ABO and Rhesus Blood Groups Distribution in Healthy Individuals: An Update Cross Sectional Study from Tertiary Care Center in Makkah City, Saudi Arabia

Ammar Khojah^1,2 and Talal Qadah^2*

^*Correspondence: Talal Qadah, Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia, Email:

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Introduction

The diversity of Red Blood Cells (RBCs) is based on their antigenic structures located on the extracellular surface of their membranes which are composed of glycoproteins and glycolipids. This feature has made scientists to classify the RBCs into different groups based on the reactions of these antigens to their counterpart antibodies which can be detected in vitro. Up to date, more than 350 genetically-different blood groups were described; however, the ABO and Rh blood group system has the most important significance in transfusion medicine [1,2]. Historically, the ABO blood group was discovered in 1900 by Landsteiner, while Rh blood group was discovered 40 years later. The antibodies of the ABO and Rh blood group system present in plasma of human individuals whose RBCs lack their antigens [3]. The importance of ABO and Rh group system is not limited to practice in blood transfusion only but it also has an impact in other clinical settings such as paternal assessment, forensic medicine and tissue transplant [4]. Blood group typing depends on the presence of specific antigen on the surface of RBC, where there are 30 different blood group antigens. Among these antigens, the most important and complex oligosaccharides antigens are A and B antigen. These two antigens are genetically controlled by three allelic genes, A, B and O, found on the long arm of chromosome 9q and produced as a result of glycosyltransferase enzymes that add specific sugars of conformation dependent epitopes [5].

Similarly, the genetic control of Rh blood group system is located in chromosome 1 and determined by Rh (D) gene which produces RhD protein and another gene encode for RhC and RhE proteins. Therefore, depending on the presence of these antigens and their ability to agglutinate RBCs, blood's individual can be categorized into four major groups A, B, AB and O with a sign of positive which indicates presence of Rh(D) antigen or negative for absence of Rh(D) [6]. Since this system has a major impact on successful of blood transfusion, more attention is carried out to ABO and Rh system as a routine computability test in transfusion medicine laboratories [7,8]. Management of blood stock and prediction of the need for a particular blood group in a particular period remains a challenge issue. The most important role of blood banks is to provide appropriate blood components that the patients need. Therefore, determination of ABO and Rh blood groups system distribution in various population is necessary along with its importance in blood transfusion to avoid mismatched transfusion reactions. Therefore, blood grouping takes the top priority among others routine works in blood centers. Previous studies on distribution of ABO and Rh grouping have revealed a wide variation in the distribution of this system based on genetic, racial differences, geographical location and socio-economic status [9,10]. This variation also occurs within particular country and between different cities. In major cities like Makkah, Saudi Arabia, the holy capital of Muslim world, it is essential to determine the common ABO and Rh blood group type to keep blood bank inventory effectively managed and operated. The main aim of the present study is to determine and update the prevalence of ABO and Rhesus blood group distribution patterns in a cohort of blood donors who visited Al-Noor tertiary hospital. We believe that having record for the common blood groups in different cities is important for effective supply of blood components during medical emergencies.

Materials and Methods

A total number of 5000 blood donor samples were recruited in the Blood Bank section of Alnoor Specialist Hospital, Makkah city. The study was approved as per the ethical approval letter no. (61147-2121436) and data was collected from January to September 2020. Blood samples included 4964 males and 36 females. ABO and Rh blood groups were determined by using the test tube method with blood group reagents: anti-A, anti-B, and anti-D (Mouse Monoclonal, Crescent Diagnostics). The data were analyzed using Excel 2010. Hemoglobin level measurement was performed based on Complete Blood Count picture using XN-1000™ Hematology Analyzer (Sysmex, Lincolnshire, USA). Estimation of allele frequencies of the ABO blood group was performed using S2 ABOestimator software freely available online (Pedro J.N., Silva, Lisbon, Portugal) [11]. Data analysis was done using Excel application to generate the descriptive statistics. P values with less than (0.05) were considered significant.

Results

The distribution of ABO and Rh blood group was determined in 5000 blood donors aged 16-69 years old comprising 99.28% (n= 4964) males and 0.72% (n=36) females during the period of January to September ,2020. The demographic characteristics is shown in Table 1 where majority of the donors were fallen under 26 – 30 years category followed by 31–35 years, 21–25 years with percentage distribution of 28.86%, 21.62% and 18.28% respectively. It is worth noting to mention that the older the age of donor the less willingness to donate. This typically happens after the age of 25 years. In respect of gender, males comprised the majority of blood donors with 99.28% (n=4964) while females represented a very minute proportion with 0.72% (n=36). In term of nationality, we found that 63.94% (n=3197) of the donors were Saudi and 36.06% (n=1803) non Saudi.

Table 1: Demographic characteristics of the participants.

The main aim of the present study was to determine the prevalence of ABO and Rh blood group system among the recruited donors. As shown in Table 2, we found that blood group O+ was the most common group among the investigated donors followed by A+, B+, Ab+, O-, A-, B- and AB-. They comprised 43.8% (n= 2190), 26.28% (1314%), 17.66% (n=883), 4.32% (n=216), 4.14% (n=207), 2.02% (n=101), 1.62% (n=81) and 0.16% (n=8) respectively.

