Frequencies and ethnic distribution of ABO and RhD blood groups in China: a population-based cross-sectional study

Guideline No. 448: Prevention of Rh D Alloimmunization

OBJECTIVE

This guideline provides recommendations for the prevention of Rh D alloimmunization (isoimmunization) in pregnancy, including parental testing, routine postpartum and antepartum prophylaxis, and other clinical indications for prophylaxis. Prevention of red cell alloimmunization in pregnancy with atypical antigens (other than the D antigen), for which immunoprophylaxis is not currently available, is not addressed in this guideline.

TARGET POPULATION

All Rh D-negative pregnant individuals at risk for Rh D alloimmunization due to potential exposure to a paternally derived fetal Rh D antigen.

OUTCOMES

Routine postpartum and antepartum Rh D immunoprophylaxis reduces the risk of Rh D alloimmunization at 6 months postpartum and in a subsequent pregnancy.

BENEFITS, HARMS, AND COSTS

This guideline details the population of pregnant individuals who may benefit from Rho(D) immune globulin (RhIG) immunoprophylaxis. Thus, those for whom the intervention is not required may avoid adverse effects, while those who are at risk of alloimmunization may mitigate this risk for themselves and/or their fetus.

EVIDENCE

For recommendations regarding use of RhIG, Medline and Medline in Process via Ovid and Embase Classic + Embase via Ovid were searched using both the trials and observational studies search strategies with study design filters. For trials, the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects via Ovid were also searched. All databases were searched from January 2000 to November 26, 2019. Studies published before 2000 were captured from the grey literature of national obstetrics and gynaecology specialty societies, luminary specialty journals, and bibliographic searching. A formal process for the systematic review was undertaken for this update, as described in the systematic review manuscript published separately.

VALIDATION METHODS

The authors rated the quality of evidence and strength of recommendations using the SOGC's modified GRADE approach. See Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations).

INTENDED AUDIENCE

The intended users of this guideline include prenatal care providers such as obstetricians, midwives, family physicians, emergency room physicians, and residents, as well as registered nurses and nurse practitioners.

TWEETABLE ABSTRACT

An updated Canadian guideline for prevention of Rh D alloimmunization addresses D variants, cffDNA for fetal Rh type, and updates recommendations on timing of RhIG administration.

SUMMARY STATEMENTS

RECOMMENDATIONS.

Lewis a-b- histo-blood group antigen phenotype is predictive of severe COVID-19 in the black South African population group

Several risk factors have been associated with SARS-CoV-2 infections and severity of COVID-19 disease it causes. This study investigated whether variations in histo-blood group antigen (HBGA) expression can predispose individuals to SARS-CoV-2 infections and severity of the disease. Nasopharyngeal swabs, randomly selected from SARS-CoV-2 positive and SARS-CoV-2 negative individuals, were tested for Lewis and H-type 1 HBGA phenotypes by ELISA using monoclonal antibodies specific to Lewis a, Lewis b and H type 1 antigens. The most common Lewis HBGA phenotype among all study participants was Lewis a-b+ (46%), followed by Lewis a-b- (24%), Lewis a+b- and Lewis a+b+ (15% each), while 55% of the study participants were H-type 1. Although SARS-CoV-2 negative individuals had a lower likelihood of having a Lewis a-b- phenotype compared to their SARS-CoV-2 positives counterparts (OR: 0.53, 95% C.I: 0.255-1.113), it did not reach statistical significance (P = 0.055). The frequency of Lewis a+b+, Lewis a+B-, Lewis a-b+, H type 1 positive and H type 1 negative were consistent between SARS-CoV-2 positive and SARS-CoV-2 negative individuals. When stratified according to severity of the disease, individuals with Lewis a+b- phenotype had a higher likelihood of developing mild COVID-19 symptoms (OR: 3.27, 95% CI; 0.9604-11.1), but was not statistically significant (P = 0.055), while Lewis a-b- phenotype was predictive of severe COVID-19 symptoms (OR: 4.3, 95% CI: 1.274-14.81), P = 0.016. In conclusion, individuals with Lewis a-b- phenotype were less likely to be infected by SARS-CoV-2, but when infected, they were at risk of severe COVID-19.

Blood Group Antigen A Carriers Exhibit an Extended Progression-Free Survival with no more Immune-Related Adverse Events

Extensive investigations have been conducted regarding the potential correlation between blood type and the immune system, as well as cancer risk in the Southern Chinese population. However, the prognostic value of the blood group and its genetic determinants in the context of immune checkpoint inhibitor (ICI) treatment remains unclear. Therefore, the associations between the ABO blood group and its single nucleotide polymorphisms (SNPs) were examined in relation to ICI treatment outcomes in 370 eligible patients with cancer. This approach allowed us to derive the blood group from the SNPs responsible for blood group determination. In the discovery cohort (N = 168), antigen A carriers (blood types A and AB) exhibited an extended progression-free survival (PFS; hazard ratio (HR) = 0.58, 95% confidence interval (CI) = 0.34-0.98). The association results from the SNP-derived blood were consistent with those from the measured blood group. In the validation cohort (N = 202), Cox regression analysis revealed that the antigen A carriers (rs507666 AA+GA genotype carriers) experienced significantly extended PFS compared with the non-antigen A carriers (HR = 0.61, 95% CI = 0.40-0.93). Therefore, a longer PFS was observed in antigen A carriers (P value = 0.003, HR = 0.60, 95% CI = 0.44-0.84). Furthermore, haplotype 2 carriers (rs507666 GA and rs659104 GG) demonstrated both extended PFS and improved overall survival. Notably, the presence of antigen A was not associated with the occurrence of overall immune-related adverse events (irAEs) or organ-specific toxicity. In summary, our findings revealed that antigen A carriers did not experience a higher incidence of irAEs while exhibiting better immunotherapy efficacy.

