Distribution of ABO blood groups in patients with ulcer disease. Its relationship to gastroduodenal bleeding

ABO blood type and functional neurological outcome in patients with severe traumatic brain injury

BACKGROUND

The ABO blood system has been involved in the pathogenesis of several diseases, including coagulopathy and bleeding complications. In trauma patients, blood type A has been associated with acute respiratory distress syndrome, and recently, blood type O has been associated with all-cause mortality. The purpose of this study was to assess the association between ABO blood types and long-term functional outcomes in critically ill patients with severe traumatic brain injury (TBI).

METHODS

We conducted a single-center, retrospective, observational study including all patients admitted to the intensive care unit with severe TBI (defined as a Glasgow Coma Scale score of ≤8) between January 2007 and December 2018. Patient characteristics and outcomes were extracted from a prospective registry of all intubated patients admitted to the intensive care unit for TBI. ABO blood types were retrospectively retrieved from patient medical records. The association between ABO blood type (A, B, AB, and O) and unfavorable functional outcome (defined by a Glasgow Outcome Scale score between 1 and 3) 6 months after injury was assessed in univariate and multivariate analysis.

RESULTS

A total of 333 patients meeting the inclusion criteria were included. There were 151 type O (46%), 131 type A (39%), 37 type B (11%), and 12 type AB patients (4%). No significant differences in baseline demographic, clinical, or biological characteristics were observed between blood types. The prevalence of unfavorable outcome was significantly different between the four groups. After adjustment for confounders, blood type O was significantly associated with unfavorable outcome at 6 months (odds ratio, 1.97; confidence interval [1.03-3.80]; p = 0.042). The prevalence of coagulopathy or progressive hemorrhagic injury was not statistically different between blood types ( p = 0.575 and p = 0.813, respectively).

CONCLUSION

Blood type O appears to be associated with unfavorable long-term functional outcome in critically ill patients with severe TBI. Further studies are needed to detail the mechanism underlying this relationship.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.

Association of ABO blood group with bleeding severity in patients with bleeding of unknown cause

Blood group O has been associated with an increased bleeding tendency due to lower von Willebrand factor (VWF) and factor VIII (FVIII) levels. We explored whether blood group O is independently associated with bleeding severity in patients with mild-to-moderate bleeding of unknown cause (BUC) in the Vienna Bleeding Biobank cohort. Bleeding severity was recorded with the Vicenza bleeding score (BS). Blood group O was overrepresented in 422 patients with BUC compared with its presence in 23 145 healthy blood donors (47.2% vs 37.6%; odds ratio, 1.48; 95% confidence interval [CI], 1.22-1.79). The BS and the number of bleeding symptoms were significantly higher in patients with blood group O than in patients with non-O after adjustment for VWF and FVIII levels and sex (least-square [LS] means of BSs: 6.2; 95% CI, 5.8-6.6 vs 5.3; 4.9-5.7; and of number of symptoms: LS, 3.5; 95% CI, 3.2-3.7 vs 3.0; 2.8-3.2, respectively). Oral mucosal bleeding was more frequent in those with blood group O than in those with other blood types (group non-O; 26.1% vs 14.3%), independent of sex and VWF and FVIII levels, whereas other bleeding symptoms did not differ. Patients with blood group O had increased clot density in comparison with those with blood group non-O, as determined by rotational thromboelastometry and turbidimetric measurement of plasma clot formation. There were no differences in thrombin generation, clot lysis, or platelet function. Our data indicate that blood group O is a risk factor for increased bleeding and bleeding severity in patients with BUC, independent of VWF and FVIII levels.

Clarifying the relationship between ABO/Rhesus blood group antigens and upper gastrointestinal bleeding

BACKGROUND AND AIM

The relationship between blood group antigens and peptic ulcer disease has been widely evaluated in the past. Data concerning the same association with upper gastrointestinal bleeding are very limited. We aimed to evaluate this association and we thought it was worthwhile to try to determine whether these components take some part in this complication.

