Bonfils and The American Rare Donor Program

A blood (antigen) type is considered rare if only one person in 1,000 or more people lacks that specific antigen. And if only one in 10,000 or more people lack a particular antigen, their antigen type is considered very rare.

As one might expect, there are patients in Colorado who have rare and very rare blood types and when these individuals require a blood transfusion antigen compatibility problems may arise. In many cases, the patient’s sample is sent to Bonfils’ Immunohematology Reference Laboratory (IRL). This laboratory is the only AABB accredited IRL in the state of Colorado and one of only 50 AABB accredited IRLs in the country.

When Bonfils identifies a patient who requires rare blood for transfusion, this blood can sometimes be found within our own facility. However, if the blood is unavailable at Bonfils, we can contact the American Rare Donor Program (ARDP) in Philadelphia for assistance.

How Did the ARDP Develop?

In the 1960’s the American Red Cross and AABB each developed registries of rare donors to supply patients in need of rare blood. Over the course of time, these registries were combined and the American Rare Donor Program was born. Today, four decades after the original rare donor registries were formed, the combined computer-based ARDP is perhaps the largest in the world. It contains information on tens of thousands of rare donors. Access to the ARDP can only be gained through the assistance of an accredited IRL which are considered member facilities.

How Does the System Work?

The ARDP has very specific antigenic criteria for what it considers a rare blood request.

When Bonfils’ IRL is contacted by a non-member facility for blood products that we are unable to provide due to lack of available donors, an ARDP search becomes necessary. In these cases, Bonfils must confirm the specificity of the alloantibodies in the patient’s sample. This can be achieved by either:

• Obtaining and performing a serologic investigation on a sample from the patient, OR
• Reviewing worksheets pertaining to the serologic investigation that identified the antibodies from the non-member facility.

Once Bonfils’ laboratory has confirmed the patient antibody specificity, we contact ARDP and their staff will search for the rare units that are requested. This service is available through the ARDP on a 24/7 basis.

ARDP staff will not perform searches solely to determine availability of rare units and/or if the antibodies have not been confirmed by an accredited IRL. For an ARDP search to occur, Bonfils’ lab must have confirmed the antibodies present AND receive an actual request for blood from the ordering hospital.

ARDP staff will also not routinely search for blood products negative for antigens such as Le^a ,    Le^b, P₁, M or N unless documentation of clinical significance is noted on the request.

Once the search is complete, the ARDP will contact Bonfils with the results of the search. If units have been found, the ARDP will provide the name of the shipping facility(ies) and then we and the shipping facility will work together to get the blood to Denver.

What Costs are Involved?

Bonfils pays a fee of $1,100 per year to be an ARDP member. Whenever we ship in a unit via ARDP, Bonfils must pay the shipping facility for the unit(s) of blood which they have sent to us. There is also a $100 per unit ship in fee for ARDP members. This fee is significantly higher for non-members.

The fees that Bonfils pays (ship in and blood unit fees) are passed along to the client hospital that placed the original order with Bonfils.

Does Bonfils Receive Requests from the ARDP?

Just as Bonfils’ IRL sometimes requests assistance finding blood through the ARDP, Bonfils often receives requests for rare blood from the ARDP.

In June, we received a request from the ARDP for the Irish Blood Transfusion Service in Dublin, Ireland. The patient in need had multiple antibodies, including the rare anti-Vel. Bonfils was one of two facilities in the United States who had the rare O Rh Negative, Vel negative unit available in inventory (not frozen) and ready to ship. Bonfils was able to work through the ARDP to ship the rare blood to Dublin for transfusion to the patient. The incidence of finding a Vel negative individual in the general population is about 1 in 4,000. This is compounded by the fact that the patient also required O Rh Negative blood, making this unit even rarer.

Bonfils received word from Dublin that the unit was transfused and that the patient’s hemoglobin rose >1 gram/dl with each unit and the patient's condition improved. This patient is chronically transfused and Bonfils may be called upon again in the future to meet the needs of this patient.

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