|Year : 2019 | Volume
| Issue : 1 | Page : 31-36
Frequencies of ABO and Rhesus (D) blood group phenotypes among pregnant women attending antenatal clinic at Murtala Muhammad Specialist Hospital, Kano, Nigeria
Isyaku Gwarzo Mukhtar, Aisha Yakubu Abdulkadir
Department of Human Physiology, Faculty of Basic Medical Sciences, Bayero University, Kano, Nigeria
|Date of Web Publication||31-Jul-2019|
Isyaku Gwarzo Mukhtar
Department of Human Physiology, Faculty of Basic Medical Sciences, Bayero University, Kano
Source of Support: None, Conflict of Interest: None
Background: Pregnancy, though a physiological phenomenon, is sometimes associated with complications requiring blood transfusion. Effective and safe blood transfusion services require a working database of the frequencies and distribution of ABO and Rhesus (Rh) (D) blood groups. Aim: The aim of this study was to determine the frequencies and distribution of ABO and Rh (D) blood groups among pregnant women attending antenatal clinic at Murtala Muhammad Specialist Hospital, Kano, Nigeria. Materials and Methods: A total of 210 pregnant women who presented to the booking section of the clinic were recruited for the study. Sociodemographic information of the patients was obtained using a semistructured interviewer-administered questionnaire. ABO and Rh (D) blood groups were determined by the agglutination method using potent monoclonal anti-A, anti-B, and anti-D reagents. Results: Blood groups O, B, A, and AB accounted for 98 (46.7%), 53 (25.2%), 45 (21.4%), and 14 (6.7%), respectively. Rh (D) positivity was 202 (96.2%) whereas Rh (D) negativity was 8 (3.8%). Conclusion: ABO phenotype O blood group is the most common among pregnant women in this environment with the majority being Rh (D) positive.
Keywords: ABO and Rh D, blood groups, Kano, Nigeria, pregnant women
|How to cite this article:|
Mukhtar IG, Abdulkadir AY. Frequencies of ABO and Rhesus (D) blood group phenotypes among pregnant women attending antenatal clinic at Murtala Muhammad Specialist Hospital, Kano, Nigeria. J Med Trop 2019;21:31-6
|How to cite this URL:|
Mukhtar IG, Abdulkadir AY. Frequencies of ABO and Rhesus (D) blood group phenotypes among pregnant women attending antenatal clinic at Murtala Muhammad Specialist Hospital, Kano, Nigeria. J Med Trop [serial online] 2019 [cited 2019 Aug 20];21:31-6. Available from: http://www.jmedtropics.org/text.asp?2019/21/1/31/263748
| Introduction|| |
The ABO and Rhesus (Rh) blood group systems are determined by the presence or absence of antigens located on the membrane of red blood cells.,, These antigenic materials are also found on other tissues, fluids, and vascular structures apart from membranes of red cells. Clinically, they constitute the most important sources of transfusion-related incompatibility reactions. Although some cases of transfusion reactions are mild, resolving with appropriate treatment, others are rapid and often fatal. Together with transfusion transmissible infections, ABO and Rh incompatibility reactions continue to be important causes of morbidity and mortality in public health institutions., Hemolytic disease of the newborn, a severe disease resulting from exposure of Rh (D)-positive fetus to maternal antibodies against Rh (D) antigen, is clinically the most important transfusion-related reaction involving incompatible Rh (D) blood especially in African continent.
Pregnancy, though a physiological phenomenon, is sometimes associated with complications requiring blood transfusion. Cesarean delivery due to obstetric hemorrhages, hypertensive disorders of pregnancies, anemia in pregnancy, and miscarriages all increase the demand for blood and blood products during pregnancy, delivery, and lactation.,
Africa, and indeed Nigeria, has one of the highest maternal mortality rates in the world., A number of the common causes of this high maternal death require blood transfusion as a form of emergency care. Therefore, any preventive strategy aimed at reducing maternal death may require prompt safe blood transfusion services. Planning for such safe and prompt transfusion services in our environment like in others will undoubtedly require a baseline data of the frequencies and distribution of ABO and Rh (D) blood group systems.