ABO-adjusted cPRA metric for kidney allocation in an Asian-predominant population

Recent studies showed that ABO-adjusted calculated panel reactive antibody (ABO-cPRA) may better reflect the histocompatibility level in a multi-ethnic population, but such data in Asians is not available. We developed an ABO-adjusted cPRA metric on a cohort of waitlist kidney transplant patients (n = 647, 99% Chinese) in Hong Kong, based on HLA alleles and ABO frequencies of local donors. The concordance between the web-based ABO-cPRA calculator and the impact on kidney allocation were evaluated. The blood group distribution for A, B, O and AB among waitlist kidney candidates were 26.2%, 27.5%, 40.1%, and 6.1%, and their chances of encountering incompatible blood group donors were 32.6%, 32.4%, 57.6%, and 0%, respectively. There is poor agreement between web-based ABO-cPRA calculator and our locally developed metrics. Over 90% of patients showed an increase in cPRA after ABO adjustment, most notably in those with cPRA between 70% and 79%. Blood group O patients had a much greater increase in cPRA scores after adjustment while patients of blood group A and B had similar increment. 10.6% of non-AB blood group waitlist patients had ABO-cPRA elevated to ≥80%. A local ABO-adjusted cPRA metric is required for Asian populations and may improve equity in kidney distribution for patients with disadvantageous blood groups. The result from the current study potentially helps other countries/localities in establishing their own unified ABO-cPRA metrics and predict the impact on kidney allocation.

Blood Type and Outcomes in Pregnant Women with Placenta Previa

Background

Placenta previa increases the risks of obstetrical complications. Many studies have reported a link between various ABO blood types and pregnancy complications. This study is aimed at describing and comparing the characteristics and outcomes of women with placenta previa by ABO blood type.

Methods

Data for this study was obtained from a retrospective cohort study between January 1, 2014, and June 30, 2019, of all clinically confirmed placenta previa in a university-based tertiary medical center. Both types of A, B, O, AB, and combining O and non-O blood types were compared to the characteristics and outcomes.

Results

1678 participants with placenta previa were included in this study. The highest participants were blood type O with 666 (39.7%), followed by type A with 508 (30.3%) and type B with 395 (23.5%), and the lowest participants were AB with 109 (6.5%). Blood type AB had a higher incidence of antepartum hemorrhage (p = 0.017), predelivery anemia (p = 0.036), and preterm birth (p = 0.015) in placenta previa women. Meanwhile, the incidence of rhesus D positive (97.9% vs. 95.8%, p = 0.012) and twins (5.0% vs. 2.7%, p = 0.011) was higher in the non-O group, and the incidence of neonatal asphyxia (5.9% vs. 9.2%, p = 0.016) was lower in the non-O group.

Conclusion

Type AB blood may be a potential risk factor for women with placenta previa. This finding may help provide any obstetrician to predict the risk of complication for placenta previa women by the ABO blood types.

ABO blood group antigens and differential glycan expression: Perspective on the evolution of common human enzyme deficiencies

Enzymes catalyze biochemical reactions and play critical roles in human health and disease. Enzyme variants and deficiencies can lead to variable expression of glycans, which can affect physiology, influence predilection for disease, and/or directly contribute to disease pathogenesis. Although certain well-characterized enzyme deficiencies result in overt disease, some of the most common enzyme deficiencies in humans form the basis of blood groups. These carbohydrate blood groups impact fundamental areas of clinical medicine, including the risk of infection and severity of infectious disease, bleeding risk, transfusion medicine, and tissue/organ transplantation. In this review, we examine the enzymes responsible for carbohydrate-based blood group antigen biosynthesis and their expression within the human population. We also consider the evolutionary selective pressures, e.g. malaria, that may account for the variation in carbohydrate structures and the implications of this biology for human disease.

Assortative mating on blood type: Evidence from one million Chinese pregnancies

Blood type is one of the most fundamental phenotypes in biological, medical, and psychological studies. Using a unique dataset of one million Chinese pregnancies, we find strong evidence from a group of statistical tests for assortative mating on blood type. After controlling for anthropometric and socioeconomic confounders, assortative mating remains robust.

Prevalence of reproductive tract infections among women preparing to conceive in Chongqing, China: trends and risk factors

Background

Reproductive tract infection has become a major public health issue all over the world for its high and growing prevalence. It can cause adverse pregnancy outcomes in pregnant women and their foetuses. This study aimed to investigate the trends and risk factors of the prevalence of reproductive tract infections among women who prepared to conceive in the Chongqing Municipality (China) from 2012 to 2016.

