Semin Thromb Hemost 2013; 39(01): 072-082
DOI: 10.1055/s-0032-1329550
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Relationship between ABO Blood Group and Hemorrhage: A Systematic Literature Review and Meta-Analysis

Francesco Dentali
1   Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
Anna Paola Sironi
1   Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
Walter Ageno
1   Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
Carlo Bonfanti
2   Department of Transfusion Medicine and Hematology, C. Poma Hospital, Mantova, Italy
Silvia Crestani
2   Department of Transfusion Medicine and Hematology, C. Poma Hospital, Mantova, Italy
Francesco Frattini
2   Department of Transfusion Medicine and Hematology, C. Poma Hospital, Mantova, Italy
Luigi Steidl
1   Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
Massimo Franchini
2   Department of Transfusion Medicine and Hematology, C. Poma Hospital, Mantova, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
08 January 2013 (online)


Several studies have suggested that patients with non–O blood group have an increased risk of both venous and arterial thromboembolic events. On the contrary, the role of ABO blood group on the risk of bleeding complications remains unclear. Thus, we performed a meta-analysis of the literature with the aim of assessing this potential association. MEDLINE and Embase databases were searched from 1946 to March 2012. Studies comparing the prevalence of different ABO blood groups in bleeding patients as well as in controls without bleeding complications were potentially includible. Two reviewers independently selected studies and extracted study characteristics, quality, and outcomes. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each trial and pooled using a random-effects model. Twenty-two studies totalling 9,468 bleeding patients and more than 450,000 controls were included. The prevalence of O blood group was significantly higher in bleeding patients than in controls, with a resulting pooled OR of 1.33 (95% CI = 1.25 to 1.42; p < 0.001). The result of this meta-analysis of a very large sample of bleeding patients and controls suggests that O blood group is a potentially important genetic risk factor for bleeding. High-quality prospective studies are warranted to confirm these preliminary findings.

