Highlights in Bioscience;


Highlights in BioScience
ISSN: 2682-4043
DOI:10.36462/H.BioSci.20221

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Review Article

Open Access

Department of Biomedical Sciences, College of
Health Sciences, Qatar University, Doha, Qatar.

Contacts of Authors

* To whom correspondence should be
addressed: Ibrahim Mustafa

Citation: Roan Zaid and Ibrahim Mustafa
(2020). The distribution of the ABO and RH
blood groups among different populations in
the MENA region: A review. Highlights in
BioScience Volume 3. Article ID 20221.
dio:10.36462/H.BioSci.20221

Received: June 13, 2020

Accepted: August 18, 2020

Published: September 10, 2020

Copyright: © 2020 Zaid and Mustafa. This is
an open access article distributed under the
terms of the Creative Commons Attribution
License, which permits unrestricted use,
distribution, and reproduction in any medium,
provided the original author and source are
credited.

Data Availability Statement: All relevant data
are within the paper and supplementary
materials.

Funding: The authors have no support or
funding to report.

Competing interests: The authors declare that
they have no competing interests.

The distribution of the ABO and RH blood groups among
different populations in the MENA region: A review

Roan Zaid and Ibrahim Mustafa*

Abstract
ABO and Rh (rhesus) blood grouping is one of the most widely

available laboratory tests that could prevent possibly deadly mismatches
following blood transfusion and organ transplantation. The distribution of
the blood group antigens varies between different populations and ethnic
groups. Our objective was to showcase these variations within the Middle
East and North Africa (MENA) region and to outline the relationship
between blood type and disease risk association to determine the current
findings and outline possible future study areas. In healthy blood donors,
blood group O was found to consistently be the most prevalent blood group
and AB the least prevalent blood group except in Turkey where A is the
most prevalent and, in the United Arab Emirates (UAE), where B is the
least prevalent blood type.

Keywords: ABO blood groups, Rh blood groups, blood donors

Introduction
According to the International Society of Blood Transfusion (ISBT),

there are 33 blood group systems that represent more than 30 antigens as of
date [1, 2]. The four common blood group antigens (A, B, AB and O) of the
ABO system, along with the D (Rhesus/Rh) and Kell antigens are the most
important in blood transfusions and organ transplantation and are
commonly tested due to their clinical significance [3]. The ABO gene
codes for glycosyltransferases that transfer complex oligosaccharide
antigens to the H antigen on the surface of red blood cells (RBCs).
N-acetylgalactosamine and galactose are transferred in the case of A and B
blood groups, respectively. Individuals with the O blood group do not
produce the glycosyltransferase due to a single point deletion (guanine-258)
and, as a result, lack these antigens on the surface of their RBCs [4, 5]. The
distribution of the ABO/Rh blood groups among different populations
within the MENA region as well as some the diseases that are associated
with these blood groups will be addressed in this review.

The distribution of the ABO blood groups in the MENA region
Ever since the discovery of the ABO blood groups by Landsteiner in

1900, the studies on human population genetics were on the rise [6]. Blood
group typing entails finding the antigenic properties of RBCs. These
antigenic properties are found to vary between different racial/ethnic
groups. Population and prevalence studies are therefore important to help
elucidate the distribution of the ABO/RH blood groups and to help prevent
possibly deadly mismatches before blood transfusions or organ
transplantation [7]. Table 1 shows the distribution of the ABO and Rh
blood groups among different populations in the MENA region.

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In healthy blood donors, blood group O was
consistently found to be the most prevalent and AB the
least prevalent blood group. Turkey and the UAE were the
only exception where A was found to be the most
prevalent in Turkey and B was the least prevalent in the
UAE.

Blood group antigens and disease association
ABO blood groups have been statistically associated

with many diseases including diabetes, venous
thromboembolism, ovarian cancer, hepatocellular
carcinoma, lung cancer, pancreatic cancer and other
gastrointestinal cancers [15, 18-22]. However, reports
have been variable and inconsistent between studies.
Some of these diseases and their associated blood group
antigens will be addressed.

Venous thromboembolism and blood group antigens
One of the most described associations between non-O

blood groups (A, B, and AB) and other diseases is that of

venous thromboembolism (VTE). Multiple studies have
established a relationship between the ABO blood groups
and its influence on normal haemostasis [19, 23]. This
relationship is attributed to the expression of the ABO
antigens on the surface of other human cells, including cells
of the epithelium, vascular endothelium and platelets [24]. In
addition, the blood group antigens largely determine the
plasma levels of the von Willebrand Factor (VWF) where
VWF levels are reported to be 25% higher in non-O blood
groups [23, 25-27]. Elevated VWF would prompt platelet
adhesion as well as maintain the coagulation factor Ⅷ (FⅧ)
in the plasma increases the risk of VTE [24]. It is also
important to note that individuals of the A2 blood groups are
reported to have low levels of the VWF and FⅧ. The risk of
developing VTE in these individuals is said to be lower when
compared to the other blood groups (A1, B and AB) [19]. In
concordance with this phenomenon, higher risk of
myocardial infraction and ischemic strokes were also
previously described in individuals with blood group A and
AB [28].

Table 1. Distribution of the ABO and RH blood groups among different populations within the MENA region.

