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Frequencies of ABO and Rhesus (D) blood group phenotypes among pregnant women attending antenatal clinic at Murtala Muhammad Specialist Hospital, Kano, Nigeria

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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
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  Journal of  Medicine in the Tropics Journal of  Medicine   Tropics in the Official Publication of Faculty of Medical Sciences, University of Jos ISSN 2276-7096VOL. 21 | Issue 1 | January-June 2019 http://www.jmedtropics.org      J     M     T  Frequencies of ABO and Rhesus (D) blood groupphenotypes among pregnant women attending antenatalclinic at Murtala Muhammad Specialist Hospital, Kano,Nigeria  ABSTRACT 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 thisstudy was todetermine the frequencies and distribution of ABO and Rh (D) blood groupsamong pregnantwomen attending antenatal clinic at Murtala Muhammad Specialist Hospital, Kano, Nigeria.  Materials and Methods:  A total of 210pregnant women who presented to the booking section of the clinic were recruited for the study. Sociodemographic information of thepatients was obtained using a semistructured interviewer-administered questionnaire. ABO and Rh (D) blood groups were determined by theagglutination method using potent monoclonalanti-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 INTRODUCTION The ABO and Rhesus (Rh) blood group systems aredetermined by the presence or absence of antigenslocated on the membrane of red blood cells. [1-3] Theseantigenic materials are also found on other tissues, fluids,andvascularstructuresapartfrommembranesofredcells. [1] Clinically, they constitute the most important sources of transfusion-related incompatibility reactions. [4]  Althoughsome cases of transfusion reactions are mild, resolving with appropriate treatment, others are rapid and oftenfatal. [5] Together with transfusion transmissible infections, ABO and Rh incompatibility reactions continue to beimportant causes of morbidity and mortality in public health institutions. [6,7] Hemolytic disease of the newborn,a severe disease resulting from exposure of Rh (D)-positivefetus to maternal antibodies against Rh (D) antigen, isclinically the most important transfusion-related reactioninvolving incompatible Rh (D) blood especially in Africancontinent. [8] Pregnancy, though a physiological phenomenon, issometimes associated with complications requiring bloodtransfusion. [9] Cesarean delivery due to obstetric hemorrhages, hypertensive disorders of pregnancies,anemia in pregnancy, and miscarriages all increase thedemand for blood and blood products during pregnancy,delivery, and lactation. [10,11] I SYAKU  G WARZO  M UKHTAR  , A ISHA  Y AKUBU  A BDULKADIR  Department of Human Physiology, Faculty of Basic MedicalSciences, Bayero University, Kano, Nigeria Address for correspondence:  Isyaku Gwarzo Mukhtar,Department of Human Physiology, Faculty of Basic MedicalSciences, Bayero University, Kano, Nigeria.E-mail: mukhtargwarzo@gmail.com This is an open access journal, and articles are distributed under the terms of theCreative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allowsothers to remix, tweak, and build upon the work non-commercially, as long asappropriate credit is given and the new creations are licensed under the identicalterms. For reprints contact:  reprints@medknow.com How to cite this article:  Mukhtar IG, Abdulkadir AY. Frequencies of ABO andRhesus(D) blood groupphenotypes among pregnant women attending antenatal clinicat Murtala Muhammad Specialist Hospital, Kano, Nigeria. J Med Trop 2019;21:31-6. Access this article online Quick Response CodeWebsite: www.jmedtropics.org DOI: 10.4103/jomt.jomt_4_19 O r i g i n al A r t i cle ©  2019 Journal of Medicine in the Tropics | Published by Wolters Kluwer - Medknow  31   Africa, and indeed Nigeria, has one of the highest maternalmortality rates in the world. [12,13]  A number of the commoncauses of this high maternal death require blood transfusionas a form of emergency care. Therefore, any preventivestrategy aimed at reducing maternal death may requireprompt safe blood transfusion services. Planning for suchsafeandprompttransfusionservicesinourenvironmentlikein others will undoubtedly require a baseline data of thefrequencies and distribution of ABO and Rh (D) blood groupsystems.To our knowledge, distribution of ABO and Rh (D) bloodgroup systems among pregnant women in thisenvironment has not