Blood donations from Black, Asian and Minority Ethnic (BAME) groups are in high demand, according to NHS Blood and Transplant (NHSBT). Around 14% of the UK population is BAME, yet ethnic minority donors such as myself only account for 6% of people who donate across the nation. To understand the chronic shortage of ‘black blood’, we must first establish why our blood is needed, and then answer why our donation numbers are lacking.
Usually, blood donations use the two most well known blood group systems; ABO and Rh. The ABO group system refers to whether a person has A, B, both A and B (AB), or neither A nor B (O) antigens on their red blood cells and is determined by the specific version (allele) of the ABO gene. The Rh group system refers to whether a person has the Rhesus factor D antigen, Rh(D), known as Rhesus positive/Rh+ or if a person does not have it, Rh(d), known as Rhesus negative/Rh-. This is determined by the presence or absence of the RHD gene. The ABO and Rh systems are used together when giving patients single transfusions. Though what many people do not know is that there are in fact 36 known blood group systems, and people who have multiple transfusions, such as through pregnancy and childbirth or a chronic blood disease, must have extensive checks of their other blood subtypes.
One of the blood subgroups is the Ro subtype, which only around 2% of NHSBT donors have as of January 2016. Without getting too technical, the Ro subtype is a specific version of the Rhesus Positive group that is most common in Africa, and so UK individuals of African descent are of much higher likelihood to have Ro blood. In fact, the NHSBT says “The Ro subtype is more than 10 times as common in individuals from Black African or Black Caribbean ethnic backgrounds, than in individuals from white ethnic backgrounds”. Thalassaemia and Sickle Cell Disease are two blood disorders that affect production of haemoglobin, the protein that gives blood its distinctive red colour and carries oxygen around the body, and almost always cause anaemia. Thalassaemia is higher amongst people of South Asian and Mediterranean heritage and Sickle Cell Disease is higher amongst people of African and Caribbean heritage. Both thalassaemia and sickle cell disease require regular ongoing transfusions, and both conditions require the Ro blood subtype. This explains the clinical need for Rh+ (specifically O+ and B+) blood from black and brown donors.
One of the biggest reasons that people of all backgrounds in the UK don’t donate blood is a lack of awareness, which can be anything from not knowing how long donations take or where to donate, to not ranking donating blood as a priority. For instance, migrant and immigrant families new to the UK likely aren’t aware of the importance of them giving blood, and the second and third generation children subsequently don’t pick up the notion of becoming a donor.
However, there are more ominous reasons why some ethnic minority communities do not give blood. Many African countries have poorly developed systems for safe blood donation, so the practice of giving blood isn’t prevalent. But on a more sinister note, the U.S. Public Health Service’s ‘Tuskegee Study of Untreated Syphilis in the Negro Male’ was an abhorrent human rights abuse that told 600 African-American men they were receiving free health care from the government. In fact, they were used to study the effects of untreated syphilis, a study that lasted 40 years, until a public health service whistleblower exposed it in 1972. It should be unsurprising then to see that black communities have mistrust and superstitions about seemingly white institutions like public health care services – though the irony is that the NHS is one of the largest employers of BAME individuals in the UK. And there are also negative attitudes towards blood donation from higher rates of haemoglobin deferral among people of African descent, cultural and religious perspectives on the body, mistreatment by staff e.g. more often being mis-punctured, and forms of social exclusion.
It is important to stress that talking about BAME people in the context of blood donations doesn’t entirely do us justice – we aren’t a monolithic group, rather, individuals who make up many diverse communities. Hopefully by talking about the importance of giving blood, we can improve attitudes towards the notion of donating and, crucially, save lives.