Abu Dhabi: An Abu Dhabi woman who needed a life-saving heart surgery first donated blood to facilitate her own procedure.
The rare self-donation process, facilitated by the Cleveland Clinic Abu Dhabi, was required to supplement supplies of Daina Bautista’s extremely uncommon blood type.
Bautista, a working mother from the Philippines, first began to suspect that something was wrong in 2018. She had been having terrible coughing fits, which were first diagnosed as asthma, but follow-up scans revealed that three of her heart valves were damaged. Bautista was wary of undergoing heart surgery, so she deferred surgical treatment at the time. But by 2020, her condition had deteriorated significantly.
“At first, I was able to live my life as normal. I knew something was wrong, but I wanted to focus on my work and family. Eventually, I couldn’t walk for more than a few minutes without losing my breath and needing to rest. I was always short of breath, and even everyday tasks became very hard for me. I knew then that it was time to go back to the doctor and finally get my heart fixed,” Bautista said.
Admitted to a hospital in Abu Dhabi, Bautista underwent routine pre-surgical tests the day before her scheduled operation. In the early hours of the next morning, a nurse told her the surgery couldn’t go ahead because the hospital had been unable to find a blood match for her within more than 100 samples.
Rare blood type
Because of the complications, her case was transferred to Cleveland Clinic Abu Dhabi. The Transfusion Medicine Pathology team at the hospital performed extensive testing. This revealed that Bautista had a rare B+ blood type, which is found in only nine per cent of people worldwide. In addition, it also lacked the JK3 protein, an extremely rare characteristic. Bautista could therefore only be given blood from donors who both matched her blood type and also lacked that specific protein.
The finding launched a global hunt for blood to help Bautista.
“As soon as we discovered that Bautista’s blood lacked the JK3 protein, something that is exceptionally rare worldwide, we began our search for donors within the UAE and abroad. For her surgery to take place, we would need at least six units of blood, and this was a difficult feat,” explained Dr Manuel Algora, a clinical pathologist and director of Cleveland Clinic Abu Dhabi’s blood bank.
Each unit of blood contains about 450 millilitres, or about 12 per cent of total blood volume. The six-unit requirement was therefore not an easy one to meet.
Need for blood
“Blood is really the foundation of modern surgery. If we can’t replace the blood lost to bleeding during surgery, many of the surgeries we take for granted today simply could not happen. Even with minimally invasive surgery, it’s vital that we have blood on hand to ensure patient safety,” said Dr Umer Darr, the heart surgeon who eventually operated on Bautista.
The pathology team tested Bautista’s relatives living in the UAE: they too lacked the JK3 protein in the blood, but their blood types did not match hers. Then, working with Abu Dhabi Blood Bank, a compatible donor was found in Abu Dhabi, who was able to donate one unit of blood.
As blood donors can only give blood every eight weeks, Dr Algora then widened the search, contacting blood banks across the UAE, the Gulf region and as far afield as Malaysia and Spain. The search was limited by the complexity of transporting blood, which can only remain outside medical freezers for a few hours before it can no longer be used. Eventually, two units of matching blood were found in Kuwait and imported.
To make up for the four-unit shortfall, a rare self-donation process was then begun in collaboration with the Abu Dhabi Blood Bank to collect blood from Bautista herself.
“Although we had a local donor and two units coming from abroad, we still needed four more units to safely perform the surgery. Collecting that much blood from the local donor would have taken months as a person can only donate one unit every two months. However, self-donation has very different requirements. As Bautista had strong haemoglobin, we were able to administer treatment to boost her red blood cell production so that she could safely self-donate at a rate of once per week,” Dr Algora said.
Enough blood collected
Under close medical supervision by her care team at the hospital’s infusion centre, Bautista gave four units over a three-week period so that the hospital would have enough blood to perform her surgery. The blood was collected by a team of specialists from Abu Dhabi Blood Bank, who travelled to the hospital along with their equipment to ease the donation process and ensure her medical needs were being taken into account.
“When I heard we had the blood needed to repair Bautista’s heart valves, I was thrilled. We could finally move ahead and get her back to living a full life,” Dr Darr said.
Bautista’s surgery finally took place on December 15, more than three months after it was initially scheduled. Although the search for blood had caused a significant delay, she made a swift recovery following her surgery, and was discharged after just about two weeks.
“I am so grateful to Dr Algora and Dr Darr for everything they have done for me. Although it was stressful, I always felt safe and cared for. I can hardly believe the effort everyone made to find the blood I needed. It has really opened my eyes to the importance of blood donation and what a beautiful gift it represents,” Bautista said.
“This was a very difficult case and I’m very proud that we were able to come together as one team across all areas of the hospital to arrange for the import of the blood Bautista so desperately needed. Fortunately, we have a fantastic relationship with Abu Dhabi Blood Bank, the Ministry of Health and Prevention, and the international blood transfusion community. When we spoke to colleagues in other countries, they understood the challenge and did everything they could to help. Without the support of our local and international partners, this could not have happened,” Dr Algora said.