The University Blood Initiative stands in solidarity with the Black Lives Matter movement and is committed to bringing about a fairer, more equitable future. As such, we are spending this week highlighting the systemic racism, discrimination, and barriers to blood donation Black Americans have historically experienced and continue to face. This is part five of seven in our ongoing series.
The US Military and Red Cross’s early refusal to take blood from Black donors was unequivocally racist and ran counter to scientific fact. Human blood is human blood, and it can be safely donated and received across racial lines without consequence (later Red Cross and US Military policies of accepting blood on a segregated basis, in which they would not give blood from Black donors to white recipients and vice versa, were also deeply harmful and anti-scientific).
However, for all we want to say that race has no bearing on blood whatsoever, that’s not entirely true. Modern science has discovered several hundred antigens, potentially harmful molecules that can trigger an immune system response, carried in blood. As Rose George writes in the New York Times, “a successful blood transfusion relies on sameness”--blood type to blood type, antigen to antigen. If a patient receives donor blood containing foreign antigens, they will suffer an adverse, and potentially (though very rarely) fatal, reaction and begin to produce antibodies, rendering them resistant to future donations containing the same antigens. To complicate matters, many antigens are linked to ethnic and racial backgrounds, driven by “evolutionary selection, by bacteria, malaria, and parasites,” as explained by Connie Westhoff of the New York Blood Center.
And so, when people with rare blood types and specific antigens need transfusions, they need blood as similar to their own as possible, which may mean it has to come from a donor of a specific race. Perhaps the most prominent example of this among Black Americans is sickle cell disease. As defined by the CDC, sickle cell disease (SCD) is “a group of inherited red blood disorders” in which red blood cells, normally round, “become hard and sticky and look like a C-shaped farm tool called a ‘sickle’.” This malformation of red blood cells makes regular travel through blood vessels difficult, which can clog the blood flow, and cause pain, infections, and strokes, among other complications. Sickle cells also die early, causing a shortage of red blood cells and a need for frequent blood transfusions. SCD occurs in about 100,000 Americans, and most of them are Black.
SCD is genetically inherited, but it is recessive: it requires two copies of the gene to manifest, which means it can be (and is more often) carried in a single silent copy by someone who does not themselves experience the disease. These carriers also have the antigens needed by SCD patients for more successful transfusions. Blood containing the necessary antigens to treat sickle cell patients is overwhelmingly more likely to come from Black donors than white, and would reduce bad reactions in recipients.
In addition to SCD and similar antigens in blood, bone marrow and organ transplants require as close a genetic match as possible, and, writes the Chicago Tribune, “the need for donors is great.” Across the board, we need diverse donors. Sickle cell is only one of many blood variants, and, though chronic, it is treatable--if we have the supplies.