received the needed attention it deserves and hence the current study. The aim of thestudy was to determine the frequency and distributionof ABO and Rh blood groups among pregnant womenattending antenatal clinic of Murtala MuhammadSpecialist Hospital, Kano, Nigeria. MATERIALS AND METHODSStudy area The study was conducted at the antenatal clinic of MurtalaMuhammad Specialist Hospital between July and August 2018. Murtala Muhammed Specialist Hospital is asecondary health facility located in the city of Kano,north-west Nigeria. It is owned by the StateGovernment and serves as a referral center within andoutside the State. Kano State is one of the 36 States of Federal Republic of Nigeria, consisting of 44 localgovernment areas.With a 12-ward 648-bed capacity, the hospital wasestablished in 1928 by the then British colonialGovernment to provide healthcare to its workers andthose of native authority. The hospital mainly providescurative 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 consideration Ethical approval was obtained from Kano State Ministry of Health, and administrative approval was obtained fromthe management of Murtala Muhammad Specialist Hospital; all participants were requested to sign anindividual informed consent form beforecommencement of the study. Helsinki declaration of 1975, as revised in 2000, was adhered to. Sample size  A total of 210 consecutive consenting pregnant women whopresented 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. Conveniencesampling technique was used to recruit patients into thestudy. Inclusion criteria  All pregnant women who presented themselves at the clinic for booking during the study period and provided consent  were recruited for the study. Exclusion criteria Pregnant women who declined consent to participate in thestudy and those with clinical and/or laboratory evidence of hypertensive disorders of pregnancy were excluded fromthe study. Data collection  A semistructured interviewer-administered questionnaire was used to obtain sociodemographic information of thepatients. Laboratory procedure  ABO and Rh (D) blood groups were determined by the tileagglutination method using potent monoclonal anti-A, anti-B, and anti-D reagents (Plasmatec laboratories ltd., Bridport,UK). Statistical analysis Data were analyzed using Statistical Package for SocialScientists version 23.0 (IBM SPSS Statistics for Windows, Version 23.0; IBM Corp., Armonk, NY, USA; 2015). [14] Results were expressed as mean±standard deviation, frequencies,and percentages. RESULTSSociodemographic characteristics of the patients  A total of 210 pregnant women were recruited into thestudy. 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 largerproportion of the patients had at least primary education.Similarly, a considerable number were full-time housewives[Table 1]. 32  Journal of Medicine in the Tropics | Volume 21 | Issue 1 | January-June 2019  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 thisenvironment followed by B, A, and AB, respectively. This issimilar to what was reported in a previous study  [15] amongprospective blood donors in the same environment. Inanother series, Chima  et al. [16] reported similar patternamong blood donors at a tertiary hospital in the state. Ingeneral, this pattern confirmed the findings of most researchers from north-west Nigeria. [17,18] Frequencies of ABO blood group phenotypes are, however,not uniform across the six geopolitical zones of Nigeria. AlthoughthemostcommontypeinallthezonesisOandtheleast 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. [19] reported a pooled patternof 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 inpublications from north-eastern parts of Nigeria, Babadoko et al. [20] reportedapatternthatissimilartothatof thisstudy from north-east. Variations in frequencies and distribution of ABO bloodgroups is not limited to the various regions of Nigeria.There have been reported variations between and within African countries. Although researchers from Madagascar [21] and Guinea [22] reported frequencies and pattern similar to Figure 1: ABO blood group of the patients.Figure 2: Rh (D) blood group of the patients. Rh, Rhesus. Table 1: Sociodemographic characteristics of the patients Characteristics  N   (%) EthnicityHausa 208 (99.0)Others 2 (1.0)Level of educationPrimary 48 (22.9)Secondary 119 (56.7)Tertiary 17 (8.1)Informal 26 (12.4)OccupationHousewife 164 (78.1)Civil servant 10 (4.8)Petty trader 36 (17.1) Journal of Medicine in the Tropics | Volume 21 | Issue 1 | January-June 