Methods

A multi-center cross-sectional study was conducted between January 2012 and December 2016. Women aged 20–49 years who intended to get pregnant were recruited for this study. All participants underwent preconception examination, which included testing for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, syphilis, bacterial vaginosis and candidiasis according to the national diagnostic standard. A total of 439,372 women with testing results for all six types of reproductive tract infections were included in our final analyses. Logistic regression and factor analysis were used to determine the possible sociodemographic factors associated with prevalence trends.

Results

In our study, the overall positive rate of RTIs among the 439,372 women of reproductive age was 5.03%. Candidiasis was the most common infection in our population (2.47%), followed by bacterial vaginosis (1.28%), syphilis (0.73%), T. vaginalis (0.49%), C. trachomatis (0.20%) and N. gonorrhoeae (0.06%). The prevalence of reproductive tract infections was highest among women aged 35 years and above, with a primary or lower education level, history of pregnancy, delivery, induced abortion, or spontaneous abortion. From 2012 to 2016, the trend of the overall prevalence of reproductive tract infections was V-shaped, decreasing steadily from 2012 to 2015, with a slight rise in 2016. Our results suggest that the distribution change of age, education level, gravidity, parity, and history of induced abortion influenced this trend.

Conclusion

Since the number of high-risk women who intend to become pregnant is growing in the Chongqing Municipality, pre-conception positive preventions including health education, regular screening, and timely treatment of reproductive tract infections are needed to prevent the impact of reproductive tract infections on maternal health and infant safety.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-022-01502-x.

Reproductive tract infections (RTIs) can cause serious health problems, such as spontaneous abortion and congenital diseases in pregnant women and their foetuses. However, there is a lack of studies focusing on the prevalence of RTIs and their trends among women who intend to conceive. This cross-sectional study examined data collected from 439,372 women during their preconception care to investigate the trend and related risk factors of the prevalence of RTIs, thereby providing essential data for their prevention. Participants were women from all 39 counties in the Chongqing Municipality of China, and data were collected between 2012 and 2016. We found that the overall prevalence of the six types of RTIs among these women was 5.03%, which was relatively lower than that in other populations in previous studies. Age, education level, history of pregnancy or delivery, and history of abortion were all associated with the prevalence of RTIs. The prevalence trend from 2012 to 2016 was V-shaped decreased steadily from 2012 until 2015 and rose slightly in 2016. Our data suggested that this trend might be influenced by changes in the proportion of ‘high-risk’ women, that is, women with higher age, lower education level, and a history of pregnancy or induced abortion. This study suggests that health education and regular screening are necessary to face new challenges experienced by older women or women with previous pregnancies who intended to get pregnant in recent years in China.

Time to Hemostasis After Trauma and Transfusion by Patient Blood Type

BACKGROUND

Although evidence supports an increased risk of mortality after major trauma among patients with type O blood, the relationship between patient blood type and clinical outcomes aside from mortality has not been fully elucidated.

OBJECTIVE

To examine the relationship between patient blood type and time to hemostasis after trauma and massive transfusion.

METHODS

A secondary analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial was performed (N = 544). Blood type was dichotomized into type O versus non-type O. It was hypothesized that patients with non-type O blood would achieve hemostasis more quickly owing to the theoretical presence of increased clotting factors. Bivariate analysis and multiple Cox regression were conducted to test this assumption.

RESULTS

No significant difference was found in time to hemostasis between patients with type O blood and those with non-type O blood. However, mechanism of injury, diastolic blood pressure, and international normalized ratio affected the time to hemostasis in these trauma patients.

CONCLUSION

This study showed no significant difference in time to hemostasis by blood type.

Blood Donation in Lebanon: A Six-Year Retrospective Study of a Decentralized Fragmented Blood Management System

Introduction

In developing countries, the lack of a sufficient and safe blood supply is a significant impediment to providing health care. Lebanon is notable for its absence of a Donor Management System to ensure continuous donor recruitment and scheduling. Herein, we report the findings of Lebanon's first large retrospective population-based study to investigate blood types and donation that is critical for managing community blood supply.

Methods

The non-remunerated voluntary blood donors were recruited by the non-profit organization “Donner Sang Compter”. The study spanned six years, from August 2015 to May 2021, and included 36,002 people from 18 districts throughout Lebanon's nine governorates.

Results

The most prevalent blood type was A (42%), followed by O (37.48%), B (13.86%), and the AB group (6.84%). RhD+ groups were predominant (88.45%), with A+ being the most (37.84%) and AB- being the least prevalent (1.05%). Furthermore, blood type and donation profiling revealed a substantial geographical variation in the frequency of blood groups, despite the relatively small country’s area. As for blood donation, when gender and age were considered, young male donors dominated the pool across the country.

Conclusion

This study on blood type prevalence and blood donor demographics may pave the way for the development of a more coherent and integrated blood management system in Lebanon, as opposed to the fragmented and decentralized system now in existence. These findings also provide crucial clinical information for the country's future transfusion medicine policies and practices, which is vital in such a precarious part of the world.

DEL in China: the D antigen among serologic RhD-negative individuals

BACKGROUND

Providing RhD-negative red cell transfusions is a challenge in East Asia, represented by China, Korea, and Japan, where the frequency of RhD-negative is the lowest in the world.

