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Genomic Blood Typing

More Than A, B, AB, and O

The four most common blood types—A, B, AB, and O plus a positive or negative RH factor—have been a medical standard since 1900. By 1940, blood and plasma centers had opened throughout the country. Their mission was to gather and store donated blood for use in surgeries and transfusions. Pregnant women, patients with inherited disease, and trauma victims frequently received life-saving treatments based on traditional blood types.

But just as technology has driven advanced web and AI development, so has genomic research changed the way that blood groups are identified. Instead of four basic categories, today’s scientists have found that human blood may contain any of more than 300 variations. These DNA-based differences often reflect mutations occurring over centuries—the result of inherited or disease-driven red blood cell antigens.

Connie Westhoff, the executive scientific director for genomics at the New York Blood Center (NYBC), heads the nation’s premier blood-typing research program. The organization’s work is shared with blood centers nationwide. In Colorado, for example, Westhoff’s team works with the Bonfils Blood Center—now Vitalant—to study why some red blood cell proteins simply don’t combine compatibly with others. “Blood is considered a drug,” she says. “FDA standards require it be collected, tested, and stored according to rigorous purity and potency standards.”

In addition to ABO blood types, researchers can now identify special markers: antigens that determine whether or not a donor’s blood is compatible with a transfusion recipient. Changes to blood proteins, Westhoff says, can occur based on where we are born, our ethnicity, or pathogens passed down by our ancestors or inherited as a result of diseases such as malaria.

Cami Meiland, the mountain region reference laboratory manager for Vitalant, works with Westhoff’s team to determine compatibility for blood transfusions. “NYBC has invested in molecular DNA–based testing to the benefit of the entire country,” Meiland says, stressing the importance of determining which antigens each donor’s blood has or lacks. “If you become sensitized through pregnancy or prior transfusions and make a rare antibody, once hospitalized, it may be tough to find compatible or rare blood. It can stop your treatment,” she adds.

And although today’s less-invasive surgeries require fewer transfusions, the nonprofit blood center’s mission is to ensure that, when a specific blood type is needed, it’s available. Provision of the “raw material” for a life-saving transfusion also depends solely on volunteer blood donors. “We appeal to folks of wide-ranging age and geographic and ethnic backgrounds,” Meiland says. “It takes 450 donors a day just to meet demand.”