To our knowledge, distribution of ABO and Rh (D) blood group systems among pregnant women in this environment has not received the needed attention it deserves and hence the current study. The aim of the study was to determine the frequency and distribution of ABO and Rh blood groups among pregnant women attending antenatal clinic of Murtala Muhammad Specialist Hospital, Kano, Nigeria.
| Materials and methods|| |
The study was conducted at the antenatal clinic of Murtala Muhammad Specialist Hospital between July and August 2018. Murtala Muhammed Specialist Hospital is a secondary health facility located in the city of Kano, north-west Nigeria. It is owned by the State Government and serves as a referral center within and outside the State. Kano State is one of the 36 States of Federal Republic of Nigeria, consisting of 44 local government areas.
With a 12-ward 648-bed capacity, the hospital was established in 1928 by the then British colonial Government to provide healthcare to its workers and those of native authority. The hospital mainly provides curative care in the fields of internal medicine, surgery (general, orthopedic, and maxillofacial), pediatrics, obstetrics and gynecology, and laboratory medicine.
The antenatal clinic is run from Monday to Thursday every week with Mondays and Tuesdays reserved for booking.
Ethical approval was obtained from Kano State Ministry of Health, and administrative approval was obtained from the management of Murtala Muhammad Specialist Hospital; all participants were requested to sign an individual informed consent form before commencement of the study. Helsinki declaration of 1975, as revised in 2000, was adhered to.
A total of 210 consecutive consenting pregnant women who presented themselves for booking at the antenatal clinic during the study period were recruited into the study.
Study design and sampling technique
This was a descriptive cross-sectional study. Convenience sampling technique was used to recruit patients into the study.
All pregnant women who presented themselves at the clinic for booking during the study period and provided consent were recruited for the study.
Pregnant women who declined consent to participate in the study and those with clinical and/or laboratory evidence of hypertensive disorders of pregnancy were excluded from the study.
A semistructured interviewer-administered questionnaire was used to obtain sociodemographic information of the patients.
ABO and Rh (D) blood groups were determined by the tile agglutination method using potent monoclonal anti-A, anti-B, and anti-D reagents (Plasmatec laboratories ltd., Bridport, UK).
Data were analyzed using Statistical Package for Social Scientists version 23.0 (IBM SPSS Statistics for Windows, Version 23.0; IBM Corp., Armonk, NY, USA; 2015). Results were expressed as mean ± standard deviation, frequencies, and percentages.
| Results|| |
Sociodemographic characteristics of the patients
A total of 210 pregnant women were recruited into the study. The mean age of the patients was 25.90 ± 6.37 years whereas their mean gestational age was 29.06 ± 4.25 years.
Majority of the patients (99.0%) were Hausa-Fulani. A larger proportion of the patients had at least primary education. Similarly, a considerable number were full-time housewives [Table 1].
Frequencies of ABO blood group
O blood group accounted for (46.7%) followed by group B (25.2%), group A (21.45%), and group AB (6.7%), respectively [Figure 1].
Frequencies of Rh (D) blood group
Over 90% of our patients (96.2%) were Rh (D)-positive whereas a few (3.8%) were negative [Figure 2].
| Discussion|| |
This study reported phenotype O blood group as the most common ABO blood group among pregnant women in this environment followed by B, A, and AB, respectively. This is similar to what was reported in a previous study among prospective blood donors in the same environment. In another series, Chima et al. reported similar pattern among blood donors at a tertiary hospital in the state. In general, this pattern confirmed the findings of most researchers from north-west Nigeria.,
Frequencies of ABO blood group phenotypes are, however, not uniform across the six geopolitical zones of Nigeria. Although the most common type in all the zones is O and the least common is AB, there are regional and perhaps ethnic differences in the frequencies of A and B. In a systematic review of various works from the six geopolitical zones of the country, Anifowoshe et al. reported a pooled pattern of O > A > B > AB. However, they noted a regional variation in the above pattern in the south-west, south-east, south-south, north-central, and some parts of north-east Nigeria. Despite O > A > B > AB pattern documented in publications from north-eastern parts of Nigeria, Babadoko et al. reported a pattern that is similar to that of this study from north-east.
