The Bombay blood group the (hh phenotype) In Ghana; a literature review and call for establishing a rare donor registry

Background: The Bombay blood group (hh phenotype) is the rarest ABO-related phenotype, caused by FUT1 mutation leading to absence of H antigen. Individuals are mistyped as group O in standard ABO grouping, leading to fatal hemolytic transfusion reactions if transfused with O blood. In Ghana, routine blood banking does not include H antigen screening. Methods: Narrative literature review using PubMed, Google Scholar, African Journals Online (2010-2025) with keywords Bombay, hh phenotype, FUT1, Africa, Ghana, and review of Ghana National Blood Service guidelines. Results: Global prevalence is 1 in 10,000 in Mumbai, 1 in 250,000 in India, 1 in 1,000,000 in Europe, with zero published data from Ghana or West Africa. Diagnosis requires anti-H lectin (Ulex europaeus) costing $0.35 per test. Ghana transfuses over 300,000 units annually, suggesting at least 30 undiagnosed Bombay individuals. Conclusion: This is the first student-led advocacy paper for Bombay phenotype in Ghana. We propose a three-phase model: awareness education in SHS, pilot screening of 5,000 Group O donors at Komfo Anokye Teaching Hospital, and establishment of a National Rare Donor Registry linked to International Rare Donor Panel. H antigen screening should be added to national blood service protocols.