Table 2: ABO-Rh blood groups distribution among the cohort study.

Makkah city is the holy capital city of Islamic world and thus multiethnic residents (non- Saudi) represent a significant population. The effect of nationality on distribution of ABO and Rh group system was investigated as shown in Table 3. More than third of the participants (36.08%) were Non-Saudi. The distribution of ABO and Rh blood group among Saudi and Non-Saudi showed similarity in the frequency ranking with a mild difference between blood groups O- and AB+. Blood group O+ showed a prominence frequency in compared to other groups. However, we run the t-test to investigate if nationality plays a significant role in the distribution of blood groups. Our result showed that there was no significant difference between Saudi and Non-Saudi cohorts as the p-value were found bigger (p value = 0.41) than the cut off value (0.05) and thus rejecting our Null hypothesis.

Table 3: ABO and Rh blood groups among Saudi and Non-Saudi residents.

Furthermore, our results showed a major predominance contribution of male donors (99.26%) than female donors (0.74%) as shown in Table 4. We run a comparison analysis through t-test to determine if the gender variable has a correlation with the blood group distribution and found out there was a significant difference between males and females as shown by the p-value.

Table 4: Distribution of blood donors according to the gender (n=5000).

To estimate the allele frequencies of the ABO blood group, we used the S2 ABOestimator software based on Bernstein method as displayed in Table 5. There was no significant difference between the ABO allele frequencies as determined by the p value.

Table 5: Allelic frequencies of ABO blood group.

Discussion

The ABO blood group antigens carry an important clinical significance since they are naturally present on the surface of RBC and can cause transfusion reaction. In transfusion medicine, the consequence of ABO blood group incompatibility between donors and recipients may lead death [12]. Frequency of ABO and Rh blood groups system among healthy individuals have been widely studied locally due to its impacts on health services. However, specific frequency determination of blood groups in major cities and regions is important for blood bank inventory and management [13]. The current study showed similar results to the previous works done on the distribution of ABO and Rh in different Saudi Arabia cities and regions [14- 27]. To further elucidate the small differences between our study with other previous works done on the distribution of ABO-Rh blood group system among other Saudi Arabian cities and regions, we summarized these differences in Table 6. The most common ABO blood group in all studies is O blood group with the highest prevalence found in Najran city comprising 69.47% [26] while the least O blood group found in Jeddah with 37.4% [19]. On the other hand, the rarest blood group in all studies was found to be AB with the lowest reported AB group in Najran city comprising 2.19% of the studied subjects [26]. In term of Rhesus blood group, it can be observed that Makkah city contained the highest percentage of positivity with 98% [21].

Previous studies showed that the distribution of ABO blood group in various countries depends upon geographic location, environment, and genetic factors [28,29]. For this reason, the comparison of ABO distribution in Saudi Arabia and other close countries does not show any difference. Similar to the result of ABO distribution in Saudi Arabia, the frequency of O blood group was found to be the highest blood group in Kuwait (44.6%) [30] and Bahrain (49.6%) [31]. However, blood group A showed the highest blood group prevalence in other countries such as Palestine (40%) [32] and Jordan (38.5%) [33]. This is probably due to the difference in geographical and ethnic background between gulf countries and other Arab countries. As can be seen in Table 6, our study showed that Rh-negative (7.94%) subjects were lower than Rh-positive (92.06%) which is in the same direction with other previous studies [14-27]. With this low percentage of Rhesus negativity, it is recommended to encourage and increase the recruitment of Rh-negative blood group donors to donate regularly. If such initiative doesn’t take place, there will be an increase in the burden of blood banks to manage the stock of Rh-negative Red Blood Cells units.

In term of blood donation recruitment, we found that most of the donors were within the age of 26–35 years comprising 50.48% of the studied subjects. Donors of less than 20 years and more than 50 years represent small portion with 7.2% only. The low percentage of donation in young adults (<20 years) may be caused by the vasovagal reactions that is observed in this particular age group as reported previously [34,35]. In addition, the low number of elderly donors (>50 years) might occur due to misinformation of the age limit for donation and blood donation guidelines in term of age-related eligibility [36,37]. Another factor determines the tendency to blood donation is the gender of the donor. Most studies showed that female participation in blood donation is significantly lower than male [38-41]. There are several factors play role in this low participation. Previous study found that there is a high risk of iron deficiency particularly among women, which make them not suitable for blood donation [42]. Other reasons are related to donation deferral including low hemoglobin levels, poor venous access, and higher frequency of vasovagal reactions [43]. In addition, some women claimed a difficulty of reaching blood bank due to transportation issue [41].

In conclusion, our results showed that O+ blood group is the prominent type followed by A+, B+, AB+, O-, A-, B- and AB-. Such study is important for analyzing population studies as well as blood donation services to keep blood bank inventory managed and operated in an effective manner.

Acknowledgements

None.

Conflict of Interest

The authors declare no conflicts of interest in this article.

Author's Contribution

AK: concept, design, data acquisition and analysis, statistical analysis, manuscript preparation. TQ: concept, design manuscript preparation, editing and manuscript review.

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