FINDINGS

Among 56 ethnic groups in China, the RhD-negative frequency in Han, the prevalent ethnicity, is 0.5% or less, similar to most other ethnic groups. The Uyghur ethnic group has the highest reported RhD-negative frequency of up to 4.7%, as compared to 13.9% in the US. However, an estimated 7.15 million RhD-negative people live in China. The RhD-negative phenotype typically results from a loss of the entire RHD gene, causing the lack of the RhD protein and D antigen. The DEL phenotype carries a low amount of the D antigen and types as RhD-negative in routine serology. The DEL prevalence in RhD-negative individuals averages 23.3% in the Han, 17% in the Hui and 2.4% in the Uyghur ethnicities. The Asian type DEL, also known as RHD*DEL1 and RHD:c.1227G > A allele, is by far the most prevalent among the 13 DEL alleles observed in China.

CONCLUSION

The purpose of this review is to summarize the data on DEL and to provide a basis for practical strategy decisions in managing patients and donors with DEL alleles in East Asia using molecular assays.

The association of ABO blood types with host susceptibility to hemorrhagic fever with renal syndrome

Since the discovery of ABO blood types, there has been mounting evidence of the association between blood types and infectious diseases. However, so far, there is rarely available research about the potential role of ABO blood types in haemorrhagic fever with renal syndrome (HFRS) infection. Our aim was to investigate the relationship between ABO blood types and the development of HFRS infection in Qingdao, China. We carried out a retrospective study enrolling 116 HFRS patients as the case group and 373 healthy subjects as the control group. ABO blood type distribution was analysed using the Chi-square test and logistic regression analysis. Results showed that the distribution of ABO blood types between the two groups was significantly different (X2 = 18.151, P < 0.05). Blood type B was less frequently observed [odds ratio (OR), 0.404; confidence interval (CI), 0.238–0.684; P < 0.01], while blood type AB was more frequently observed in the case group (OR, 2.548; CI, 1.427–4.549; P < 0.01). Since significantly more males were affected than females, we further analysed the data by gender as well as blood types and obtained consistent results for males. Our findings indicated that populations with blood type AB might be more prone to HFRS infection, whereas those with blood type B might be less susceptible to HFRS infection, which will help to make risk stratification in infection control.

Distribution of ABO and Rhesus Blood Group Phenotypes Among Blood Donors at Bahir Dar Blood Bank, Amhara, Northwest Ethiopia: A Retrospective Cross-Sectional Study

Background

Among the blood group antigens identified, ABO and Rhesus are the most important in transfusion medicine. ABO blood group antigens are the most immunogenic followed by Rhesus (D antigen). These blood groups’ frequency distribution varies among different regions and races of the world. This study aimed to identifying the frequency distribution of ABO blood group and rhesus factors among blood donors in Ethiopia.

Methods and Materials

Aretrospective cross-sectional study was conducted from September 12/2019 to March 18/2021 at Bahir Dar blood bank service. After getting a permission letter from the blood bank, data were collected from the blood bank donor data registration system, and descriptive statistical results were presented in number (frequency) and percentage. A Chi-square test was used to show the difference in the frequency distribution of ABO and Rh blood groups among sex and blood donation site.

Results

From 40,053 blood donors, 67.7% were males and younger donors (within the age range of 18–24 years) account for 63.7%. All donations were from voluntary non-remunerated blood donors. The most common blood group was blood group O (41.5%) followed by A (29.8), B (23.2%), and AB (5.5%). Considering ABO and Rh blood group altogether blood group O positive with 37.9% was the predominant blood group followed by A positive (27.2%), B positive (21.4%), AB positive (5%), O negative (3.6%), A negative (2.6%), B negative (1.8%), and AB negative (0.4%). The majority of study participants were 91.5% Rh (D) positive.

Conclusion

This study showed that blood group O was the predominant followed by A, B, and AB and most of the blood donors’ blood groups were Rh-positive (91.5%). About 68.9% of the total donations were from the first time donor.

Lewis and ABO histo-blood types and the secretor status of patients hospitalized with COVID-19 implicate a role for ABO antibodies in susceptibility to infection with SARS-CoV-2

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) targets the respiratory and gastric epithelium, causing coronavirus disease 2019 (COVID-19). Tissue antigen expression variations influence host susceptibility to many infections. This study aimed to investigate the closely linked Lewis (FUT3) and ABO histo-blood types, including secretor (FUT2) status, to infections with SARS-CoV-2 and the corresponding severity of COVID-19.

STUDY DESIGN AND METHODS

Patients (Caucasians, n = 338) were genotyped for ABO, FUT3, and FUT2, and compared to a reference population of blood donors (n = 250,298). The association between blood types and severity of COVID-19 was addressed by dividing patients into four categories: hospitalized individuals in general wards, patients admitted to the intensive care unit with and without intubation, and deceased patients. Comorbidities were considered in subsequent analyses.

