THE ASSOCIATION BETWEEN HEPATITIS B VIRUS INFECTION WITH ABO AND RHD BLOOD GROUPS

Sadeq Kaid Mohammed Al-Mohani1image, Ebraheem Ali Ahmed Al-Nawd2image 

1Dean of Faculty of Medical Laboratories, Jiblah University for Medical and Health Sciences, Ibb Governorate, Yemen.

2Division of Clinical Biochemistry, Department of Chemistry, Faculty of Medical Laboratories Sciences, Jiblah University for Medical and Health Sciences, Ibb Governorate, Yemen.

 

Abstract

Background: ABO and Rh blood types are associated with a higher risk of disease and are essential for clinical practice and blood transfusion safety. The findings of earlier research on the relationship between blood types and HBV infection are still up for debate. There is no study conducted on the study population to reveal the relationship between ABO and RhD blood groups and infection with hepatitis B virus.

Aims: This study aimed to identify the relationship between blood types and hepatitis B virus infection in blood donors at Jiblah University Hospital in Jiblah town, Yemen 

Methods:  A hospital-based cross-sectional study was conducted. Venous blood samples were drawn from 120 blood donors and tested for hepatitis B core antigen (anti-HBc) using commercial kits (Roche Diagnostics GmbH, United Kingdom). ABO and Rh blood groups were determined by the cell pooling method. The results were analyzed using SPSS v.20.

Results: This study reported that the most frequent blood types were O positive and A positive 57 (47.5%) and 28 (23.3%) respectively, followed by B positive 14 (11.67%) and O negative 13 (10.83%). The overall phenotypic frequencies of ABO and RhD blood groups were O+>A+>B+>O->A->AB+>B->AB-. The prevalence of hepatitis B virus was 12 (10%). No statistical association was detected between ABO and RhD blood groups and hepatitis B infection.

Conclusions: High prevalence rates of hepatitis B virus infection among blood donors were identified in this study. There was no statistical association between ABO and RhD blood groups and hepatitis B infection.

Keywords: Blood group, Hepatitis B infection, Jiblah, RhD, Yemen. 

 

INTRODUCTION

 

Blood donation has a critical role in almost every area of clinical practice1,2. Although blood donation is important for a safe life, there are many blood-borne diseases that can be transmitted by healthy blood donors in both developed and developing countries3. The World Health Organization (WHO) recommends that all blood donors should be tested for blood-borne diseases, such as hepatitis B infection, hepatitis C infection, HIV, and syphilis4. HBV infection remains a major concern in blood transfusion practice5. Hepatitis B virus infection is a global public health concern and is the tenth leading cause of death in the world, with 1.2 million deaths annually4,6,7.About 1.5 million people were newly infected with HBV8. Different ABO-Rh blood group systems in humans play an important role in saving human life9. Blood antigens are important ligands and receptors or co-receptors for bacteria, viruses and parasites1,10,11. In recent years, many studies have been conducted and found a link between ABO blood types and chronic infections such as diabetes mellitus type 212, several malignancies, such as gastric cancer and pancreatic cancer1, infectious diseases, such as cholera and dengue fever12 and blood-borne illnesses, such as viral hepatitis13.

In previous studies, ABO blood types have been documented as a risk factor for infection with HBV and HCV13,14. Hroob AMA et al., revealed a association between HBV and blood group O, but no relationship between blood types and HCV was reported10. Lao et al., reported that HBV prevalence was higher in blood group O (10.2%), but lower in blood AB (9.1%), group B (9.6%)15. In a study carried out in Tehran, Iran, it was reported that the rate of infection with HBV was lower in donors with blood type O16. Various reports indicate the importance of ABO and Rh antigens in individual susceptibility to HBV infection9.

Yemen is a developing country and has been suffering from political conflict since 2015. Several studies carried out in Yemen revealed that frequency of HBV among general population varies from the intermediate (2–8%) to high endemicity (>8% infection rate)17. In 2022, a study carried out in the city of Jiblah, Yemen, showed that the incidence of HBsAg was 3.33%8. Regarding the recurrence of HBV infection among blood donors, several studies were conducted in Hodeidah, Jiblah, Aden, and Sana'a reported that HBV represents a major public health problem among blood donors and that the infection rate of HBV ranges from 2.1% to 6.56%. From these findings, HBV infection remains a major health problem in Yemen. O+ blood type is the dominant type in Yemen18. To date, the frequency of HBV and the prevalence of ABO and RhD blood groups in the study have not yet been studied. Therefore, the current study aims to identify the relationship between blood types and HBV infection among blood donors at Jiblah University Hospital in the city of Jiblah, Yemen.

