Prevalence of blood groups and Rh factor in Bannu region (NWFP) Pakistan

Pakistan J. Med. Res.

Vol. 43 No.1, 2004

Prevalence of blood groups and Rh factor in Bannu region (NWFP) Pakistan

Mohammad Shoaib Khan, Fazli Subhan, Faheem Tahir, Birjees Mazhar Kazi, Athar Saeed Dil, Sikandar Sultan, Fariyal Deepa, Farah Khan and Mubashir Ahmed Sheikh

National Institute of Health, Islamabad, Jinnah Postgraduate Medical Centre, Karachi, Pakistan

SUMMARY

Objective: A community-based study was carried out on blood groups representing a random population sample from urban and rural areas of Bannu region, North West Frontier Province (NWFP) of Pakistan. The objective was to determine the frequency of different blood groups in the region, which would not only help in blood transfusion services but also eliminate the risk of erythroblastosis fetalis in the neonates.

Method: Blood group determination was carried out over a period of 16 months from January 2002 to April 2003, and encompassed 2581 subjects, in which 57.09% were male and 42.9% female, these were categorized by their groups, A, B, AB, and O.

Results: The percentage of these groups were 31.03% (A), 36.23% (B), 7.67% (AB), and 25.07% (O). The Rh positive and negative distribution in the studied population was 89.23% and 10.77% respectively.

Conclusion: The studied population exhibited a predominance of group B, in the order of B>A>O>and AB, as well as Rh positive antigen for both male (90.26%) and female (87.98%) subjects within the population, with Rh negative men and women being 9.74% and 12.02% respectively.

Keywords: Blood groups; Rh factor; Transfusion; Bannu; Pakistan.

INTRODUCTION

Blood is man’s complete and unchangeable identity. Although almost 400 blood grouping antigens have been reported, the ABO and Rh is recognized as the major (clinically significant) blood group antigens. This system derives its importance from the fact that A and B are strongly antigenic and anti A and anti B occur naturally in the serum of persons lacking the corresponding antigen, these antibodies being capable of producing hemolysis in vivo1. Rhesus blood group system was the fourth system to be discovered and yet it is second most important blood group from the point of view of transfusion2

Karl Landsteiner was the first person to put forward the ABO blood group system in 19003,4. After 40 years (1940-1941), Landsteiner and Wiener discovered that blood group antigens could be recognized with specific antisera and a vast number of antigens have been detected on human blood cells, of which about 10-15% from well defined systems and only 1-2% play a significant role in blood transfusion. These blood group antigens are divided into many blood group systems. Each of this system is inherited quite independently from all the other systems2,5,6 Human blood antigens may be erythrocytic related, leukocytic related and platelet related 7. The need for blood group prevalence studies is multipurpose, as besides their importance in evolution; their relation to disease and environment is being increasingly sought in modern medicine8,9. Blood group antigens are not only important in relation to blood transfusion and organ transplantation, but also have been utilized in genetic research, anthropology and training ancestral relation of humans9.

The present study has been carried out to record the frequency of various blood groups in the population of Bannu, North West Frontier Province (NWFP), Pakistan, with a view to generate data with multipurpose future utilities for the health planners.

MATERIALS AND METHODS

Subjects

A total of 2581 subjects, comprising 1123 female and 1458 males, were screened for their blood groups. The subjects belonged to both rural and urban areas of Bannu, NWFP, Pakistan.

Collection of blood samples

A 2.0 ml sample of blood was drawn from the antecubital vein of each subject in a disposable syringe, and transferred immediately to a tube containing ethylene diamine tetra acetic acid (EDTA).

Determination of blood group

Blood grouping (ABO) and Rhesus factors (Rh), was done by the antigen antibody agglutination test. The antisera used were obtained from Plasmatec (Kent, UK). Plasmatec ABO monoclonal reagents are in vitro culture supernatants of hybridized immunoglobulins secreting mouse cell-line. For determination of Rh factor, plasmatec anti D (1gm) Lo.-Du and LO-Du2 monoclonal reagents prepared from different antibody producing human B-lymphocyte cell lines were used.