Variations in frequencies and distribution of ABO blood groups is not limited to the various regions of Nigeria. There have been reported variations between and within African countries. Although researchers from Madagascar and Guinea reported frequencies and pattern similar to that of this study, those from Ethiopia, Cameroun, Tunisia, Mauritania, and Morocco reported type A blood group to be the next most frequent group after O. However, despite these variations, type O is the most common group in Africa.
Dewan reported wide variations in the frequencies and allelic distribution of ABO blood groups among five major ethnic nationalities of southern Bangladesh. Although Bengali ethnic nationality had pattern and distribution similar to what is reported from this study, those of Tripura had type A blood group as the most common followed by B, AB, and O, in that order. The other three ethnic nationalities had type O as the most common group followed by B, A, and AB. In their analysis of over 3 million blood donors from different ethnic backgrounds across five centers, Garraty et al. noted wide variations in the frequencies of ABO blood group among different ethnic and racial groups in the United States. Despite these variations, they reported a pooled pattern in the order of O > A > B > AB. Similar variations were also reported among different ethnic groups in China with A > O > B > AB being the main pattern.
Human ABO blood group is generally determined by the presence or absence of complex carbohydrates that are usually located not only on the membranes of red blood cells but also on other body fluids and tissues.,, These carbohydrates serve as inherited antigenic materials that are passed from generation to generation. ABO blood group is one out of the over 34 different blood group systems known to mankind; it is made up of three antigens − A, B, and H (ABH antigens). Individuals with type O blood group have antigen H whereas those with types A and B have antigens A and B, respectively.
Apart from its traditional role in transfusion medicine, ABO blood group has become a subject of intense research interest due to association with various disease conditions. The wide variations in the frequencies of various ABO blood types from one region to another and from one ethnic nationality to another could have evolved as a natural selection phenomenon due to varied exposure to different disease conditions.
Type O blood group has been associated with protection against severe Plasmodium falciparum malarial infection as opposed to type AB blood group individuals that are said to be most susceptible to the infection. This could explain the dominance of type O blood group in this environment and indeed Nigeria and other tropical countries that are malaria endemic. One mechanism developed to explain this phenomenon is the reduction and disruption of P. falciparum rosettes formation, a virulence factor that causes microvascular obstruction among other things, in type O blood group individuals. In contrast, type O blood group is reported to be associated with susceptibility to cholera by certain strains of Vibrio cholerae and to diarrheal disease due to Norwalk virus infection. This may probably explain the common cholera outbreaks in the tropical and developing countries where type O blood group is very common. However, despite the link associating type O blood group to Norwalk virus infection, Taylor et al. reported no significant difference in the seroprevalence of Norwalk virus immunoglobulin between European and African ethnic groups in South Africa.
Type B blood group has been reported to be protective against cholera infection. It has also been reported to be protective against hemolytic uremic syndrome from infection by certain strains of Escherichia More Details coli. The relatively higher frequency of this type of blood group in north-western part of Nigeria compared to other regions could be an evolutionary adaptive response to these infections.
Majority of the participants in this study are Rh (D) positive concurring with reports from different parts of the world.,,,,,,,,,,,
Unlike ABH antibodies that are preformed, anti-Rh (D) antibodies are only produced after prior exposure. Therefore, Rh (D)-negative pregnant women carrying Rh (D)-positive fetuses for the first time may have normal babies. However, subsequent pregnancies with Rh (D)-positive fetuses may result in severe hemolytic disease of the newborn.
| Conclusion|| |
Type O blood group is the most common ABO blood group among pregnant women in this environment followed by B, A, and AB. Red blood cell Rh (D) antigen is also very common among our pregnant women.
The authors acknowledge the management and staff of Murtala Muhammad Specialist Hospital, especially staff of the antenatal clinic and maternity blood bank unit, for their support. They also thank all the pregnant women who provided their consent to participate in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Franchini M, Maria GM. ABO blood group: old dogma, new perspective. Clin Chem Lab Med 2013;51:1545-53.
