A large-scale pioneer study has been conducted in Indonesia in order to aid in the effort to optimize transfusion guidelines at the national level. Results of the analysis were published recently in BMC Research Notes.
To date, 45 blood group systems have been recognized officially by the International Society of Blood Transfusion. Among these, the most clinically relevant are ABO and Rhesus (Rh). Although ABO blood group antibodies may be to blame for severe hemolytic transfusion reactions (HTRs) among individuals who receive incompatible red blood cell (RBC) transfusions, hemolytic disease of the fetus and newborn (HDFN) associated with ABO antibodies is relatively common and typically of milder clinical importance.
The D antigen, which is harbored by RhD transmembrane protein, is considered to be the most likely Rh antigen to generate an immune response. In fact, D-positive RBCs from donors and fetuses can trigger alloanti-D production among D-negative patients and pregnant women, respectively, which is termed alloimmunization. In alloimmunized individuals, novel exposure to the D antigen may lead to HTR or HDFN, with severity varying from asymptomatic to the occurrence of fatal outcomes.
Recognizing that the frequency of blood group antigens in Indonesia has been reported scarcely in the literature, the researchers of the current study sought to report on the distribution of ABO and D antigens among blood donors from Yogyakarta, Java Island, Indonesia. Between January 1, 2018, and December 31, 2023, phenotypic data (on ABO and RhD blood group antigens) were obtained from the blood donor registry of the Yogyakarta Blood Donor Unit. Frequency of the phenotypes was computed separately.
Read more about testing and diagnosis of HDFN
As the fourth most populous country in the world, the population of Indonesia is estimated to be more than 280 million inhabitants of various ethnicities.
A total of 245,307 donor blood samples were evaluated over six years, in order to establish the distribution of ABO and D blood group antigens. Results of the study revealed the following frequency of the ABO phenotype:
- O-positive: 38.42%
- B-positive: 29.35%
- A-positive: 24.10%
- AB-positive: 7.67%
- AB-negative: 0.31%
- O-negative: 0.08%
- A-negative: 0.04%
- B-negative: 0.04%
In the Rh blood group system, the frequency of phenotypes was as follows: D-positive: 99.5% vs D-negative: 0.5%.
Globally, the phenotypic pattern reported in this analysis is similar to that observed in prior reports originating from Southeast Asia. Distribution of the D antigen is similar to the world distribution as being the most common blood group.
“We are still conducting a more comprehensive nationwide study involving blood donors from different regions and backgrounds in Indonesia to confirm these findings and identify any region-specific variations in the ABO and D antigens, considering the country’s heterogeneous geography, ethnicity and genetic variation,” the authors concluded.