RESULTS

Patients with blood type Lewis (a-b-) or O were significantly less likely to be hospitalized (odds ratio [OR] 0.669, confidence interval [CI] 0.446-0.971, OR 0.710, CI 0.556-0.900, respectively), while type AB was significantly more prevalent in the patient cohort (OR 1.519, CI 1.014-2.203). The proportions of secretors/nonsecretors, and Lewis a+ or Lewis b+ types were consistent between patients and controls. The analyzed blood groups were not associated with the clinical outcome as defined.

DISCUSSION

Blood types Lewis (a-b-) and O were found to be protective factors, whereas the group AB is suggested to be a risk factor for COVID-19. The antigens investigated may not be prognostic for disease severity, but a role for ABO isoagglutinins in SARS-CoV-2 infections is strongly suggested.

Demographic Characteristics and Lifestyle Habits of Chinese Plasma Donors: A Multicenter Study

BACKGROUND The demand for plasma and plasma products has increased in China, which has a short supply. Compared with whole blood donors, plasma donors and their donation behavior have received less attention. This study aimed to investigate the demographic characteristics and lifestyle habits of Chinese plasma donors. MATERIAL AND METHODS During 2018-2019, information on plasma donors was collected from blood product companies using a 25-item questionnaire, including sex, age, height, weight, blood group, donation frequency, occupation, smoking and drinking, and sleeping and dietary habits. RESULTS Among 15 497 plasma donors, 70.5% were women and 78.5% were aged 46-55 years. Among 4847 plasma donors, the average height of men was 169.5±6.2 cm and the average height of women was 157.0±4.6 cm. In addition, the average weight of men was 67.0±10.4 kg and the average weight of women was 60.0±8.3 kg. The prevalence of obesity (body mass index ≥30.0 kg/m²) of all donors was 14.8%; 14.7% of men were obese, and 15% of women were obese. Among all plasma donors, 88.8% were farmers and 60% were frequent donors with a donation history of at least 5 years. Among all donors, 84.0% did not smoke, 67.3% did not drink, and 95.1% reported good sleep quality. All respondents reported healthy dietary habits. CONCLUSIONS Healthy lifestyle habits considerably affect the health of plasma donors and the quality of source plasma. Chinese plasma donors in this study demonstrated imbalances in terms of characteristics, which became more marked with age.

ABO and Rhesus Blood Group Distribution and Blood Donation Willingness Among First-Year Health Students in a Saudi University

Background

Understanding the distribution of blood groups and blood donation willingness in a population is crucial in managing blood banks and transfusion services. Moreover, awareness of one’s own blood group is essential especially in emergencies that mandate blood donation. This study aimed to determine the distribution of ABO and Rhesus (Rh) blood groups among health students, the students’ knowledge about their blood group, and their willingness to donate blood.

Methods

This cross-sectional study included all newly accepted health students in a large university in the Eastern Province of Saudi Arabia (N=1145) during August 2020. The data included a self-administered questionnaire and the serology results of ABO and Rh factors. Chi-squared and Fisher’s exact tests were performed followed by a multivariable binary logistic regression analysis which identified the predictors of willingness of blood donation.

Results

Blood group O was the most frequent type among students (51.1%), followed by group A (24.5%) and B (20.4%). The majority (93.3%) of students had Rh-positive factor. When we compared students’ answers with their sample results, most students (75.5%) correctly reported their ABO and Rh blood groups. Male students and those with a previous history of blood donation correctly reported their blood group more than others. Of the total sample, 47.3% were willing to donate blood within the next year. Positive predictors of the willingness of student to donate blood included being male, and those with a history of blood donation. Interestingly, students with a family member in the healthcare field were significantly less likely to donate blood.

Conclusion

Blood group O and Rh positive were the most frequent blood groups. Most students had a good knowledge about their blood groups, and about half of students were willing to donate blood. Efforts to encourage the young population to participate in blood donation are crucial.

ABO blood groups and liver cancer: prospective results from an HBsAg cohort study

OBJECTIVE

The association between ABO blood group and risk of liver cancer is unclear, although few studies have reported positive results. This study examined the relationship between ABO blood group and liver cancer in hepatitis B surface antigen (HBsAg)-positive individuals.

DESIGN

A high-risk population-based cohort study.

SETTING

The study was started in 2007 and closed in 2019; the number of observed person-years as obtained by ABO blood group.

PARTICIPANTS

The study included 3663 individuals with positive HBsAg, including men aged 30-70 and women aged 40-70.

OUTCOME MEASURES

The frequencies of ABO group in the cohort population and patients with liver cancer were calculated, respectively. χ² test was used to compare differences, and the relative risk (95% CI) for development of liver cancer was evaluated.

RESULTS

The frequency distribution of blood types A, B, O and AB was 1118 (30.52%), 1073 (29.29%), 1104 (30.14%) and 368 (10.05%), respectively, among 3663 cohort individuals. In the cohort, patients with liver cancer (n=336) were of the following frequencies: type A: 104 (30.95%); type B: 97 (28.87%); type O: 95 (28.27%); and type AB: 40 (11.90%). No significant difference was found between patients with liver cancer and other individuals. The annual incidence rate of liver cancer was 906.34 per 100 000 person-years, and for blood type A, B, O and AB the rates were 917.76, 893.78, 846.02 and 1093.43 per 100 000 person-years, respectively. The relative risk (95% CI) was 0.97 (0.74 to 1.29), 0.92 (0.70 to 1.22) and 1.19 (0.82 to 1.72) for blood types B, O and AB, respectively, compared with blood type A.