Storry JR, Olsson MI. The ABO blood group system revisited: a review and update. Immunohematology 2009;25:48-9.
Avent ND, Reid ME. The Rh blood group system: a review. Blood 2000;95:375-87.
Daniel-Johnson J, Leitman S, Klein H, Alter H, Lee-Stroka A, Scheinberg P et al.
Probiotic-associated high-titre anti-B in a group A platelet donor as a cause of severe haemolytic transfusion reactions. Transfusion 2008;48S(Suppl 2):260A.
Issitt PD, Anstee DJ. Applied Blood Group Serology. 4th ed. Miami: Montgomery Scientific Publications; 1998.
Sazama K. Reports of 355 transfusion-associated deaths: 1976 through 1985. Transfusion 1990;30:583-90.
Stainsby D, Jones H, Asher D, Atterbury C, Boncinelli A, Brant L et al.
Serious hazards of transfusion: a decade of haemovigilance in the UK. Transfus Med Rev 2006;20:273-82.
Erhabor O, Adamu KS, Yakubu A, Shehu CE, Hassan M, Singh S. Rh (D) phenotype among pregnant women in Sokoto,North Western Nigeria. Implications on haemolytic disease of the new-born and haemolytic transfusion reaction. Health Sci Res 2014;1:19-24.
Ibrahim UN, Garba N, Tilde IM. Acute blood transfusion reactions in pregnancy: an observation study from north eastern Nigeria. J Blood Disorders Transfus 2013;4:145-8.
Akinlusi FM, Rabiu KA, Durojaiye IA, Adewunmi AA, Ottun TA, Oshodi YA. Caesarean delivery-related blood transfusion: correlates in a tertiary hospital in Southwest Nigeria. BMC pregnancy and Childbirth 2018;18:1-9.
Akintola OI, Fabamwo AO, Tayo AO, Rabiu KA, Oshodi YA, Onyekwere CA. Evaluation of blood reservation and use for caesarean sections in a tertiary maternity unit in south western Nigeria. BMC pregnancy and Childbirth 2010;10:57-63.
Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A et al.
Global, regional, and national levels and trends in maternal mortality between1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Inter-Agency Group. Lancet 2016;387:462-4.
Say L, Chou D, Gemmill A, Tunҫalp Ӧ, Moller AB, Daniels JD et al.
Global causes of maternal death: a WHO systematic analysis. Lancet 2009;374:881-2.
International Business Machines Corporation. IBM SPSS Statistics for Windows Version 23.0. Armonk, NY: IBM Corp; 2015.
Mukhtar IG, Muhammad SM, Yakasai BW, Salisu IA. ABO and Rh blood group phenotypes of Nigerian blood donors at Murtala Muhammad specialist hospital,Kano − a one year retrospective study. Bayero J Med Lab Sci 2018;3:48-53.
Chima OK, Mohammed TB, Aisha K, Alhaji SA, Muhammad BM, Kwaru AH. ABO and rhesus blood groups among blood donors in Kano,North-Western Nigeria. Niger J Basic Clin Sci 2012;9:11–3. [Full text]
Hassan A, Babadoko AA, Ahmed AJ, Isa HA, Suleiman AM. The pattern of distribution of ABO blood groups in North Western Nigeria. Ann Niger Med 2005;1:17-8.
Erhabor O, Isaac IZ, Saidu A, Ahmed HM, Abdulrahaman Y, Festus A et al.
The Distribution of ABO and Rhesus blood groups among residents of Gusau, Zamfara State, North Western Nigeria. Res Rev J Med Health Sci 2013;2:58-63.
Anifowoshe AT, Owolodun OA, Akinseye KM, Iyiola OA, Oyeyemi BF. Gene frequencies of ABO and Rh blood group in Nigeria: a review. Egypt J Med Hum Genet 2015;18:205-10.
Babadoko AA, Takai IU, Kawuwa MB. Distribution of ABO,Rh D blood groups and haemoglobin phenotypes among antenatal attendees in Federal Medical Centre Nguru, Nigeria. Borno Med J 2014;1:86-91.
