|Year : 2016 | Volume
| Issue : 1 | Page : 38-42
Distribution of ABO, Rh D blood groups and hemoglobin phenotypes among pregnant women attending a Tertiary Hospital in Yola, Nigeria
Jessy Thomas Medugu1, Usman Abjah2, Idris Abdullahi Nasir3, Simeon Adegoke4, Emmanuel Etim Asuquo5
1 Department of Medical Laboratory Science, University of Maiduguri, Borno State, Nigeria
2 Department of Haematology, University of Maiduguri, Borno State, Nigeria
3 Department of Medical Laboratory Services, University of Abuja Teaching Hospital, Gwagwalada, FCT Abuja, Nigeria
4 Department of Laboratory Investigations, Zankli Medical Services, Garki, FCT Abuja, Nigeria
5 Department of Medical Laboratory Services, Federal Medical Centre, Adamawa State, Yola, Nigeria
|Date of Web Publication||1-Mar-2016|
Idris Abdullahi Nasir
Department of Medical Laboratory Services, University of Abuja Teaching Hospital, Gwagwalada, FCT Abuja
Source of Support: None, Conflict of Interest: None
Background: Attempts being made to unravel the relationship between blood antigens, hemoglobin (Hb) genotypes and increased susceptibility to certain diseases are ongoing.
Objective: The study was carried out to provide data on the distribution of ABO, Rh D, and Hb variants among pregnant women receiving antenatal care at Federal Medical Centre, Yola, Nigeria.
Materials and Methods: Medical records of these subjects (n = 2226) were sorted out and analyzed according to their ABO blood group phenotypes and Hb variants.
Results: Blood group O was the most prevalent (47.7%) among our subjects, followed by A (26.6%), B (22.2%), and AB (3.5%). The Rh D antigen was positive in 97.1% and negative in 2.9% of the study population. There were five Hb genotypes AA (81.94%), AC (0.34%), AS (17.57%), SC (0.05%), and SS (0.14%). The occurrence of different ABO, Rh D blood groups and Hb variants varied significantly (P < 0.05) among pregnant women studied.
Conclusion: The frequency of ABO and Rh D blood groups will assist in the formulation of genetic counseling policies.
Keywords: ABO, RhD, blood groups, hemoglobin variants, Nigeria, pregnant women
|How to cite this article:|
Medugu JT, Abjah U, Nasir IA, Adegoke S, Asuquo EE. Distribution of ABO, Rh D blood groups and hemoglobin phenotypes among pregnant women attending a Tertiary Hospital in Yola, Nigeria. J Med Trop 2016;18:38-42
|How to cite this URL:|
Medugu JT, Abjah U, Nasir IA, Adegoke S, Asuquo EE. Distribution of ABO, Rh D blood groups and hemoglobin phenotypes among pregnant women attending a Tertiary Hospital in Yola, Nigeria. J Med Trop [serial online] 2016 [cited 2023 Oct 2];18:38-42. Available from: https://www.jmedtropics.org/text.asp?2016/18/1/38/177829
| Introduction|| |
Previous attempts made to establish the relationship between blood group antigens and increased susceptibility to certain diseases has linked some illnesses with the presence or absence of specific red cell antigens., Abnormal hemoglobin (Hb) variants expressed in humans such as sickle cell disorders have been tagged hemoglobinopathies.
ABO and Rh blood group systems are among the most important blood groups in clinical practice. ABO blood group as described by Landsteiner in 1900 constitutes the fundamental basis of blood banking and modern transfusion medicine. The presence of Rh D blood group was recognized in 1939 and subsequently confirmed to be of importance in blood group serology. The importance attached to Rh D blood group system is due to its immunogenicity in negative individuals with multiple blood transfusions and pregnancies.
The first abnormal Hbs were discovered in the middle of last century, and about 1200 variants are currently documented in the Hb variants database. Most of the abnormal Hbs result from a single point mutation while a minor group follows deletional mutations. However, more complex mechanisms have been observed in other associated disorders. Epidemiological data have ascribed what Wajcman in 2013 referred to as Hb genotypes; Hb AA, AS, SS, AC, or SC.
Sickle cell Hb (HbS) differs from normal Hb (HbA) because it has a valine in place of a glutamic acid in position number six of the beta chain of the globin molecule (β6Glu → Val). Whereas Sickle cell disease occurs when an individual is homozygous for the sickle cell mutation or is a compound heterozygote for sickle Hb and beta-thalassemia, Hb C, or some less common beta-globin mutations, the homozygous inheritance of the HbS is referred to as sickle cell anemia.
The homozygous (HbSS) sickle cell disease runs a chronic steady state punctuated by episodes of acute complications (crises). Hb C, the second most common structural Hb variant in people of African descent, is caused by the substitution of glutamic acid in position 6 of the β chain by lysine (β6Glu → Lys).