Type 2 Diabetes Mellitus and blood group antigens
A study done in Qatar revealed that Type 2 Diabetes

Mellitus (T2DM) patients are significantly more likely to be
of blood type B as compared to healthy individuals (25.7% vs.
20.4%; P < 0.001) (table 1). In the same study, blood group O
was significantly higher in healthy individuals than in T2DM
patients (38.5% vs. 45.4%; P < 0.001) [10]. A study done in
Kingdom of Saudi Arabia (KSA) found a 52.2% decrease
(2.1 fold reduction) in Rh (-) blood groups in T2DM female
patients as compared to healthy controls (4.21% vs. 8.8%; P
= 0.043) [12]. Similar findings were reported for male T2DM
patients in KSA where males had a 3.4 fold reduction in RH
(-) blood group in comparison to healthy controls (3.13% vs.
10.6%; P = 0.028) [13]. Blood group B was higher in both
male and female T2DM patients in KSA, however, these
findings were not statistically significant [12, 13]. In Iraq, it
was reported that blood group O individuals had significantly
higher levels of total cholesterol, glucose and blood pressure
in comparison to other blood groups (P < 0.01). These
parameters showed a decreasing trend starting from group O
to A to B and then AB [22]. Although all the reported results
were of high significance in all populations, it is clear that
these findings cannot be extrapolated to other populations

due to the conflicting reports. These variations between
populations could be explained by the multifactorial nature
of T2DM.

Cancer and blood group antigens
Multiple studies consistently report that individuals

with the O blood group have reduced risk of developing
pancreatic cancer than non-O individuals [4, 20, 29, 30]. One
study reported that the risk of pancreatic cancer increases
with each addition of non-O allele. In this study, individuals
with AO and AA genotypes had odds ratios (ORs) of 1.33
and 1.66 respectively when compared with individuals of the
OO genotype. Whereas BO and BB individuals had ORs of
1.45 and 2.42, respectively [30]. It was also recently reported
that the genetic variant of the ABO gene, rs505922 (T allele),
which is said to confer protective properties against
pancreatic cancer, is in complete linkage disequilibrium (r2=
1.0) with the guanine-258 deletion that encodes the O allele
[4, 31]. This variant entails a single nucleotide polymorphism
in the first intron of the ABO gene.

Comparable findings were reported for hepatocellular
carcinoma (HCC) where blood group O was found to
improve the disease’s prognosis after hepatectomy [21].

Country Population studied Sample size A (%) B (%) AB (%) O (%) RH+ (%) RH- (%) Ref.

Iraq Blood donors 5,000 32.6 22.8 7.6 37.0 91.3 8.7 [8]
Pakistan Blood donors 3679 31.87 21.71 12.22 34.2 88.86 11.14 [9]
Qatar Blood donors

T2DM patients
1,650
1,633

27.6
29

20.4
25.7

6.5
6.8

45.4
38.5

-
-

-
-

[10]
[10]

Saudi Arabia Blood donors
Male blood donors
T2DM female patients
T2DM male patients

57,396
944
214
128

26.0
33.4
24.8 (A+)
22.6 (A+)

18.0
6.0
27.1 (B+)
30.5 (B+)

4.0
3.8
7.0 (AB+)
4.7 (AB+)

51.0
56.8
36.9 (O+)
39.1 (O+)

92.0
92.8
95.8
96.88

8.0
7.2
4.21
3.13

[11]
[7]
[12]
[13]

Sudan Blood donors 3,087 19.14 14.0 - 66.8 74.4 25.6 [14]
Turkey Blood donors

Blood donors
Lung cancer patients

3,022,883
86,797
2,044

42.2
44
43.9

16.4
16.2
17.3

7.5
6.5
8.1

33.9
33.3
30.7

87.7
88.2
86.2

12.3
11.8
13.8

[15]
[16]
[15]

United Arab Emirates Blood donors 661 24.0 22.8 31 48.4 91 8.9 [17]

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Zaid and Mustafa, 2020 The distribution of the ABO and RH blood groups in the MENA region

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Studies conducted by Wu et al., revealed the mean overall
survival (OS) of HCC after hepatectomy to be 55, 39, 34 and
34 months for blood groups O, A, B and AB, respectively.
The overall hazard ratio for non-group O individulas in this
study was 1.485 (95% CI, 1.204–1.830; P < 0.001) [21].

Studies done by Urun et al. in Turkey found that having
O and Rh- blood decreased the risk of lung cancer by 14%
and 13% respectively [15]. However, another study, also
done in Turkey, showed no correlation between blood groups
and lung cancer status of patients [32].

Finally, Zhang et al. compared findings for 89 studies
with 30 different cancer types. For these studies, the pooled
OR for A blood groups vs. non A blood groups was 1.12
(95%CI: 1.09-1.16) showing a significantly increased risk of
blood group A. In the other hand, individuals with the O
blood group had a significantly reduced risk of cancer
compared to other blood groups with an OR of 0.84 (95%CI:
0.80-0.88) [33]. In all the reported cases, the exact
mechanism by which blood group O causes a risk reduction
is not fully understood. However, many possible
explanations were suggested. For instance, the intracellular
adhesion molecule-1 (sICAM-1) levels were found to be
higher in group O individuals [34]. It is possible that the
reduced levels of sICAM-1 promote tumor metastasis in
non-group O individuals [35]. Furthermore, the single
nucleotide polymorphism (SNP) of the ABO gene (rs505922)
was found to be associated with higher levels of tumor
necrosis factor (TNF) levels. [31] These findings could
explain the relationship between specific blood groups and
carcinogenesis [36].

Conclusion
In conclusion, an understanding of blood group data

between different populations is important for effective
management of blood bank inventory and for more efficient
transfusion practices. The present study collected data from
different populations of the MENA region to reveal that
blood group O is the most common blood group type, while
AB is the least prevalent. Some of the diseases associated
with specific blood groups were also addressed. However,
more studies are required to fully understand the reported
associations and to address the inconsistencies between
studies.

Author Contributions
IM conceived and planned the manuscript writing. RZ

took the lead in writing the manuscript with equal
contribution. All authors provided critical feedback and
helped shape the research, analysis and manuscript.

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