2019  33  that of this study, those from Ethiopia, [23] Cameroun, [24] Tunisia, [25] Mauritania, [26] and Morocco [27] 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 [28] reported wide variations in the frequencies andallelic distribution of ABO blood groups among five majorethnic nationalities of southern Bangladesh. AlthoughBengali ethnic nationality had pattern and distributionsimilar to what is reported from this study, those of Tripura had type A blood group as the most commonfollowed by B, AB, and O, in that order. [28] The otherthree ethnic nationalities had type O as the most common group followed by B, A, and AB. In their analysisof over 3 million blood donors from different ethnic backgrounds across five centers, Garraty   et al. [29] noted wide variations in the frequencies of ABO blood groupamong different ethnic and racial groups in the UnitedStates. Despite these variations, they reported a pooledpattern 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. [30] Human ABO blood group is generally determined by thepresence or absence of complex carbohydrates that areusually located not only on the membranes of red bloodcells but also on other body fluids and tissues. [1,2,31] Thesecarbohydratesserveasinheritedantigenicmaterialsthatarepassed from generation to generation. ABO blood group isone out of the over 34 differentblood group systems knownto mankind; it is made up of three antigens −  A, B, and H(ABH antigens). [31] Individuals with type O blood group haveantigen H whereas those with types A and B have antigens A and B, respectively. Apart from its traditional role in transfusion medicine, ABOblood group has become a subject of intense researchinterest due to association with various diseaseconditions. [32] The wide variations in the frequencies of  various ABO blood types from one region to another andfromoneethnicnationalitytoanothercouldhaveevolvedasa natural selection phenomenon due to varied exposure todifferent disease conditions.Type O blood group has been associated with protectionagainst severe  Plasmodium falciparum  malarial infection asopposed to type AB blood group individuals that are said tobe most susceptible to the infection. [33] This could explainthe dominance of type O blood group in this environment and indeed Nigeria and other tropical countries that aremalaria endemic. One mechanism developed to explain thisphenomenon is the reduction and disruption of   P. falciparum rosettes formation, a virulence factor that causesmicrovascular obstruction among other things, in type Oblood group individuals. [34] In contrast, type O blood groupis reported to be associated with susceptibility to cholera by certain strains of   Vibrio cholerae [35] and to diarrheal diseaseduetoNorwalkvirusinfection. [36] Thismayprobablyexplainthe common cholera outbreaks in the tropical anddeveloping countries where type O blood group is very common.However,despitethelinkassociatingtypeObloodgroup to Norwalk virus infection, Taylor et al. [37] reportednosignificant difference in the seroprevalence of Norwalk virusimmunoglobulin between European and African ethnic groups in South Africa.Type B blood group has been reported to be protectiveagainst cholera infection. [35] It has also been reported to beprotective against hemolytic uremic syndrome frominfection by certain strains of   Escherichia coli . [38] Therelatively higher frequency of this type of blood group innorth-western part of Nigeria compared to other regionscould be an evolutionary adaptive response to theseinfections.Majority of the participants in this study are Rh (D) positiveconcurring with reports from different parts of the world. [8,9,15-24,29,30] 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 normalbabies. However, subsequent pregnancies with Rh (D)-positive fetuses may result in severe hemolytic disease of the newborn. [8] CONCLUSION Type O blood group is the most common ABO blood groupamong pregnant women in this environment followed by B, A,and AB.Redbloodcell Rh (D)antigen is alsovery commonamong our pregnant women. Acknowledgements The authors acknowledge the management and staff of Murtala Muhammad Specialist Hospital, especially staff of the antenatal clinic and maternity blood bank unit, for theirsupport. They also thank all the pregnant women whoprovided their consent to participate in this study. Financial support and sponsorship Nil. 34  Journal of Medicine in the Tropics | Volume 21 | Issue 1 | January-June 2019
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