing this narration, Moorthy asked me if there is an explanation for this. He was perplexed that his blood group had changed. He asked me, "Doctor, does a person's blood group change like that?"
To be very honest, I had never heard of changing blood groups. I had no clue how to answer him. For gaining a better understanding of the blood group phenomenon, I will explain briefly how it works. The Red Blood Cells that we all have in our blood, has several proteins on its surface called antigenic proteins. There are three of them which are very important in determining the blood group of a person. These are A antigen, B antigen and D antigen. If A, B, and D antigen are present, the person belongs to A, B, and Positive blood groups respectively. If both A and B antigens are present they belong to the AB blood group and if neither is present they belong to the O blood group. This is an oversimplified version of how the blood groups work. In Moorthy's case, he lacked the A and B antigens and so he was O group. Also, he initially lacked the D antigen and was called negative, but subsequently he was said to be D antigen positive. This was the confusion.
I discussed this with my colleagues who were there at work and they had no idea about this either. We had to find an answer to explain this phenomenon to Moorthy. Before going into the process of discovery of blood group changes, I must explain why Moorthy was in so much distress over this matter. Blood group is a matter of identity. Just like how signature, finger printing, iris scans etc. are all biometric indicators of one's identity, blood group is also understood to be a person's identity. Moorthy has been believing over the past 8 years that he had O negative blood group. Not only this, he was a proud blood donor. He also believed that being O negative he was a universal donor and so his blood could be used for anyone without any difference. All these matters were important to Moorthy as a matter of identity and purpose in life. Now suddenly he was being told that his blood group has changed. Moorthy is a smart man and so he understood that a change in blood group is not a normal thing. He asked me, "Doctor, the blood group is entered in our Driving Licence as an identity. This means that it is a permanent thing, right? How can it then change?" To Moorthy, the blood group meant more than just a set of alphabets. He was worried and confused and sat there in a state of distress.
I told Mr. Moorthy that I did not know anything about this problem. I have never heard of anyone's blood group changing like that. I reassured him that it is unlikely to be anything serious. I am not sure if I was even right in doing that. I promised to read up and find more information on this matter and get back to him. Moorthy left the clinic dissatisfied and still in distress. My colleagues and I started searching the literature to find out if anything like this has been reported before. Many of our friends and colleagues also helped in searching for the answer.
There could be two possible explanations for the phenomenon of changing blood groups. I will briefly describe them here. Firstly, there is a type of D antigen (the one that determines the positive or negative blood group) called the Weak D Antigen. Read more about this Weak D antigen here (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4922919/). The antigen is so weak that when tested it shows up as a negative group. However, during certain conditions of the body, it may show up as positive. This has been reported in the past and there have been situations where people have had inconsistent positive and negative blood groups results in testing. The reports say that the prevalence of this Weak D antigen is about 0.189%. In other words, only 2 in 1000 will have this form of weak D antigen. The second explanation is also interesting. There are some situations that have been shown to be associated with drastic changes in blood groups of individuals. Some infections of the blood such as infection with Cytomegalo Virus (CMV) have been shown to cause minor changes in expression of the antigens on the surface of the Red Blood Cells, causing a change in blood group. Also, cancers of the blood and bone marrow have led to changes in the blood groups. There are reports where patients had a change in blood group when they developed Acute Myeloid Leukemia (a form of blood cancer) but this reverted to their old blood group when the disease went into remission (cure). This reference can be read here. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5242122/). It has also been reported that when a patient undergoes a bone marrow transplant, there is a possibility of a change in the blood group.
So what does all this mean to Moorthy? I will have to sit with him during the next visit and talk to him that what he has is not something that is completely unheard of. I have to take him through the steps of how we can understand his condition further. A clear immunohematological testing to see if he has the Weak D antigen is the place to start. After that, we may have to look for alternative explanations. Moorthy's episode taught me the importance of certain small things that we take for granted in giving identity to individuals. My first reaction to his distress was, what is the problem? He is not having any pain or suffering. Why is he reacting like this to just a change in blood group? But then a deeper understanding of Moorthy and his life, helped me see how distressing it can be to have your identity completely changed. I will update this blog with what happened to Moorthy's tests and how we managed to get over this problem.
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