 

MATERIALS AND METHODS

 

This cross sectional study was performed among blood donors attending the blood bank, Jiblah University Hospital in Jiblah town, Yemen. A convenience sample of blood donors was included in the study. All ethical considerations (reference number 80-9/2023) were considered, and confidentiality was maintained. Ethical and institutional approval for the study was obtained from Jiblah University for Medical and Health sciences. All required data for the target population including socio-economic data were collected using a structured questionnaire. Blood samples were obtained from all eligible donors and tested for the presence of HBV. Hepatitis B infection was diagnosed by the detection of total antibody to hepatitis B core antigen (anti-HBc) by using commercial kits (Roche Diagnostics GmbH, UK). The ABO and Rh  blood type was determined by cell grouping method. Rh-negative blood groups were confirmed by the antiglobulin technique. 

Statistical Analysis

SPSS (version 20) was used to analyze the collected data. Chi-square test was used to find the significance of the probability level. A p value <0.05 was considered statistically significant.

 

RESULTS

 

This study was conducted on 120 blood donors who attended to the blood bank at Jiblah University Hospital in Jiblah town, Yemen. All participants in this study were males 120 (100%). Among all participants, 12 (10%) tested positive for HBV as shown in Figure 1. The prevalence of anti-HBc decreased with age, from 11.90% in the age group of 19–28 years to 10% in the age group >48 years. The difference was not statistically significant (p<0.986). The difference between HBV infection and previous donation was found to be statistically significant (p< 0.045). In this study, no statistical association was detected between HBV infection and marital status, education level, monthly income, occupation, shaving tools and HBV knowledge (Table 1). The most common blood type in the current study was O 69 (57.5%) and the least common was AB 3 (2.5). The frequency of ABO blood groups among subjects was O>A>B>AB. However, Rh blood types distribution in this study showed that 85.0% of donors were Rh positive (Table 2). The overall phenotypic pattern of ABO and RhD blood types were O+>A+>B+>O->A->AB+>B->AB. This finding shows the order of blood types frequency in the current study. Based on the analyzed data which are shown in the Table 3, there was no significant association between ABO and RhD blood types and HBV infection (p<0.678) (p <0.209), respectively. The seroprevalence rate of HBV infection investigated in the present study based on the blood group and Rh factor of donors are indicated in (Table 3). O+, A+, and B+ were the most widespread blood groups among the people with positive HBV. Moreover, AB+, O-, A-, B-, and AB- were the least prevalent blood groups among people with positive HBV. No significant association was found between ABO and Rh blood systems and HBV infection (p<0.826).

 

DISCUSSION

 

Viral hepatitis is a major health problem with huge health and economic burdens on countries19. Globally, hepatitis B virus and hepatitis C virus represent a major public health burden, especially in developing countries. During 2019, WHO estimated that 296 million people worldwide were infected with HBV. HBV infection is usually transmitted through direct blood contact, blood and blood product transfusions, intravenous injections, and unprotected sex6.

Transfusion of blood and blood products is a risk factor for infection with hepatitis HBV. Therefore, WHO has recommended routine serological testing for transfusion-transmitted infections (TTIs) including HBV to reduce transmission of this infection20.The prevalence of HBV varies from country to country. The differences may be due to geographical and socioeconomic differences as well as the use of more than one marker such as HBsAg, anti-HBc and HBV DNA, which have been used in previous studies, may contribute to this difference21. The present study aims to determine the frequency of HBV infection among people who attend Jiblah University Hospital in Jiblah Town, Yemen, to donate blood. The seroprevalence of anti-HBc was 12 (10%). The results of this study reports that the prevalence of HBV was higher compared to findings previously detected in Yemen, which ranged from 2.1% to 6.7%21. Differences between these studies can be attributed to behavioral, environmental and host factors as well as differences in the selection of participants. Furthermore, the use of more than one marker such as HBsAg, anti-HBc and HBV DNA, which have been used in the previous studies, may contribute to these variations. The frequency of ABO blood groups among study subjects was O 69 (57.5%), A 33 (27.5%), B 15 (12.5%) and AB 3 (2.5%). A similar pattern has been reported by different studies carried out in different regions in Yemen such as Ibb, Sana'a and Dhamar18. The results of the present study were similar to studies conducted in Saudi Arabia and in different African and European countries22. The results of this study reported that the most prevalent Rh blood type was Rh positive 102 (85%) and the least prevalent Rh blood type was Rh negative 18 (15%). The results of studies conducted in the Arabian Peninsula were similar to the results of this study22.

