The Need for Blood

It's another Monday in October, which means it's time for another blog post on something spooky! This week's topic builds on last week's post about the discovery of blood types and the risky and definitely gross history of blood transfusion. I definitely suggest reading that one first, but you won't miss anything (except an awesome story) by skipping it. 

Last week we talked about how there are four main blood type groups: A, B, AB, and O. Each of these blood types have proteins called antigens on their red blood cells. Blood also has an additional antigen called the Rh factor, which can either be positive or negative. We'll only be talking about these two antigens in this post, but doctors and blood scientists have found over 600(!) other known antigens. The presence or absence of these antigens is what makes a person's blood a certain type.

When antigens from different blood types mix, it causes the blood to clot. In a scientific lab this isn't a big problem, but if someone has two different types of blood in their body, it could lead to a bunch of life-threatening issues. This is part of why blood transfusions before 1910 were so dangerous, and why blood transfusion was regarded as a last-ditch effort to save a life. As with the overall type, the Rh factor must match in order for blood to be safe to receive. Because O blood has no antigens on its red blood cells, it can go to any other blood type without any problems, making it the universal donor. AB blood types have both A and B antigens on the red blood cells, which means they can receive any blood type, hence why it is called the universal receiver.

Safe blood transfusions between donors and recipients. Notice that the O blood type can be donated to any other blood type, but can only receive O blood. This is why O blood is called the universal donor. AB types can receive any kind of blood as the universal receiver type.
Diagram from: https://www.redcrossblood.org/donate-blood/blood-types.html

A person's blood type is controlled by genetics (specifically chromosome 9q34.2, if you want to get technical). Each person's DNA contains half of its characteristics from each parent. Sometimes these characteristics are both expressed simultaneously, but sometimes one parent's genes are the only ones expressed. The variant of the gene that dominates is called the dominant trait, and the other is called the recessive trait. This is the case with blood types. A and B types are dominant, whereas the O types is recessive. For completeness, Rh+ is dominant over Rh-; this is important for later.

How is a person's blood type decided? Each parent has two alleles, or variants of a gene, that they inherited from their own parents. Which single allele is passed down to the child is completely random. The child receives two alleles, and their blood type is decided by which allele is dominant. If either an A or B gene is present, the child will be that blood type. If the parents both supply the recessive O traits, only then will the child have O blood. In the case when a parent with A blood has a child with a parent with B blood, that child could have AB type blood, where both of the alleles are expressed. This is a special case of genetics called codominance, when both traits are expressed at the same time.

The blood type possibilities of parents vs. child.
Chart from: https://www.redcrossblood.org/donate-blood/blood-types.html

The O- blood type is relatively rare because both the O and the Rh- traits are recessive. Across racial demographics in the United States, 8% of Caucasians, 4% of African-Americans, 1% of Asian-Americans, and 4% of Latinx-Americans have O- blood. Overall, that means that 7% of the U.S. population has O- blood. The most common blood type is O+ (38% of U.S. adults), followed by A+ blood (34% of U.S. adults). Of the eight most common blood types (the ABO and Rh factor combinations), the rarest is AB-, which only 0.6% of U.S. adults have.

Percentage of people with the O- blood type. Image credit:
https://www.redcrossblood.org/donate-blood/blood-types.html

Right now, it's also the only blood type that any person can receive without any problems. In an emergency situation where a person is in dire need of blood and there is no time for laboratory tests, doctors and surgeons give that person O- blood until the patient's blood type is known. On any given day, 35,000 pints of blood are given to people for emergencies, scheduled operations, and routine transfusions. That's means that one person every 2 seconds needs blood.

Even with all of modern medicine's tools, blood is something that cannot be made in a laboratory. The only way to get more blood is for people to donate it. According to the American Red Cross organization, while 50% of U.S. adults are able to give blood, only 5% do. When combined with the low rate of O- blood in the U.S. population, the result is that O- blood is usually in short supply, even though it is most needed.

To help provide more blood for medical use without forcing people to donate blood, a team led by researcher Stephen Withers, a chemical biologist at the University of British Columbia in Vancouver, Canada, has found a way to change type A blood into blood that can be used by anyone. This team of researchers was able to isolate DNA from different human gut microbes to create a new type of organism that could produce a new type of protein. This protein has the ability to remove the A antigens from red blood cells, making them identical to O-type blood. Right now the team is doing more testing to make sure the formerly-A blood is safe to use in transfusions, but if it is, then this discovery can potentially double the amount of universal donor blood available. This will help meet the need for blood in the U.S. and save more lives.

Blood shortages usually peak in the summer, when need is greatest
but supply falls. Giving blood addresses a critical need in most
communities. Image credit: American Red Cross.

In the meantime, if you can donate blood, we ask that you seriously consider doing so, especially during the month of October. Yes, needles are scary, and I admit that even I don't like that part. I do it because I know that my blood will go to someone who needs it. Plus, the cookies I get afterwards are tasty. My blood will be replaced in a few weeks. For so many, that isn't guaranteed.

