Campaigners have appealed for eligible black people in Hong Kong to give blood after a man was hospitalised due to a life-threatening episode of sickle cell crisis. The disease affects mostly black people and the patient is in need of a transfusion. However, his blood subtype rarely occurs among ethnic Chinese populations and it is currently unavailable at the city’s blood banks.
On top of the shortage, Hong Kong places a host of restrictions upon donors from countries historically affected by malaria and mad cow disease, creating extra hurdles for those who may wish to donate blood.
The patient’s sister Amy Ansaba – who lives in the UK and has given HKFP a pseudonym – has been liaising with groups in Hong Kong in an effort to find suitable donors for her brother, who wished to remain anonymous: “In getting to this stage, it was an incredibly critical, life-or-death situation… The option was a blood transfusion, but [the blood bank] didn’t have a match for him.”
Sickle cell disease is a typically hereditary illness whereby abnormally-shaped oxygen-carrying proteins are found in red blood cells. Sickle cell crisis is a particularly painful acute condition that patients can also suffer from.
“If his condition worsens, he may need another transfusion in the next week or two,” Ansaba said, but the blood bank is out of the type of blood he requires. She, or other family members are unable to travel to Hong Kong in time due to current Covid-19 restrictions placed on travellers from the UK.
Ansaba added that she was appealing for people of sub-Saharan African descent “to make donation appointments online and donate as soon as possible.”
“Just by being of the same ethnicity, the chances of finding a match is higher… Types A+ and O are great but others can also work well.”
Barriers to donate
Ansaba is liaising with The Africa Center in Hong Kong to call on eligible people in the city to donate blood, but has encountered what she described as “layers of obstacles.” Potential donors who have lived in areas affected by malaria, or the human form of mad cow disease, Creutzfeldt–Jakob Disease (CJD), cannot give blood in Hong Kong. Asylum seekers also face additional restrictions that disproportionally affect potentially suitable donors.
Innocent Mutanga, co-founder and CEO of the Africa Center, told HKFP that he has appealed to business and community leaders in the center’s network, which includes individuals originally from sub-Saharan Africa, the Caribbean, the UK and the US for help.
Mutanga visited a blood donation centre at the Polytechnic University on Wednesday to give blood. Staff there were initially “reluctant” to accept him as a donor, he said, citing that he was from Zimbabwe, and there were restrictions on donors from regions affected by malaria.
He was first asked to fill a form which asked donors if they had contracted malaria before and whether they last visited regions affected by the disease under specified period of time. “I told them it was seven years ago that I was last in Zimbabwe,” He said nurses then checked his country of origin against a list of countries and allowed his donation after he assured them that he has lived in the US and Hong Kong since leaving his home country.
Mutanga also said several people who wanted to give blood following his appeal were turned away on grounds that they had no Hong Kong ID card or passport, as they are asylum seekers.
The Hospital Authority (HA) last updated its blood donation screening policy in September 2020. The latest revision relaxed some restrictions related to malaria and CJD.
The deferral period for travellers who have visited malaria-endemic areas has been shortened from one year to three months, while individuals who once resided in those areas can donate after three years of continued residence in Hong Kong or other non-endemic regions, according to the Red Cross’s blood donation information. Individuals who once contracted malaria can donate three years after recovery.
Hong Kong also has a variety of restrictions on blood donation by individuals who resided in UK, France or Ireland, which were affected by CJD in the past.
‘A rare situation’
A medical specialist familiar with sickle cell disease and rare blood types, who wished to remain anonymous because they are not authorised to speak, told HKFP that the situation was rare. They said that most sickle cell disease patients public hospitals previously encountered – who were invariably African in descent – have not required a large amount of blood transfusion and did not have a rare blood type.
However, they said some blood sub-types were close to non existent in ethnically Chinese populations: “During a blood transfusion, we’d have to match their main blood group and also their minor blood group,” they said.
Patients of rare minor blood groups may lack certain antibodies in their blood: “If blood of an unsuitable type was transfused, some antigens it contains may cause the patients’ body to generate antibodies against the antigens. These antibodies mean they will not be able to receive more transfusions in the future containing such antigens, because doing so will cause hemolysis, a life threatening situation,” they said.
The Hong Kong blood bank keeps rare blood types among its inventory using special treatments to prolong their shelf lives, the doctor said, but there still can be shortages.
Ansaba said the stock needed to be built up: “If you’re an expat and you want to move to Hong Kong, you have to understand that the hospital may not be able to provide you with the blood type you need… This drive will create a stock for the future for those in need.”
In a response to HKFP’s enquiries, a Red Cross Blood Transfusion Service spokesperson said it is “working closely with the patient’s hospital and blood bank in recruiting the patient’s close relatives and friends, who may have a higher chance to match with the patient’s blood type, for blood group typing and donation if possible.”
“However, all prospective donors must have to meet the prevailing donor eligibility criteria and their donated blood be screened for infectious diseases as required in Hong Kong,” the statement read. The service also maintains a rare blood inventory and encourages donors of rare blood types to invite family members to help keep the inventory stocked.
“We also collaborate with overseas’ blood services for provision of blood products in case we don’t have the suitably matched blood units in our inventory to cater to patients’ needs,” the statement continued. “Currently, the blood inventories in Hong Kong have dropped to very low level amid the impact of the pandemic. We appeal to the public to come give blood and maintain a stable blood supply for clinical transfusion to patients. To prevent crowds from gathering and long waiting times at the donor centres, donors are advised to make appointments by calling the BTS’ donor centres or via “HK Blood” mobile app.”