Randriamanantany ZA, Rajaonatahina DH, Razafimanantsoa FE, Rasamindrakotroka MT, Andriamahenina R, Rasoarilalamanarivo FB et al.
Phenotypic and allelic profile of ABO and Rhésus D blood group system among blood donor in Antananarivo. Int J Immunogenet 2012;39:477-9.
Loua A, Lamah MR, Haba NY, Camara M. Frequency of blood groups ABO and Rhesus D in the Guinean population. Transfus Clin Biol 2007;14:435-9.
Tesfaye K, Petros Y, Andargie M. Frequency distribution of ABO and Rh (D) blood group alleles in Silte Zone,Ethiopia. Egypt J Med Hum Genet 2015;16:71-6.
Ndoula ST, Noubiap JJN, Nansseu JRN, Wonkam A. Phenotypic and allelic distribution of the ABO and Rhesus (D) blood groups in the Cameroonian population. Int J Immunogenet 2014;41:206-10.
Said N, BenAhmed F, Doghri A, Ghazouani E, Layouni S, Gritli N et al.
The ABO system polymorphism in Tunisian blood donors. Transfus Clin Biol 2003;10:331-4.
Hamed CT, Bollahi MA, Abdelhamid I, Mahmoud M, Ba B, Ghaber S et al.
Frequencies and ethnic distribution of ABO and Rh (D) blood groups in Mauritania: results of first nationwide study. Int J Immunogenet 2012;39:151-4.
Benahadi A, Alami R, Boulahdid S, Adouani B, Laouina A, Mokhtari A et al.
Distribution of ABO and Rhesus D blood antigens in Morocco. Int J Biol Anthropol 2013;6:1-10.
Dewan G. Comparative frequencies and allelic distribution of ABO and Rh (D) blood groups of five major tribal communities of southern Bangladesh with general population and their determinants. Egypt J Med Hum Genet 2015;16:141-7.
Garraty G, Glynn SA, McEntire R. ABO and Rh (D) phenotype frequencies of different racial/ethnic groups in the United State. Transfusion 2004;44:703-6.
Liu J, Zhang S, Wang Q, Shen H, Zhang Y, Liu M et al.
Frequencies and ethnic distribution of ABO and Rh blood groups in China: a population-based cross-sectional study. BMJ Open 2017;7:e018476.
Reid ME, Lomas-Francis C, Olsson ML. Blood antigen FactsBook. 3rd ed. Waltham, MA: Academy Press; 2012.
Anstee DJ. The relationship between blood groups and disease. Blood 2010;115:4635-43.
Pathirana SL, Alles HK, Bandara S, Phone-Kyaw M, Perera MK, Wickremasinghe AR et al.
ABO-blood-group types and protection against severe,Plasmodium falciparum malaria. Ann Trop Med Parasitol 2005;99:119-24.
Rowe JA, Handel IG, Thera MA, Deans AM, Lyke KE, Kone A et al.
Blood group O protects against severe Plasmodium falciparum malaria through the mechanism of reduced resetting. PNAS 2007;104:17471-6.
Glass RI, Holmgren J, Haley CE, Khan MR, Svennerholm AM, Stoll BJ et al.
Predisposition for cholera of individuals with O blood group.Possible evolutionary significance. Am J Epidemiol 1985;121:791-6.
Hutson AM, Atmar RL, Graham DY, Estes MK. Norwalk virus infection and disease is associated with ABO histo-blood group type. J Infect Dis 2002;185:1335-7.
Taylor MB, Parker S, Grabow WO, Cubitt WD. An epidemiological investigation of Norwalk virus infection in South Africa. Epidemiol Infect 1996;116:203-6.
Shimazu T, Shimaoka M, Sugimoto H, Taenaka N, Hasegawa T. Does blood type B protect against haemolytic uraemic syndrome? An analysis of the 1996 Sakai outbreak of Escherichia coli
O157:H7 (VTEC O157) infection. The Osaka HUS critical care study group. J Infect 2000;41:45-9.
[Figure 1], [Figure 2]