Original Article

The Probable Association between Blood Groups and Prognosis of COVID-19


Background: We aimed to verify the association between blood group systems and prognosis of SARS-Cov-2 disease.

Methods: In this cross-sectional study, 329 patients infected with SARS-Cov-2 diagnosed based on their COVID-19 RT-PCR results and chest CT scans, were enrolled in the study. These patients were admitted to Kamkar Arab Nia Hospital, Qom, Iran from March to June 2020. Their blood groups and RH were determined, and demographic characteristics and clinical signs of patients were recorded. The patients’ temperature and peripheral capillary oxygen saturation levels (SpO2) were measured. Finally, the duration of hospitalization, intubation, and death rate were also analyzed.

Results: The results of the patients' blood group analysis were as follows: 129(39.2%) patients had A type, 66(20.1%) B type, 21(6.4%) AB type, and 113(34.3%) O type. Of 329 patients, 297 (90.3%) had Rh antigen. The dead cases were higher in O blood type at 13 cases (11.5%). Considering the positive and negative rhesus antigen, 31 (10.4%) and 1 (3.1%) were dead respectively, but the difference was not statically significantAs for the A group, the mean of admission duration (8.4±6.1 days) was not significantly different from the B group (8.8 ±7.2 days). AB group with a mean (7.4 ±4.4 days) was not significantly different from the O group (7.8 ± 5.4 days). There was no significant difference in the duration of hospitalization in RH patients, positive or negative. B blood group showed a significant association with the time interval to return to normal oxygen levels.

Conclusion: Blood type was not associated with COVID-19 death rate, nor was it associated with admission duration. B blood group showed a significant association with the time interval to return to normal oxygen levels.