CONCLUSION

There were no significant differences in the frequency distribution of ABO blood groups in patients with liver cancer within this high-risk cohort, which demonstrates lack of positive association between ABO blood group and risk of liver cancer.

Frequency of ABO and Rh Blood Group Distribution at Debre Tabor Blood Bank, Amhara Region, North-Central Ethiopia. A Six-Year Retrospective Survey

Introduction

Blood is arranged into four groups based on their surface antigen (A, B, AB, and O). In addition to this classification based on the Rhesus factor, each blood group clustered into RH positive and RH negative. This study was done to identify the distribution of blood group and rhesus factors on the local blood bank.

Objective

To identify the frequency of ABO blood group and RH factors distribution on voluntary blood donator at Debre Tabor blood bank from May 2014 to May 2020.

Methods

A retrospective cross-sectional survey was conducted to identify the frequency of ABO and Rh factor distribution on voluntary blood donors at Debre Tabor town blood bank. The data was collected at Debre Tabor blood bank. A six-year data and a total of 19,901 bags collected blood samples were used for summarization of the data. The data was analysed by using SPSS version 21.

Results

Blood group "O" was the dominated one with 39.6% followed by blood group "A", "B" and "AB" with 29.48%, 24.06%, and 6.7%, respectively. When we see the RH classifications, RH positive accounts the highest percentage 92.77% and the remaining 7.23% was Rh negatives.

Conclusion

In this survey, the majority of blood groups were found "O" followed by "A", "B", and "AB". Among the collected blood unities, 92.77% was RH positive. The leading blood donators were male.

Distribution characteristics of ABO and RhD blood groups among the voluntary blood donors in Chongqing: A retrospective study

The distribution characteristics of ABO and RhD blood groups in the world were different and the data were limited. The aim was to investigate the distribution characteristics of ABO and RhD blood groups in Chongqing, and to provide scientific-effective data for a more reasonable blood collection program. We retrospectively analyzed 795 698 blood donors who had donated blood from 2014 to 2019 at the Chongqing Blood Center. The data on ABO and RhD blood groups were extracted based on blood management system. We used percentages to describe the extraction of data on blood donors by gender, age, and nationality. The data on the distribution of ABO (A, B, AB and O) and RhD (RhD-Positive and RhD-Negative) blood groups were reported also in percentages. Of those, 427 516 (53.73%) were males and 368 182 (46.27%) were females. Among all the blood donors, 321 916 (40.46%) were under the age of 25, followed by 26-35 years age group (22.65%), 36-45 years age group (18.95%), 46-55 years age group (16.98%) and 56-60 years age group (0.96%). There were 755439 (94.94%) of the blood donors who were of the Han nationality. The distribution of blood groups O, A, B and AB were 35.54%, 31.90%, 24.14% and 8.42%, respectively. The distributions of RhD-Negative group was found in 4362 (0.55%) blood donors. The distribution characteristics of the ABO and RhD blood group should be considered when improving blood collection program in Chongqing.

Relationship between blood group and risk of infection and death in COVID-19: a live meta-analysis

The relationship between ABO blood group and the incidence of coronavirus disease 2019 (COVID-19) infection and death has been investigated in several studies. The reported results were controversial, so the objective of the present study was to assess the relationship between different blood groups and the onset and mortality of COVID-19 infection using a meta-analysis method. We searched relevant databases using appropriate MeSH terms. We screened articles on the bases of titles, abstracts and full text, and articles that met the inclusion criteria were selected. Quality assessment was done with the Newcastle-Ottawa scale checklist. The estimated frequency of COVID-19 infection and death in terms of ABO blood group and the overall estimate of the odds ratio between blood group with COVID-19 infection and death was calculated with 95% confidence interval. The pooled frequency of blood groups A, B, O and AB among COVID-19-infected individuals was estimated as 36.22%, 24.99%, 29.67% and 9.29% respectively. The frequency of blood groups A, B, O and AB among patients who died of COVID-19 infection was estimated as 40%, 23%, 29% and 8% respectively. The odds ratio of COVID-19 infection for blood group A versus the other blood groups was estimated as 1.16 (95% confidence interval (CI), 1.02-1.33). The corresponding figures for blood groups O and AB versus other blood groups were estimated as 0.73 (95% CI, 0.60-0.88) and 1.25 (95% CI, 0.84-1.86) respectively. This meta-analysis showed that individuals with blood group A are at higher risk for COVID-19 infection while those with blood group O are at lower risk. Although the odds ratio of death for AB blood group was nonsignificant, it was considerable.