Globally, many studies have attempted to explain the relationship between ABO blood groups and Rh types and transmissions of infection. A previous study conducted in Iran showed that O+ blood group is the most common blood group associated with blood-borne infections. While this study indicated that there is no statistical relationship between HBV infection and blood type.  The results of studies conducted in Yemen, Iraq, Saudi Arabia10, Iran and Nigeria are consistent with the results of this study7,17-22. On the other hand, some studies reported that blood types B and AB were the most common among people infected with HBV23. While, a study conducted in Iraq revealed that infection with HBV was statistically related to the blood type of donors; HBsAg was found to be higher in donors with blood group O and lower in donors with blood group AB, while the frequency of RhD in HBV infected donors was higher among rhesus-positive donors7. In research conducted in Peshawar, Pakistan, it was indicated that HBV infection was more prevalent among people with blood type A22. However, a study in India reported that AB negative blood group was the most common blood group associated with HB infection24.

Limitations of the study

This study had several limitations, the sample size and study period are small, which makes generalization based on the observed outcome difficult and does not accurately reflect the prevalence of HBV infection among participants.

 

CONCLUSIONS 

 

The seroprevalence of 12 (10%) HBV patients was high according to the WHO classification. Previous donation has been identified as a modifiable risk factor for HCV infection. O+, A+, and B+ blood types were more common among participants with HBV infection. However, this study reported no significant association between the ABO and Rh blood systems and HBV infection. This study advises that further studies be conducted over a longer period and of a larger size to determine whether there is a real association between ABO blood groups and the RhD factor with hepatitis B virus infection in Yemen.

 

ACKNOWLEDGEMENTS

 

Authors would like to thank Dr. Mohammed Abduh Khoshafah for his cooperation in linguistic review of the article. Also our thanks to Miss Ahalam Alsaber and Mr Wheeb Alshikh for their cooperation in collecting research data.

 

AUTHOR'S CONTRIBUTION

 

Al-Mohani SKM:  collection of samples, writing original draft, methodology, investigation. Al-Nawd EAA: formal analysis and  conceptualization. All authors read and approved the final manuscript.

 

DATA AVAILABILITY

 

Data will be made available on reasonable request.

 

CONFLICT OF INTEREST 

 

No conflict of interest is associated with this work.

 

REFERENCES

 

