In this study, the distribution of ABO and Rh blood group systems in donors of a blood bank directory from Yogyakarta, Java Island, was reported retrospectively over six years (2018–2023). To our knowledge, this is the first study conducted on such a large scale in Indonesia.
In this research, the distribution of the ABO blood group phenotype is O > B > A > AB, which is a pattern typically shared by several South East Asian countries, [12,13,14,15,16,17] and several other countries (Table 2). [18,19,20,21,22,23] However, variability may be observed between countries. Still, the world distributions occur in the following order: O > A > B > AB [5, 24,25,26,27,28,29,30]. The blood group A was more dominant in the Northern Hemisphere. [5] The blood group distribution pattern was complex, clinal, and discontinuous. The distribution pattern can remain constant for several decades, [31] but also can change over time. [32]
The D antigen was found to be carried by the vast majority of donors (Table 2: 99.5%), which is also a general observation in East and Southeast Asia. It is worth mentioning that the D antigen frequency reported here in donors may not reflect precisely the actual distribution in the general population. Indeed, due to a shortage in the availability of D– RBC units in Indonesia, D– donors are encouraged to give their blood regularly. Thus, the frequency of D– individuals may be somewhat overestimated in this study. Next, it will be essential to investigate the nature of D– donors by additional serological and molecular methods to address the potential Asian-type DEL samples in this subset, which have recently been recommended to be considered as D + donors and patients, conversely to the true D– individuals. [33]
Because it is well known that blood group antigen expression varies between populations due to specific genetic variations, knowledge of the distribution of blood groups at a local level/regional/national is critical for blood banks, transfusion services, and patients’ healthcare. This report describing the distribution of ABO and D phenotypes among donors in Indonesia is thought to be a milestone towards the establishment of general guidelines for blood group distribution in the country. Our findings will be helpful to clinicians in their daily practice, planners, and policymakers for optimizing the management of RBC stocks, as well as non-governmental organizations involved in blood supply. This report also has valuable implications for modifying and producing blood products (blood components) to prevent shortages. This finding implies that blood type O is the most available blood group and is more advantageous for the population in transfusion practices. Blood group O, especially O-negative, is crucial to transfusion practice. In Asian countries, including Indonesia (Yogyakarta), the frequency of the O-negative phenotype was lower than in European countries so, the regional bank needs to improve O-negative blood availability to avoid shortages. [18]
Finally, Indonesia is a large country known for its complex geography and heterogeneity in terms of ethnicity, thus assuming a broad range of genetic backgrounds. While we are currently involved in another comprehensive study nationwide, we encourage other blood banks nationwide to publish their data to increase the amount of data and get a global overview of blood group distribution. Indonesian policymakers need to enhance the standard for blood grouping tests, which include subgrouping and other blood group antigens. While these tests may not be available in regional blood banks, having them accessible in the national blood reference laboratory would be beneficial.
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