  • References

  • 1 Preston AE, Barr A. The plasma concentration of factor VIII in the normal population. II. The effects of age, sex and blood group. Br J Haematol 1964; 10: 238-245
  • 2 Franchini M, Capra F, Targher G, Montagnana M, Lippi G. Relationship between ABO blood group and von Willebrand factor levels: from biology to clinical implications. Thromb J 2007; 5: 14
  • 3 Moeller A, Weippert-Kretschmer M, Prinz H, Kretschmer V. Influence of ABO blood groups on primary hemostasis. Transfusion 2001; 41 (1) 56-60
  • 4 O'Donnell JS, Laffan MA. The relationship between ABO histo-blood group, factor VIII and von Willebrand factor. Transfus Med 2001; 11 (4) 343-351
  • 5 Jenkins PV, O'Donnell JS. ABO blood group determines plasma von Willebrand factor levels: a biologic function after all?. Transfusion 2006; 46 (10) 1836-1844
  • 6 Gastineau DA, Moore SB. How important are ABO-related variations in coagulation factor levels?. Transfusion 2001; 41 (1) 4-5
  • 7 Wu O, Bayoumi N, Vickers MA, Clark P. ABO(H) blood groups and vascular disease: a systematic review and meta-analysis. J Thromb Haemost 2008; 6 (1) 62-69
  • 8 Dentali F, Sironi AP, Ageno W , et al. Non-O blood type is the commonest genetic risk factor for VTE: results from a meta-analysis of the literature. Semin Thromb Hemost 2012; 38 (5) 535-548
  • 9 Gill JC, Endres-Brooks J, Bauer PJ, Marks Jr WJ, Montgomery RR. The effect of ABO blood group on the diagnosis of von Willebrand disease. Blood 1987; 69 (6) 1691-1695
  • 10 Franchini M, Lippi G. Recent acquisitions in acquired and congenital von Willebrand disorders. Clin Chim Acta 2007; 377 (1–2) 62-69
  • 11 Stroup DF, Berlin JA, Morton SC , et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283 (15) 2008-2012
  • 12 McGinn T, Wyer PC, Newman TB, Keitz S, Leipzig R, For GG. Evidence-Based Medicine Teaching Tips Working Group. Tips for learners of evidence-based medicine: 3. Measures of observer variability (kappa statistic). CMAJ 2004; 171 (11) 1369-1373
  • 13 Langman MJ, Doll R. ABO blood group and secretor status in relation to clinical characteristics of peptic ulcers. Gut 1965; 6 (3) 270-273
  • 14 Merikas G, Christakopoulos P, Petropoulos E. Distribution of ABO blood groups in patients with ulcer disease. Its relationship to gastroduodenal bleeding. Am J Dig Dis 1966; 11 (10) 790-795
  • 15 Horwich L, Evans DA, McConnell RB, Donohoe WT. ABO blood groups in gastric bleeding. Gut 1966; 7 (6) 680-685
  • 16 Mitra A. Relation of ABO blood groups to duodenal ulcer and bleeding. J Indian Med Assoc 1971; 57 (12) 447-449
  • 17 Viskum K. Long-term survival of patients with gastrointestinal haemorrhage with special reference to the ABO blood groups. Scand J Gastroenterol 1972; 7 (1) 55-63
  • 18 Garcia AA, van der Heijden JF, Meijers JCM, Rosendaal FR, Reitsma PH. The relationship between ABO blood group and the risk of bleeding during vitamin K antagonist treatment. J Thromb Haemost 2006; 4 (6) 1418-1420
  • 19 Pruissen DMO, Rosendaal FR, Gorter JW, Garcia AA, Kappelle LJ, Algra A. SPIRIT Study Group. Haemostatic genetic variants, ABO blood group and bleeding risk during oral anticoagulant treatment after cerebral ischaemia of arterial origin. J Neurol 2007; 254 (12) 1660-1665
  • 20 Clark P, Walker ID, Govan L, Wu O, Greer IA. The GOAL study: a prospective examination of the impact of factor V Leiden and ABO(H) blood groups on haemorrhagic and thrombotic pregnancy outcomes. Br J Haematol 2008; 140 (2) 236-240
  • 21 Lethagen S, Hillarp A, Ekholm C, Mattson E, Halldén C, Friberg B. Distribution of von Willebrand factor levels in young women with and without bleeding symptoms: influence of ABO blood group and promoter haplotypes. Thromb Haemost 2008; 99 (6) 1013-1018
  • 22 Reddy VM, Daniel M, Bright E, Broad SR, Moir AA. Is there an association between blood group O and epistaxis?. J Laryngol Otol 2008; 122 (4) 366-368
  • 23 Antón AI, González-Conejero R, Roldán V , et al. Study of 18 functional hemostatic polymorphisms in mucocutaneous bleeding disorders. Ann Hematol 2010; 89 (11) 1147-1154
  • 24 Peebles Brown DA, Melrose AG, Wallace J. The blood groups in peptic ulceration. BMJ 1956; 2 (4985) 135-138
  • 25 Evans DA, Horwich L, McConnell RB, Bullen MF. Influence of the ABO blood groups and secretor status on bleeding and on perforation of duodenal ulcer. Gut 1968; 9 (3) 319-322
  • 26 Berg M. Influence of age and ABO blood groups in the precipitation of bleeding peptic ulcers. Gut 1969; 10 (12) 1029-1030
  • 27 Lam SK, Ong GB. Duodenal ulcers: early and late onset. Gut 1976; 17 (3) 169-179
  • 28 Gutiérrez Cabano CA. ABO blood groups, onset age of ulcer symptoms, family history of dyspepsia and complications in duodenal ulcer. Acta Gastroenterol Latinoam 1983; 13 (2) 171-178
  • 29 Quiroga T, Pérez M, Rodríguez S , et al. Skin and mucous membrane hemorrhages: clinical assessment, study sequence and relative frequency of hereditary diseases of the hemostasis in a Chilean population [in Spanish]. Rev Med Chil 1997; 125 (4) 409-418
  • 30 Kuyvenhoven JP, Veenendaal RA, Vandenbroucke JP. Peptic ulcer bleeding: interaction between non-steroidal anti-inflammatory drugs, Helicobacter pylori infection, and the ABO blood group system. Scand J Gastroenterol 1999; 34 (11) 1082-1086
  • 31 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7 (3) 177-188
  • 32 Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327 (7414) 557-560
  • 33 Amer Z, Aboul-Enein Mel-S, Sheir ZM, Gorgy AN, Refai MR. An epidemiological evidence of association between ABO blood groups and ruptured oesophago-gastric varices. J Egypt Med Assoc 1971; 54 (1) 61-67
  • 34 Ionescu DA, Marcu I, Bicescu E. Cerebral thrombosis, cerebral haemorrhage, and ABO blood-groups. Lancet 1976; 1 (7954) 278-280
  • 35 Larsen S, Anthonisen B, Marquardsen J. Cerebral infarction, cerebral haemorrhage, and ABO blood-groups. Lancet 1977; 1 (8020) 1064
  • 36 Bayan K, Tüzün Y, Yilmaz S, Dursun M, Canoruc F. Clarifying the relationship between ABO/Rhesus blood group antigens and upper gastrointestinal bleeding. Dig Dis Sci 2009; 54 (5) 1029-1034
  • 37 Clark P, Sattar N, Walker ID, Greer IA. The Glasgow Outcome, APCR and Lipid (GOAL) Pregnancy Study: significance of pregnancy associated activated protein C resistance. Thromb Haemost 2001; 85 (1) 30-35
  • 38 Abdoosh UB, El-Dewi SJ. Egypt. Med. Assoc 1949; 32: 10
  • 39 Doll R, Jones FA, Pygott F, Stubbe JL. The risk of gastric cancer after medical treatment for gastric ulcer. Gastroenterologia 1957; 88 (1) 1-12
  • 40 Friedlander PH. Ambulatory treatment of duodenal ulcers: effects of fruit juice, olive oil, hexamethonium, and methantheline. Lancet 1954; 266 (6808) 286-289
  • 41 Doll R, Swynnerton BF, Newell AC. Observations on blood group distribution in peptic ulcer and gastric cancer. Gut 1960; 1: 31-35