METHODS

The study population consisted of 1,098 adults (364 patients and 734 volunteer blood donors as controls). Demographic features, comorbid illnesses, and use of aspirin/nonsteroidal anti-inflammatory drugs (NSAIDs) were recorded. Blood groups were examined by gel centrifugation method. We included only patients with bleeding from peptic ulcer disease and erosive gastropathy. Ulcers were classified by using Forrest's classification system in terms of rebleeding risk. Helicobacter pylori was examined by histology.

RESULTS

The gender distribution was similar in both groups. The ABO blood group phenotype distribution in patients and controls (respectively) was as follows: 46.2% versus 34.9% for group O, 32.4% versus 39.5% for group A, 15.7% versus 18.4% for group B, and 5.8% versus 7.2% for group AB. Blood group O was found to have higher frequency in the patient group than in the control group (P=0.004). Rh positivity was also higher in patients than in controls (P=0.007). H. pylori positivity was similar between blood groups among patients. The rebleeding and mortality rates between blood groups were also similar.

CONCLUSION

ABO blood group O had an important role in patients with upper gastrointestinal bleeding. The impact of blood group on rebleeding and mortality may be a focus for further studies.

ABH and Lewis antigen distributions in blood, saliva and gastric mucosa and H pylori infection in gastric ulcer patients

AIM: To investigate the ABH and Lewis antigen expression in erythrocytes, saliva and gastric epithelium, as well as the association between H pylori and the presence of gastric epithelial lesions.

METHODS: The distribution of ABH and Lewis blood group antigens in erythrocytes, saliva and gastric mucosa of H pylori-infected gastric ulcer patients was analyzed. Forty-two patients with gastric ulcer were studied, and fifty healthy individuals were used as control group. The blood group antigens were determined by direct hemagglutination, dot-ELISA and immunohistochemical methods in erythrocytes, saliva and gastric mucosa specimens, respectively. Diagnosis for H pylori infection was performed by conventional optical microscopy and ELISA.

RESULTS: A higher seroprevalence of IgG H pylori specific antibodies was observed in gastric ulcer patients (90%) compared to the control group (60%). We observed a significant increase of phenotypes O, A₂ and Lewis b in H pylori-infected patients. The expression of these antigens had progressive alterations in areas of ulcerous lesions and intestinal metaplasia.

CONCLUSION: ABH and Lewis blood group antigens are a good indicator for cellular alterations in the gastric epithelium.

ABO blood group, secretor status and detection of Helicobacter pylori among patients with gastric or duodenal ulcers

Patients (454) referred for gastroscopy to the General Hospital of Athens were examined to determine (1) if non-secretors were over-represented among patients with ulcers and (2) if there was an association with ABO blood group or secretor status and carriage of Helicobacter pylori. Compared with the local population, among patients with either gastric ulcer (51) or duodenal ulcer (96) there was a significant increase in the proportion of those who were blood group O (P less than 0.025); however, there were no significant differences in the proportions of non-secretors. H. pylori was identified in 62% of the 454 patients: 59.5% of those without evidence of ulcers; 62.5% of those with gastric ulcer; 88% of those with duodenal ulcer (P less than 0.0005). These bacteria were cultured more often and in higher numbers from patients with duodenal ulcer (P less than 0.025). There was no association between ABO blood group and prevalence of H. pylori. The prevalence of H. pylori among non-secretors with gastric ulcer (12.5%) was significantly lower than that for non-secretors with duodenal ulcer (100%) (P less than 0.0005). This was not observed for secretors.

