Type of the Paper (Article LMRJ Volume 4 Issue 02 80 | P a g e Original Article ANALYSIS OF PATTERN OF ABO BLOOD GROUPS IN PEDIATRIC DIABETIC PATIENTS – AN OBSERVATIONAL STUDY Nimra Javed1, Shazia Yasin1, Javeria Fatima1, Tehmina Nafees Sonia Khan2, Tooba Fateen1, Nazish Saqlain1, Saima Farhan1 1University of Child Health Sciences and the Children’s’ Hospital, Lahore, Pakistan, 2Sir Syed College of Medical Sciences for Girls, Karachi, Pakistan ABSTRACT Diabetes Mellitus (DM) is the most frequently occurring metabolic disorder, caused by inadequacy in secretion of insulin or malfunction leading to chronic hyperglycemia. Well-established corroborations have been re- ported in the literature suggesting association of ABO blood group with DM. The available literature focuses on adult population, with limited infor- mation of said association in children. Thus this study was aimed to deter- mine the association of ABO blood group with Diabetes in pediatric patients having confirmed diagnosis. This was a comparative cross sectional study conducted from October 2021-January 2022 at Endocrinology Ward, Chil- dren Hospital Lahore (CHL), Pakistan. The study was approved by the local research ethics committee of CHL and conducted according to the declara- tion of Helsinki 2000. Blood grouping was done by forward and reverse methods. A total of 25 patients, including 18 males and 7 females were in- cluded. Frequency of blood group B (n=10;40%) was highest followed by blood group O (n=4;16%), A blood group (n=3;12%), and AB (n=1;4%) in males. In females, the blood group AB (n=3;12%) has the highest frequency followed by O (n=2;8%). Blood group A (n=1;4%) and B (n=1;4%) had the same frequency among female diabetic patients. Key Words: Diabetes mellitus, ABO blood groups, Endocrinology, Type I Diabetes, Pediatric age group. INTRODUCTION Diabetes mellitus (DM) is a chronic disorder characterized by hyperglycemias as a result of insulin dysfunction or reduced release or development of insulin resistance at cellular level. Diabetes melli- tus may occur due to disturbed metabolism of carbohydrates, protein and fat which as a result of deficiency in insulin secretion or insulin malfunction or in combination (1). Pathogenesis of diabetes mellitus has a very wide range from pancreatic cell destruction due to autoimmune disorder (2). Diabetes Mellitus is comprised of two types including insulin-dependent diabetes mellitus (IDDM or Type I), which results from the reduced insulin production, and non-insulin-dependent diabetes mellitus (NIDDM or type 2) related to the insulin resistance at the peripheral level, where insulin level remains normal or sometimes even enhanced but unable to maintain blood glucose levels (3). In Type 1 diabetes mellitus the insulin-making cells in the pancreas are destroyed by the immune system. The cell of the pancreas which produce insulin are called beta cells (4). This type of diabetes Correspondence: Dr. Tehmina Nafees, Sonia Khan Assistant Professor Department of Pathol- ogy Sir Syed College of Med- ical Sciences, Karachi Email: dr_tehmina@ya- hoo.com DOI: 10.38106/LMRJ.2022.4.2-06 Received: 29.03.2022 Accepted: 26. 06.2022 Published: 30. 06.2022 mailto:dr_tehmina@yahoo.com mailto:dr_tehmina@yahoo.com LMRJ Volume 4 Issue 02 81 | P a g e mellitus is more common in children and young people so it has another name called juvenile dia- betes mellitus (5). Type 2 DM is the most frequently reported type accounting for ~95% of all diabetic cases (6). While DM type I is commonly seen in pediatric population. On the other hand blood grouping is deter- mined by the presence of genetic pattern inherited from mother and father. There are two funda- mental systems used for blood grouping, that is ABO system based on A and B antigen i.e. A blood group: having A antigen on Red blood cells (RBC), B blood group suggest B antigen on RBC, AB blood group having both A and B antigen while O blood group have none. It is interesting that the blood group having A antigen will have anti-B antibodies and vice versa. The Rh grouping deter- mines the presence of Rh antigen and divides each blood group of ABO system into two groups; positive and negative. Blood grouping is a genetic determination, thus there is some disease preponderance, where some diseases are found more in one blood group than the other. Given the nature of DM in children this study was conducted to evaluated the pattern of ABO blood grouping pediatric children. METHODS This was a comparative cross-sectional study, conducted from October 2021 to January 2022 at en- docrinology ward, Children Hospital Lahore (CHL), Pakistan. The study was approved by the eth- ical committee of CHL and performed according to the declaration of Helsinki 2000. Total 25 diag- nosed cases of diabetes mellitus and same number for healthy (non diabetic) controls with age range 1 to 18years were included. The samples were collected through convenient sampling from the en- docrinology ward of Children Hospital Lahore. For assessment of blood group whole blood was drawn in an EDTA vial (Lavender top) and a heparinized serum vial (Yellow top). Both forward and reverse grouping was performed in the blood bank following standard procedure (7). Statistical package for the social sciences (SPSS) version 23 was used for the analysis of the data. Frequencies were evaluated and Chi-square test was used for the association between variables. A p- value was set at 0.05, and <0.05 was considered significant. RESULTS Total 25 patients and equal number of healthy controls’ samples were analyzed including 7 females in the study group and 18 males, while in control group 16 were