Blood type and outcomes in patients with COVID-19

This study aimed to determine if there is an association between ABO blood type and severity of COVID-19 defined by intubation or death as well as ascertain if there is variability in testing positive for COVID-19 between blood types. In a multi-institutional study, all adult patients who tested positive for COVID-19 across five hospitals were identified and included from March 6th to April 16th, 2020. Hospitalization, intubation, and death were evaluated for association with blood type. Univariate analysis was conducted using standard techniques and logistic regression was used to determine the independent effect of blood type on intubation and/or death and positive testing. During the study period, there were 7648 patients who received COVID-19 testing throughout the institutions. Of these, 1289 tested positive with a known blood type. A total of 484 (37.5%) were admitted to hospital, 123 (9.5%) were admitted to the ICU, 108 (8.4%) were intubated, 3 (0.2%) required ECMO, and 89 (6.9%) died. Of the 1289 patients who tested positive, 440 (34.2%) were blood type A, 201 (15.6%) were blood type B, 61 (4.7%) were blood type AB, and 587 (45.5%) were blood type O. On univariate analysis, there was no association between blood type and any of the peak inflammatory markers (peak WBC, p = 0.25; peak LDH, p = 0.40; peak ESR, p = 0.16; peak CRP, p = 0.14) nor between blood type and any of the clinical outcomes of severity (admission p = 0.20, ICU admission p = 0.94, intubation p = 0.93, proning while intubated p = 0.58, ECMO p = 0.09, and death p = 0.49). After multivariable analysis, blood type was not independently associated with risk of intubation or death (referent blood type A; blood type B: AOR: 0.72, 95% CI: 0.42–1.26, blood type AB: AOR: 0.78, CI: 0.33–1.87, blood type O: AOR: 0.77, CI: 0.51–1.16), rhesus factor positive (Rh+): AOR: 1.03, CI: 0.93–1.86. Blood type A had no correlation with positive testing (AOR: 1.00, CI: 0.88–1.13), blood type B was associated with higher odds of testing positive for disease (AOR: 1.28, CI: 1.08–1.52), AB was also associated with higher odds of testing positive (AOR: 1.37, CI: 1.02–1.83), and O was associated with a lower risk of testing positive (AOR: 0.84, CI: 0.75–0.95). Rh+ status was associated with higher odds of testing positive (AOR: 1.23, CI: 1.003–1.50). Blood type was not associated with risk of intubation or death in patients with COVID-19. Patients with blood types B and AB who received a test were more likely to test positive and blood type O was less likely to test positive. Rh+ patients were more likely to test positive.

Specific Combinations of Erythrocyte Group Antigens in Blood Donors

Blood groups are inherited biological characteristics that do not change throughout life only in healthy people. Blood group antigens determine the adaptation of a human, as a biological species, to the surrounding environment. Our goal was to study the combination and frequency characteristics of three group systems (ABO, RH, KELL) in blood donors. The blood of 743 donors (aged ≥ 18 years) has been investigated on erythrocyte blood group antigens (521 male and 222 female). The sample has been provided from diagnostic laboratory of "Health Centre Medina Ltd" of Batumi. Research was agreed with hematology department of the clinic. Blood typing of the sample has been carried out on the basis of immunogenetic laboratory of Batumi Shota Rustaveli State University. The express method with universal mono-clone antibodies was used in order to reveal blood group system antigens. ABO blood group are distributed the following order: O > A > B > AB. We allocated 16 phenotypic groups. O, Rh+, K- (38.62 ± 1.7%) are represented with the highest percentage among donors and a rather large number of the investigated donors (287 donors) is the carrier of this phenotype. A frequency distribution of the A, Rh+, K- phenotype group 10% (28.93 ± 1.6) was less. 215 donors carry A, Rh+, K- phenotype combination. O, Rh+, K+ and A, Rh+, K+ variations of the phenotype are represented with an equal percentage (3.23 ± 0.4%). 7.94 ± 0.9% donors are characterized by features of the O, Rh-, K- Erythrocyte group. A frequency distribution of B, Rh+, K- phenotype is slightly less - 6.86 ± 0.9%. A, Rh-, K combination of phenotype occurs with a frequency of 4.97 ± 0.7%, and AB, Rh+, K- occurs with a frequency of 2.28 ± 0.5%. I n the donor population there were only single cases of B, Rh-, K+ (0.13 ± 0.01); AB, Rh+, K+ (0.13 ± 0.01); AB, Rh-, K- (0.40 ± 0.2); B, Rh+, K+ (0.26 ± 0.1); O, Rh-, K+ (0.40 ± 0.2); A, Rh-, K+ (0.67 ± 0.2) combination of phenotype. The phenotype AB, Rh-, K+ was not identified. The existence of this database will increase the safety level of transfusion, widen donors database and allow the clinics to find quickly the rare combination of blood group for transfusion and decrease of the risk of post-transfusion complications.

Association of ABO blood group and antituberculosis drug-induced liver injury: A case-control study from a Chinese Han population

WHAT IS KNOWN AND OBJECTIVE

Antituberculosis drug-induced liver injury (ATLI) is a serious adverse drug reaction, and its pathogenic mechanism is still largely unknown. Rifampin (RIF) has been reported to cause haemolysis due to the production of drug-dependent antibodies, and haemolysis results in an increased level of free haem, which affects the function of hepatocytes. Blood group determinants can act as specific receptor sites for drug-antibody complexes, causing erythrocyte destruction in the presence of RIF. RIF-induced immune haemolysis may be a potential mechanism for ATLI. Thus, the study aimed to explore the role of ABO blood group systems in Chinese ATLI patients.