  1. Tyagi S, Tyagi A. Possible correlation of transfusion transmitted diseases with Rh type and ABO blood group system. J Clin Diagn Res 2013;7(9):1930-1931.http://doi:10.7860/JCDR/2013/6002.3360
  1. Siraj N, Achila OO, Issac J, et al. Seroprevalence of transfusion-transmissible infections among blood donors at National Blood Transfusion Service, Eritrea: A seven-year retrospective study. BMC Infect Dis 2018; 18: 264.https://doi.org/10.1186/s12879-018-3174-x
  1. Ahmed R, Fatima M, Ashfaq J, et al. Frequency of Hepatitis B, C, and human immunodeficiency virus in blood donors. Cureus 2022;14(6):e25978. Published 2022 Jun 15. http://doi10.7759/cureus.25978 
  2. Kasraian L, Imanieh MH, Tabrizi R, Shahriarirad R, Erfani A, Hosseini S. Prevalence of HBV and HCV infections in iranian blood donors: An updated systematic review and meta-analysis. Middle East J Dig Dis 2021 Jul;13(3):237-252. http://doi:10.34172/mejdd.2021.231
  3. Alzahrani FM, Muzaheed, Shaikh SS, Alomar AI, Acharya S, Elhadi N. Prevalence of Hepatitis B Virus (HBV) among blood donors in Eastern Saudi Arabia: Results from a five-year retrospective study of HBV Seromarkers. Ann Lab Med 2019;39(1):81-85.http://doi:10.3343/alm.2019.39.1.81
  1. Martyn E, Eisen S, Longley N, et al. The forgotten people: Hepatitis B virus (HBV) infection as a priority for the inclusion health agenda. Elife. 2023;12:e81070. Published 2023 Feb 9. http://doi:10.7554/eLife.81070
  2. Burns GS, Thompson AJ. Viral hepatitis B: Clinical and epidemiological characteristics. Cold Spring Harb Perspect Med. 2014;4(12):a024935. Published 2014 Oct 30. http://doi:10.1101/cshperspect.a024935
  3. Al-Mohani SK. Seroepidemiology and risk factors of Hepatitis B virus in Jiblah town, Yemen. Universal J Pharm Res 2022; 8(2):67-70.https://doi.org/10.22270/ujpr.v8i2.928
  1. Oladeinde BH, Olaniyan MF, Muhibi MA, et al. Association between ABO and RH blood groups and Hepatitis B virus infection among young Nigerian adults. J Prev Med Hyg 2022 Apr 26;63(1):E109-E114.http://doi:10.15167/2421-4248/jpmh2022.63.1.1967  
  1. Hroob AMA, Saghir SAM, Almaiman AA, et al. Prevalence and association of transfusion transmitted infections with ABO and Rh Blood groups among blood donors at the National Blood Bank, Amman, Jordan. Medicina (Kaunas) 2020; 56(12):701.http://doi:10.3390/medicina56120701
  1. İsmail NH, Bülent D, Sibel B, Turan A. Evaluation of the relationship between ABO/rh blood groups and severity of liver fibrosis in patients with chronic Hepatitis B. Viral Hepat J.2016 Apr;22(1):23-27.http://doi:10.4274/vhd.49368
  1. Kavi Manasa, Gurudutta Pattnaik, Y. Madhusudan Rao, et al. Evaluation of ABO blood groups system with infection to Hepatitis C Virus: A tertiary hospital study in India, 14 December 2023, PREPRINT (Version 1) available at Research Square.https://doi.org/10.21203/rs.3.rs-3745800/v1
  1. Wang DS, Chen DL, Ren C, et al. ABO blood group, hepatitis B viral infection and risk of pancreatic cancer. Int J Cancer 2012;131(2):461-468.https://doi:10.1002/ijc.26376
  1. Behal R, Jain R, Behal KK, Dhole TN. Variation in the host ABO blood group may be associated with susceptibility to hepatitis C virus infection. Epidemiol Infect 2010, 138:1096-1099.https://doi:10.1017/S095026880999111
  1. Lao TT, Sahota DS, Chung MK, Cheung TK, Cheng YK, Leung TY. Maternal ABO and rhesus blood group phenotypes and hepatitis B surface antigen carriage. J Viral Hepat 2014;21(11):818-823.https://doi:10.1111/jvh.12219
  1. Mohammadali F, Pourfathollah A. Association of ABO and Rh blood groups to blood-borne infections among blood donors in Tehran-Iran. Iran J Public Health 2014, 43:981-9.
  2. Alzubiery TKA, Alhazari T, Alcantara JC, Majed SA, Bazaid AS, Aldarhami A. Updated seroprevalence of Hepatitis B surface antigen and anti-hepatitis core antibody among blood donors in Yemen. Infect Drug Resist 2022;15:2787-2796.https://doi:10.2147/IDR.S357819
  1. Almohani SKM, Al-Nawd EAA. Distribution of ABO and RH blood groups among blood donors in Jiblah university hospital in IBB province, Yemen. J Traditional Med Applications 2024;3:01-07.https://doi:10.33140/JTMA.03.01.01
  1. Bhadoria AS, Khwairakpam G, Grover GS, Pathak VK, Pandey P, Gupta R. Viral Hepatitis as a public health concern: A narrative review about the current scenario and the way forward. Cureus 2022;14(2):e21907.https://doi:10.7759/cureus.2190
  1. Rasheed Hussein N, Mohamad Haj S, Amin Almizori L, Ahmed Taha A. The Prevalence of Hepatitis B and C viruses among blood donors attending blood bank in Duhok, Kurdistan Region, Iraq. Int J Infect. 2017;4(1):e39008. https://doi.org/10.17795/iji-39008
  2. Bello KE, Mat Jusoh TNA, Irekeola AA, et al. A recent prevalence of Hepatitis B Virus (HBV) genotypes and subtypes in Asia: A Systematic review and meta-analysis. Healthcare (Basel). 2023;11(7):1011.https://doi.org/10.3390/healthcare11071011
  1. Altayar MA, Jalal MM, Kabrah A, et al. prevalence and association of transfusion transmitted infections with ABO and Rh blood groups among blood donors in the western region of Saudi Arabia: A 7-year retrospective analysis. Medicina (Kaunas) 2022;58(7):857.https://doi.org/10.3390/medicina58070857
  1. Jing W, Zhao S, Liu J, et al. ABO blood groups and hepatitis B virus infection: A systematic review and meta-analysis BMJ Open 2020;10:e034114.https://doi.org/10.1136/bmjopen-2019-034114
  1. Halder A, Halder AK. Association between blood group and hepatitis B virus infection in blood donors in West Bengal. J Evolution Med Dent Sci 2020, 9:3726-3730.https://doi.org/10.14260/jemds/2020/818