ABO blood group system and likely predates human migration from Africa. The O01 allele is considered to predate the O02 allele. Some evolutionary biologists theorize that there are four main lineages of the ABO gene and that mutations creating type O have occurred at least three times in humans. From oldest to youngest, these lineages comprise the following alleles: "A101/A201/O09", "B101", "O02" and "O01". The continued presence of the O alleles is hypothesized to be the result of balancing selection. Both theories contradict the previously held theory that type O blood evolved first. It is possible that food and environmental antigens (bacterial, viral, or
Blood transfusion by using blood type testing to identify a less scarce alternative. Jehovah's Witnesses object to blood transfusions due to their belief that blood is sacred. Although there are clinical situations where transfusion with red blood cells is the only clinically appropriate option, clinicians look at whether alternatives as feasible. This can be due to several reasons, such as patient safety, economic burden or scarcity of blood. Guidelines recommend blood transfusions should be reserved for patients with or at risk of cardiovascular instability due to the degree of their anaemia. In these cases parenteral iron is recommended. Thus far, there are