METHODS

A 1:4 matched case-control study was conducted among 146 ATLI cases and 584 controls. Multivariable conditional logistic regression and Cox proportional regression were used to estimate the association between ABO blood group and risk of ATLI by odds ratio (OR), hazards ratio (HR) and 95% confidence intervals (CIs), and liver disease history and taking hepatoprotectant were used as covariates.

RESULTS AND DISCUSSION

Patients in the A, B, AB and non-O blood groups had a significantly higher risk of ATLI than those in the O blood group (OR = 1.832, 95% CI: 1.126-2.983, P = .015; OR = 1.751, 95% CI: 1.044-2.937, P = .034; OR = 2.059, 95% CI: 1.077-3.938, P = .029; OR = 1.822, 95% CI: 1.173-2.831, P = .007, respectively). After considering the time of ALTI occurrence, similar results were found in the A, B, AB and non-O blood groups (HR = 1.676, 95% CI: 1.072-2.620, P = .024; HR = 1.620, 95% CI: 1.016-2.584, P = .043; HR = 2.010, 95% CI: 1.130-3.576, P = .018; HR = 1.701, 95% CI: 1.138-2.542, P = .010, respectively). Furthermore, subgroup analysis also detected a significant association between ABO blood group and ATLI in patients taking RIF (P < .05). However, no significant difference was observed in patients not taking RIF (P > .05).

WHAT IS NEW AND CONCLUSION

The present study is the first to evaluate the role of ABO blood group systems in Chinese ATLI cases. Based on the present matched case-control study, the ABO blood group may be associated with susceptibility to ATLI in the Chinese antituberculosis population, especially in patients with blood groups A, B and AB who are taking RIF.

Optimizing O-negative RBC utilization using a data-driven approach

BACKGROUND

O-negative red blood cells (ON-RBC) are a precious resource and the international blood banking community has become increasingly concerned with its inappropriate utilization. AABB recently made several recommendations to address the issue. Solutions must be multifaceted and involve donor centers, blood banks, and clinical departments. From the perspective of a hospital blood bank, it is difficult to rely solely on increased donor recruitment and ubiquitous blood typing of the entire in-patient population. We therefore focused on interventions within the blood bank to optimize inventory and policies to ensure appropriate ON-RBC utilization.

STUDY DESIGN AND METHODS

Transfusion data over one year was examined for the rate of out-of-group/inappropriate ON-RBC. Furthermore, we assessed whether that rate was related to product life on the day of transfusion. We also examined our stock inventory levels and how excess inventory can contribute to inappropriate ON-RBC usage.

RESULTS

The ON-RBC inventory level was decreased in order to reduce the rate of inappropriate transfusions while maintaining a safe level for optimal patient care. Compared to baseline, our intervention caused ON-RBCs to be transfused earlier in their shelf-life (9.27 vs. 11.15 days from expiration [DFE], p = 0.0012). This reduced the overall rate of inappropriate ON-RBC transfusions (67% vs. 54%, p = 0.0035), approximating 185 units of ON-RBC saved over the course of 6 months.

CONCLUSIONS

A data-driven approach to optimize stock inventory levels is widely applicable; it can be adopted by numerous institutions to improve utilization and establish a benchmark for the broader blood banking community.

The characteristic of otoacoustic emissions in full-term neonates according to ABO blood groups

Introduction

Previous research has suggested that individuals with different blood groups show varied incidences of noise-induced hearing loss. The reduced otoacoustic emissions amplitudes indicate the higher possibilities of outer hair cell damage for noise exposure.

Objective

The objective is to analyze the characteristics of otoacoustic emissions, including the occurrence of spontaneous otoacoustic emission and the amplitudes of distortion product otoacoustic emission at certain frequencies in full term neonates with different ABO blood groups.

Methods

A total of 80 selected full-term female neonates who passed the initial newborn hearing screen were enrolled into the study, with equal number of participants in four ABO blood groups (Blood Group A, Blood Group B, Blood Group AB, Blood Group O). Measurements of spontaneous otoacoustic emission and distortion product otoacoustic emission were performed in both ears for all participants.

Results

(1) The blood group O participants showed significantly fewer spontaneous otoacoustic emission occurrences than the other three blood groups (A = 70%, B = 80%, AB = 67%, O = 25%, p <  0.05). (2) The blood group O participants showed lower DPOAE amplitudes at 1257 Hz (M = 4.55 dB, SD = 8.36), 1587 Hz (M = 11.60 dB, SD = 6.57), 3174 Hz (M = 7.25 dB, SD = 5.99), 5042 Hz (M = 13.60, SD = 6.70) than participants with the other three blood groups in left ears (p < 0.05). In right ears, the blood group O participants showed reduced amplitudes at 1257 Hz (M = 6.55 dB, SD = 8.36), 1587 Hz (M = 13.60 dB, SD = 6.57), 3174 Hz (M = 7.65 dB, SD = 6.43), 5042 Hz (M = 13.65 dB, SD = 6.50) than participants from non-O blood groups (p < 0.05).

Conclusion

Female individuals with blood group O have lower otoacoustic emissions values than individuals with the other three blood groups. We need to further investigate the possible relationships between ABO blood group and cochlear function, including the potential influences of noise damage on cochlear outer hair cells.