RESULTS

Table-1 shows the prevalence of ABO blood groups in the studied population, with gender distribution. The distribution of blood group in the total sample was 36.2%, 31.0%, 25.06% and 7.67% for groups B, A, O and AB, respectively. B group was dominant in both the genders, and AB was rare in both males as well as females.

Table 1: Prevalence of various blood groups (ABO and Rh) in the studied population.

Blood Group	Total Subjects % (n)			Male Subjects % (n)			Female Subjects % (n)
Blood Group	Complete	Rh+	Rh-	Complete	Rh+	Rh-	Complete	Rh+	Rh-
A B AB O	31.03(801) 36.23(935) 7.67(198) 25.07(647)	31.08(716) 36.37(838) 6.86(158) 25.69(592)	30.69(85) 35.02(97) 14.44(40) 19.85(55)	34.84(508) 36.08(526) 4.80 (70) 24.28(354)	34.96(460) 36.70(483) 3.57 (47) 24.77(326)	33.80(48) 30.28(43) 16.20(23) 19.72(28)	26.09(293) 36.42(409) 11.40(128) 26.09(293)	25.91(256) 35.93(355) 11.24(111) 26.92(266)	27.41(37) 40.00(54) 12.59(17) 20.00(27)
Total	100.00(2581)	100.00(2304)	100.00(277)	100.00(1458)	100.00(1316)	100.00(142)	100.00(1123)	100.00(988)	100.00(135)

In the study under discussion, the relative frequency of the various blood groups does not seem to deviate from those which have been recorded for studies on various segments of the Pakistani population (Table 2). However, comparison with the data from the British and African populations, presented in the same table, reveals that there is an equal dominance of group B and O in the Indo-Pak sub-continent, in contrast to only O group for the British and African populations. The least reported group, in all the populations, has been AB.

It has been reported10-12, that in the populations of the United States, Asian, Syrian Arabs and Palestinians, group O is dominant, with AB being the rarest. Racial (genetic) and environmental factors have been reported to influence the frequency of various blood groups in studies carried in various societies, including Bangladesh and Latin America13-16. The genetic and environmental factors responsible for varying frequency of the blood groups, among the Pakistani populace, needs to be probed further.

In terms of presence of Rh antibodies, the data from several studies on Pakistani as well as certain African populations is compared in Table 3. The present study has shown comparatively the highest percentage of Rh negative cases, however, it is still very low and follows the global trend of being significantly rarer than Rh positive individuals.

An association of several diseases, specially cardiovascular, which has been reported over the years17-25, would make the data generated by the study, to be useful for health planners, while making efforts to face the future health challenges in the region.

In short, generation of a simple database of blood groups, not only provides data about the availability of human blood in case of regional calamities, but also serves as a forewarner of future burden of disease. Such studies need to be carried out at regional levels, wherever human resides.

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	Frequency (%)
Population	A	B	AB	O	Reference
Britain	41.70	8.60	3.00	46.70	(7)
India	24.70	37.50	5.30	32.50	(7)
Nigeria	24.43	23.88	2.75	48.94	(26)
Kenya	26.20	22.00	4.40	47.48	(27)
Hazara (Pakistan)	24.00	32.00	11.00	33.00	(8)
Swabi (Pakistan)	27.60	30.40	8.80	32.20	(9)
Peshawar (Pakistan)	28.00	34.00	7.00	31.00	(28)
Bahawalpur (Pakistan)	21.00	36.00	6.00	37.00	(29)
Bannu (Pakistan)	31.03	36.23	7.67	25.07	Present study

	Frequency (%)
Population	Rh+	Rh-	Reference
Lahore (Pakistan)	92.00	8.00	(30)
Nigeria	95.67	4.33	(26)
Kenya	96.10	3.90	(27)
Azad Jammu and Kashmir	97.70	2.30	(31)
Islamabad (Pakistan)	92.67	7.33	(32)
Peshawar (Pakistan)	94.60	5.40	(25)
Bannu (Pakistan)	89.27	10.73	Present study