males and 9 were females. The blood group B (n=11; 44%) followed by blood group O (n=6; 24%) were high in patients with diabe- tes mellitus. While blood group A and AB were shown to have equal frequencies (n=4; 16%). Among the healthy controls, the frequency of blood group B (11; 44%) was the highest followed by blood group A (9; 36%) and O (5; 20%). The least frequency among all the healthy control showed by blood group AB (0; 0%), as shown in Table 1. There was a significant difference in the distribution of A and O groups (p-value <0.001). Table 1. Comparison of ABO blood groups in Diabetic pediatric patients and healthy controls Blood group Controls n(%) Cases n(%) p-value A 9(36) 4(16) <0.001 B 11(44) 11(44) 0.42 AB 0 4(16) 0.09 O 5(20) 6(24) <0.001 LMRJ Volume 4 Issue 02 82 | P a g e DISCUSSION Populations showing genetic association with diabetes mellitus are crossbreed populations com- prised of the recent parenteral populations mixing in addition to the ancestral mixing. The available literature has conflicting data regarding association of blood grouping and DM, showing positive association in some studies and no significant in others. B blood group has shown more association among all blood groups. The study on the association of the ABO blood group with diabetes mellitus in Bangladesh shows that there is no significant association between blood group distribution and diabetes mellitus, in which they studied 2,312 patient samples and 8,936 control samples (8). On the contrary, this study has shown the frequency of blood group B is highest among all, and O and AB blood groups are least. Further investigation and confirmation of my studies can be done by using a larger sample size. In India, the study on the association of the ABO blood group has also been carried out on 511 patients with different racial distribution and 475 healthy control samples from the same geograph- ical and socioeconomic status with the patients provided the exclusion of diseased condition (9). Another research study demonstrated that the frequency of A and O blood group is higher in healthy controls than in diabetic patients but statistical significance was still absent. For controls, the statistical significance was present in terms of racial distribution but still absent in diabetic pa- tients (10). In current study, the prevalent blood group was B (44%) both among diabetic patients and healthy controls even having the same frequencies but there was no statistical significance p- value <0.05. AB blood group had the least frequency both in patients and healthy controls. However, the blood group A and O have shown lower frequencies among diabetic patients 16% and 24% respectively, and the same for AB which might be protective against DM. In this study the associa- tion of gender and blood groups of both patients and control samples have also been studied, which shown a significant association in chi-square test. The frequency of male (18;72%) among 25 diabetic patients is higher than females (7;28%) so, male are at higher risk of acquiring diabetes mellitus then females. Further, among males, those having blood group B (10;40%) are at risk because its fre- quency is highest among all others. Among female patients AB blood group has highest percentage (3;12%) so, in females the AB blood group is at higher risk than others. In normal control sample the frequency of male (16;64%) is higher than female (9;36%) but still lower than in patients which is 72%. These results confirm the higher association of male with diabetes mellitus. However, due to limitations of time and resources and small sample size this study has not been conducted at broader level. Further investigation on this association should be done. CONCLUSION The results obtained from this study have shown that there is no significant association of ABO blood groups with diabetes mellitus but the frequency of blood group B is highest among all and lowest frequency of O and AB shown the lower risk of diabetes mellitus among these blood groups. Other results have shown the significant association of gender with diabetes mellitus the higher percentage of male in diabetic patients than females. REFERENCES 1. Association AD. Diagnosis and classification of diabetes mellitus. Diabetes care. 2009;32(Supple- ment_1):S62-S7. 2. Kadhem RC, Farawn KD, Al-Baaj MLA. Association of ABO blood groups with diabetes mellitus. Journal of Global Pharma Technology. 2018;10:192-5. LMRJ Volume 4 Issue 02 83 | P a g e 3. Ozougwu J, Obimba K, Belonwu C, Unakalamba C. The pathogenesis and pathophysiology of type 1 and type 2 diabetes mellitus. J Physiol Pathophysiol. 2013;4(4):46-57. 4. Dave SD, Trivedi HL, Chooramani SG, Chandra T. Management of type 1 diabetes mellitus using in vitro autologous adipose tissue trans-differentiated insulin-making cells. Case Reports. 2013;2013:bcr2013200226. 5. DiMeglio LA, Evans-Molina C, Oram RA. Type 1 diabetes. The Lancet. 2018;391(10138):2449-62. 6. Kamil M, Al-Jamal HAN, Yusoff NM. Association of ABO blood groups with diabetes mellitus. Libyan Journal of Medicine. 2010;5(1). 7. Rudmann SV. Textbook of blood banking and transfusion medicine: Elsevier Health Sciences; 2005. 8. Rahman M. Non-association of ABO blood groups with diabetes mellitus in Bangladesh. Bangla- desh Medical Research Council bulletin. 1976;2(2):144-6. 9. Koley S. The distribution of the ABO blood types in patients with diabetes mellitus. The Anthro- pologist. 2008;10(2):129-32. 10. Qureshi MA, Bhatti R. Frequency of ABO blood groups among the diabetes mellitus type 2 patients. Journal of the College of Physicians and Surgeons--Pakistan: JCPSP. 2003;13(8):453-5.