Genetic factors in the population of Plati, Greece

One-thousand, thirty-eight individuals from Plati, Greece were examined for the following red cell antigens, serum proteins, and red cell enzymes A A1 Ai B H; MNSs Mg Henshaw Nya Mur Vw; CCwcDEeCe; K k Kpa Kpb Jsa Jsb; P1; Lua; Fy1 Fy2; Jka Jkb; Wra; Zt; Vel; Swa; Jensen, Radin, Gerbich, Diego, Gregory, Haptoglobin, Transferrin, Acid phosphatase, Adenylate kinase, Adenosine deaminase, Esterase-D, Glucose-6-phosphate dehydrogenase, Phosphoglucomutase, 6-Phosphogluconate dehydrogenase, Phosphohexose isomerase, Lactate dehydrogenase, Malate dehydrogenase, and Superoxide dismutase. The results are discussed in detail and compared with other Greek and neighbouring populations. Because of the Plati population's long history of residence in the Cappadocian area of Turkey the data have been compared, whenever possible, with results for that region.

Investigation of associations between ABO blood groups and coagulation, fibrinolysis, total lipids, cholesterol, and triglycerides

To investigate possible associations between ABO blood system and coagulability levels, fibrinolysis, total lipids, cholesterol, and triglycerides, the plasma and serum of 300 Rh-positive male blood donors were tested. The tests performed were: RT, PTT, K-PTT, PT, F.V, F.II, F.VII, Complex II, VII, and X, TGT, fibrinogen, HAE 0.2, HAE 0.5, ELT, LIP, Col.1, Col.2 and TRI. Analysis of the laboratory data shows a lower coagulability in O blood group individuals. This result was obtained in coagulation tests (RT, PTT, and K-PTT) specific for factor VIII level. In addition, a higher sensitivity to the in vitro heparin anticoagulant effect in O group individuals was confirmed. Nevertheless, these conclusions are specific for Negroids, the same effects not being observed in Caucasians. None of the other laboratory tests revealed any differences related to either blood group or race.

The later clinical course of haematemesis

A study was conducted on the natural history of haematemesis in patients with peptic ulcer and in those with negative radiological examination, the bleed having occurred at least 5 years previously; excluded were those who had undergone emergency or interim surgery.

No significant difference was found in the average severity of the bleed between the ulcer and non-ulcer groups, which were comparable in age-distributions.

Routine follow-up after the haemorrhage was discontinued following correction of the post-haemorrhagic anaemia; the present haematological status was found to be satisfactory in the very great majority and it appears that the acute bleed bears little if any relationship to the process of chronic blood loss.

Physical examination and liver function tests revealed no evidence of delayed hepatic damage ensuing as a consequence of transfusion.

Recurrent haemorrhages occurred in similar proportions in the ulcer and non-ulcer groups; they revealed no particular time interval or features of significant distinction from those of the initial bleed.

Persistence of dyspepsia showed no correlation with a bleeding tendency.

There is a preponderance of blood group O in the ulcer and non-ulcer bleeders.

The radiological presence of a peptic ulcer does not necessarily indicate that this is the source of the bleeding and it is suggested that the comparable features of the select group of ulcer cases of our series and the non-ulcer cases offer support to the view that the origin of the bleed in a fair proportion of instances is common to the two groups; the possibility of a derangement of the microvasculature as the operating mechanism is mooted.

Peptic ulcer in Central Scotland

This article concerns the social class incidence, duration of symptoms, age at onset of symptoms and the blood groups of patients who were found during 1962 at Stirling Royal Infirmary to have peptic ulcer. The ulcer was either proven radiologically or was found at laparotomy which was being carried out for perforation, severe haematemesis or some other reason.

A low incidence in males of both gastric and duodenal ulcers was found in Social Class 3 and an increase in incidence in Social Class 4. Gastric ulcer in males tends to occur later in life than duodenal ulcer and in females there is a striking increase in duodenal ulcer in the 40 to 49 decade of life. The hypothesis is advanced that this may be due to hormonal changes. A second hypothesis is advanced that ‘secretors’ of blood group genotype AA, BB, or AB are immune to duodenal ulcer.