1. Weiss SR, Navas-Martin S (2005). Coronavirus pathogenesis and the emerging pathogen severe acute respiratory syndrome coronavirus. Microbiol Mol Biol Rev , 69(4):635-664.
2. Taherizadeh M, Tabibzadeh A, Panahi M, et al (2020). An Introduction to SARS Coronavirus 2; Comparative Analysis with MERS and SARS Coronaviruses: A Brief Review. Iran J Public Health, 49:30-37.
3. Poutanen SM, Low DE, Henry B, et al (2003). Identification of severe acute respiratory syndrome in Canada. N Engl J Med, 348(20):1995-2005.
4. Stark CJ, Atreya CD (2005). Molecular advances in the cell biology of SARS-CoV and current disease prevention strategies. Virol J, 2:35.
5. Chafekar A, Fielding BC (2018). MERS-CoV: Understanding the Latest Human Coronavirus Threat. Viruses, 10(2):93.
6. Arabi YM, Arifi AA, Balkhy HH,et al (2014). Clinical course and outcomes of critically ill patients with Middle East respiratory syndrome coronavirus infection. Ann Intern Med, 160(6):389-97.
7. Senga M, Arabi YM, Fowler RA (2017). Clinical spectrum of the Middle East respiratory syndrome coronavirus (MERS-CoV). J Infect Public Health, 10(2):191-194.
8. Browne A, Ahmad SS, Beck CR, Nguyen-Van-Tam JS (2016). The roles of transportation and transportation hubs in the propagation of influenza and coronaviruses: a systematic review. J Travel Med, 23(1):tav002.
9. Corman VM, Albarrak AM, Omrani AS,et al (2016). Viral Shedding and Antibody Response in 37 Patients With Middle East Respiratory Syndrome Coronavirus Infection. Clin Infect Dis, 62(4):477-483.
10. Xie M, Chen Q (2020). Insight into 2019 novel coronavirus—an updated intrim review and lessons from SARS-CoV and MERS-CoV. Int J Infect Dis,94:119-124.
11. Paraskevis D, Kostaki EG, Magiorkinis G, Panayiotakopoulos G, Sourvinos G, Tsiodras S (2020). Full-genome evolutionary analysis of the novel corona virus (2019-nCoV) rejects the hypothesis of emergence as a result of a recent recombination event. Infect Genet Evol, 79:104212.
12. Giannis D, Ziogas IA, Gianni P (2020). Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past. J Clin Virol,127:104362.
13. Ru H, Yang E, Zou K (2020). What do we learn from SARS-CoV-1 to SARS-CoV-2: Evidence from global stock markets. https://www.economicsobservatory.com/ongoing-research/what-do-we-learn-from-sars-cov-1-to-sars-cov-2-evidence-from-global-stock-markets
14. Fani M, Teimoori A, Ghafari S (2020). Comparison of the COVID-2019 (SARS-CoV-2) pathogenesis with SARS-CoV and MERS-CoV infections. Future Virol,10.2217/fvl-2020-0050.
15. Ghadir M, Ebrazeh A, Khodadadi J ,et al (2020). The COVID-19 Outbreak in Iran; The First Patient with a Definite Diagnosis. Arch Iran Med,23(7): 503-504.
16. Zheng Z, Peng F, Xu B, et al (2020). Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect, 81(2):e16-e25.
17. Liumbruno GM, Franchini M (2013). Beyond immunohaematology: the role of the ABO blood group in human diseases. Blood Transfus, 11(4):491-9.
18. Garratty G (2000). Blood groups and disease: a historical perspective. Transfus Med Rev, 14(4):291-301.
19. Zietz M, Tatonetti NP (2020). Testing the association between blood type and COVID-19 infection, intubation, and death. medRxiv,the preprint server for health sciences:2020.04.08.20058073.
20. Latz CA, DeCarlo C, Boitano L, Png CYM, Patell R, Conrad MF, Eagleton M, Dua A (2020). Blood type and outcomes in patients with COVID-19. Ann Hematol,12 : 1–6.
21. Woolf B (1955). On estimating the relation between blood group and disease. Ann Hum Genet, 19(4):251-253.
22. Fry AE, Griffiths MJ, Auburn S, et al (2008). Common variation in the ABO glycosyltransferase is associated with susceptibility to severe Plasmodium falciparum malaria. Human Mol Genet, 17(4):567-576.
23. Boren T, Falk P, Roth KA, Larson G, Normark S (1993). Attachment of Helicobacter pylori to human gastric epithelium mediated by blood group antigens. Science, 262(5141):1892-1895.
24. Swerdlow DL, Mintz ED, Rodriguez M, et al (1994). Severe life-threatening cholera associated with blood group 0 in peru: implications for the latin american epidemic. J Infect Dis, 170(2):468-472.
25. Wu Y, Feng Z, Li P, Yu Q (2020). Relationship between ABO blood group distribution and clinical characteristics in patients with COVID-19. Clin Chim Acta, 509:220-223.
26. Zhao J, Yang Y, Huang H, et al (2020). Relationship Between the ABO Blood Group and the Coronavirus Disease 2019 (COVID-19) Susceptibility. medRxiv, ciaa1150. doi: https://doi.org/10.1101/2020.03.11.20031096
27. Zietz M, Zucker J, Tatonetti NP (2020). Associations between blood type and COVID-19 infection, intubation, and death. Nat Commun, 11, 5761.
28. Franchini M, Liumbruno GM, Lippi G (2016). The prognostic value of ABO blood group in cancer patients. Blood Transfus, 14(5):434-440.
29. Melendez M, Vargas-Tank L, Fuentes C, et al (1979). Distribution of HLA histocompatibility antigens, ABO blood groups and Rh antigens in alcoholic liver disease. Gut, 20(4):288-290.
30. Scheiner B, Northup PG, Gruber AB, et al (2020). The impact of ABO blood type on the prevalence of portal vein thrombosis in patients with advanced chronic liver disease. Liver Int,40(6): 1415–1426
31. Chakrani Z, Robinson K, Taye B (2018). Association Between ABO Blood Groups and Helicobacter pylori Infection: A Meta-Analysis. Scientific Reports, 8:17604.
32. Evans AS, Shepard DA, Richards VA (1972). ABO blood groups and viral diseases. The Yale J Biol Med, 45(2):81-92.
33. Conton B, Gevao S, Sahr F,et al (2017). Do ABO and Rhesus Blood Groups Affect Susceptibility to, and Prognosis of Ebola Virus Infection? Journal of Virology & Antiviral Research, 06.
34. Mackenzie JS, Fimmel PJ (1978). The effect of ABO blood groups on the incidence of epidemic influenza and on the response to live attenuated and detergent split influenza virus vaccines.J Hyg (Lond), 80(1):21-30.
35. Li J, Wang X, Chen J, Cai Y, Deng A, Yang M (2020). Association between ABO blood groups and risk of SARS-CoV-2 pneumonia. Br J Haematol, 190(1):24-27.
36. Gallian P, Pastorino B, Morel P, Chiaroni J, Ninove L, de Lamballerie X (2020). Lower prevalence of antibodies neutralizing SARS-CoV-2 in group O French blood donors. Antiviral Res, 181:104880.
37. Dai X (2020). ABO blood group predisposes to COVID-19 severity and cardiovascular diseases. Eur J Prev Cardiol, 27(13):1436-1437.
38. Guillon P, Clément M, Sébille V, Rivain J-G, Chou C-F, Ruvoën-Clouet N, Le Pendu J (2008). Inhibition of the interaction between the SARS-CoV spike protein and its cellular receptor by anti-histo-blood group antibodies. Glycobiology, 18(12):1085-1093.
39. Golinelli D, Boetto E, Maietti E, Fantini MP (2020). The association between ABO blood group and SARS-CoV-2 infection: A meta-analysis. PLoS One, 15(9):e0239508.
IssueVol 50 No 4 (2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v50i4.6009
SARS-Cov-2 Blood Group Antigens Iran

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How to Cite
Nasiri M, Khodadadi J, Hajrezaei Z, Bizhani N. The Probable Association between Blood Groups and Prognosis of COVID-19. Iran J Public Health. 2021;50(4):825-830.