Sources:
https://www.sciencemag.org/news/2019/06/type-blood-converted-universal-donor-blood-help-bacterial-enzymes
https://www.redcrossblood.org/donate-blood/blood-types.html
https://www.mayoclinic.org/tests-procedures/blood-transfusion/expert-answers/universal-blood-donor-type/faq-20058229
https://ghr.nlm.nih.gov/gene/ABO
https://en.wikipedia.org/wiki/Blood_type_distribution_by_country

The History of Blood Types

Blood has always had a mystical, life-giving quality to it, even in ancient societies. It is something worth protecting. Even today there are many terrifying stories across cultures of bloodsucking animals who prey on innocent humans in the night, either killing them outright or changing them into wicked creatures. Other real animals, mainly mosquitoes, are known to spread diseases such as malaria and West Nile virus via their bloody bites.

But this blog post isn't about blood diseases, though they are certainly worth a mention. It's instead about how science gained the basic understanding of blood and blood types and used it to save millions of lives.

A lab technician examining blood samples.
PC: iStock.com/Arindam Ghosh

Today, most people are aware that there are four blood types: A, B, AB, and O. Each person has one blood type, and for 99% of people, it's one of these. Some people are also aware of something called the Rh factor, which names a protein first found in a rhesus monkey in a laboratory (more on that later). 85% of people are Rh+ positive, and the rest are Rh negative. Except in very rare cases and in some pregnant women, Rh factor has no impact on a person's health. The way we talk about our blood types is putting the information about the type and the Rh factor together. For example, my blood type is A+, while my best friend's is O+. What makes my blood different from his?

It all comes down to something called antigens, which are sugars that exist on every single one of my red blood cells. Different blood types have different antigens in different places. For example, my A antigens are on my red blood cells, but I also have B antigens that exist in my plasma, the clear fluid that holds my red blood cells as well as other proteins and sugars that my body needs. A person with B blood has the opposite arrangement: B on the red blood cells, A in the plasma. Someone with AB blood has both A and B antigens on their red blood cells, and no antigens in their plasma, and someone with O blood has nothing on their blood cells and A and B antigens in the plasma.

Visualization of blood types.
From: https://www.redcrossblood.org/donate-blood/blood-types.html

Cool information, I guess, but what good does any of that knowledge do? Quite a bit, as it turns out! If someone gets a blood transfusion (a medical procedure where a patient receives blood from another human) and the blood type is not the same as theirs, there could be a potentially fatal reaction. Blood clots when it is mixed with an antigen it does not recognize. That's because foreign antigens trigger a response from a human's immune system, which is the system in our bodies that fights infection and sickness. Instead of helping the person by giving them blood, the new blood could actually kill them. Before 1900 and the discovery of blood types, a blood transfusion was a last-ditch effort in dying patients because it often resulted in the patient's death. No one knew precisely why.

The first blood transfusion was conducted in 1667 on a 15 year-old French boy by the physician Dr. Jean-Baptiste Denys. His early transfusions used animal blood instead of human blood, most often sheep but sometimes dogs. Patients who received large quantities of animal blood usually died after multiple transfusions, and today we can probably understand why: animals and humans have different blood types. Back then it was assumed that all blood was the same though, and sick people were willing to try anything to stay alive. Transfusion quickly was labeled so dangerous and controversial that in 1668 the French government and the Royal Society of London banned the procedure in their respective countries, and the Vatican condemned it in 1670. Transfusions were taboo for 150 years.

Physician James Blundell.
PC: engraving by John Cochran,
public domain.

In 1818, British physician James Blundell used a blood transfusion to treat a woman who had uncontrollable bleeding after giving birth. He may have been desperate to save her, even if the procedure was technically illegal. He saved her life, and decided to keep trying this technique on other patients. Out of ten transfusions he did in 1825 and 1830, five of them were successful and kept the patient alive. Even in the 1800s, this was a poor success rate, and the medical community viewed transfusions as risky and not medically sound. The procedure even made its way into horror literature: in Bram Stoker's Dracula, the character Lucy actually receives two blood transfusions from her suitors to replenish the blood Dracula has sucked away, but dies anyway. The death is attributed to the titular vampire, but I wonder if the transfusion itself didn't help advance her death.

It wasn't until 1900 that Austrian physician Karl Landsteiner noticed that blood from different humans would clump together when mixed (he also noticed the blood clumped when it was mixed with animal blood, which probably wasn't a surprise to him, given how many people had died from transfusions before). This was the first evidence of any difference in blood. He didn't yet know if the source of the differences was an inherent characteristic of the individual or the result of an infection acquired at some point in life. His experiments in 1901 showed that the blood of an individual would not clump with some people's blood, but would always clump with others. In this way he discovered the three blood groups, which he initially named A, B, and C. Group C would eventually be renamed after the German word for zero or null, ohne, and become what we call it today, O. Two of his students discovered the fourth main blood type, AB, in 1902.

Dr. Karl Landsteiner, blood type discoverer.
PC: The Rockefeller Archive Center.

 Though we today might think of blood types as basic information, especially given how many times it's mentioned in crime shows and medical dramas, this was a groundbreaking discovery in the early 1900s. Dr. Landsteiner refined his theory of blood groups and published it. The number of deaths from blood transfusions dropped dramatically after doctors learned to test blood before putting it into someone. Today it is one of the most common medical procedures, saving up to 4.5 million lives annually in the United States alone. For his discovery and work, and in recognition of the lives he had saved, Landsteiner was awarded the 1930 Nobel Prize in Medicine and Physiology. Landsteiner went on to discover the human Rh factor in 1937 by studying the similar antigen in the rhesus monkey.

Turns out there's a lot more to say about blood types and where they come from, so I'll continue that in next week's post. Until then, be safe and keep your blood where it belongs!