Some vaso-occlusive complications accompanying the inheritance of abnormal Hb variants include splenic infarction and attendant autosplenectomy, stroke, bone infarcts and aseptic necrosis, leg ulcers, priapism, pulmonary hypertension, pyelonephritis, pulmonary infarction, pneumonia, acute chest syndrome, prematurity, and renal failure. The severity of the clinical manifestation varies greatly from patient to patient influencing the aggressiveness of treatment modification accordingly.,
Fertility and pregnancy in women with sickle cell anemia are associated with increased infertility and fetal wastages., Megaloblastic anemia alongside chronic hemolysis associated with sickle cell anemia is responsible for chronic jaundice, a major clinical manifestation. In pregnancy, increased demand for folate for fetal growth tips the patient to more severe forms of anemia. However, folic acid supplement has aided to preserve the fetus from developing central nervous system complications, e.g., spina bifida. The birth weights of infants of mothers with sickle cell anemia are generally below average.,
The cause of neonatal death is obscure, but it may sometimes result from vaso-occlusion of the placenta; and the postmortem findings are those of intrapartum anoxia. The maternal mortality in sickle cell disease was prohibitively high, with rates that averaged 33%, lowered to about 1.5% in various series.,,
In Nigeria, most published reports on ABO and Rh D blood groups and Hb variants are centered on the outcome of pregnancies associated with this inherited condition. Published studies in Nigeria were largely carried out among the Yoruba ethnic community in the South Western part. There is a paucity of data on this subject in Yola, North-East of Nigeria. This study was carried out to generate and provide data on the frequency of ABO and Rh D blood groups and Hb genotypes among antenatal care patients in our setting.
| Materials and Methods|| |
Registers and results of all Hb phenotypes investigations carried out in the Department of Hematology, Federal Medical Centre, Yola, North-Eastern Nigeria, between March, 2010 and December, 2012 were extracted, reviewed and analyzed retrospectively using Statistical Package for Social Sciences (SPSS) (IBM SPSS, version 20, California, USA) software after obtaining ethical approval from the Ethical research Committee of the Federal Medical Centre, Yola, Nigeria.
The studied population of all pregnant women sequentially booked in antenatal care clinic of the Federal Medical Centre, Yola, between March 2010 and December 2012 were reviewed for possible inclusion into the study.
This retrospective study used a statistical power called post hoc power rather than the calculation of sample size. At 5% significance difference and 80% power, the actual difference observed with a previous study, Babadoko et al. was 2553 however, only 2226 women record conformed to the criteria for inclusion in this study.
Inclusions and Exclusions
Only pregnant women tested for ABO, Rh D, and Hb phenotypes were included in the study. Pregnant women with incomplete data entry were excluded.
Data Presentation and Statistical Analysis
Frequency distribution and prevalence of the various parameters were determined. Differences in proportions were determined by Chi-square tests using the SPSS software. A two-sided P < 0.05 at 95% confidence interval was considered statistically significant for the variables.
| Results|| |
A total of 2226 (n = 2226) records of women attending antenatal care was obtained and analyzed. The frequencies of all the ABO and Rh D blood groups are shown in [Table 1]. The most and least prevalent blood groups were blood group O and AB, 47.7% and 3.5%, respectively. Rh D + and Rh D − were recorded in 97.1% and 2.9% of studied subjects, respectively. The frequencies of Rh D groups among the four ABO groups are shown in [Table 2]. Rh D − was recorded most in group O (1.7%) and least (0.1%) AB.
|Table 1: Frequencies of ABO and Rh D blood groups of women attending antenatal care in Federal Medical Centre, Yola, between March, 2010 and December, 2012 (n=2226)|
Click here to view
|Table 2: Rh D distribution among the ABO blood groups of women attending antenatal care in Federal Medical Centre, Yola, between March, 2010 and December, 2012|
Click here to view
The most predominant Hb phenotype in this study was AA (81.9%) [Table 3]. The Hb homozygous HbCC variant was not encountered in this study. There were significant differences in the occurrence of ABO blood groups and Hb phenotypes in the studied antenatal care subjects (P < 0.05) [Table 3].
|Table 3: Frequencies of hemoglobin phenotypes of women attending antenatal care in Federal Medical Centre, Yola, between March, 2010 and December, 2012 (n=table2226)|
Click here to view
| Discussion|| |
The study was carried out to provide information on the distribution of ABO, Rh blood groups, and Hb phenotypes in pregnant women in Yola, North-Eastern Nigeria. The prevalence of ABO blood groups reported in our study is in agreement with other studies from other parts of the country. For instance, Jeremiah  reported 26.7% blood group A, 18.3% B, 2.2% AB, and 52.8% O in the South-South region of Nigeria and Uneke et al. who documented similar ABO blood group distribution in South-Eastern Nigeria. In South Western Nigeria, Tamitayo and Timothy  found a similar pattern of ABO phenotypes in their work.
The values in our study vary widely from what obtained in other races. In the Western Europe, the prevalence of group A (42%) second to 46% group O. Values obtained from South-Western Germany show group A accounting for the highest proportion of 43.26%, exceeding 41.2%, group O.
High prevalence of group O among expectant mothers offers a window for mobilizing available blood for transfusion, especially in emergencies or when there is a shortage of blood in the blood bank. There is, therefore, need to keep contacts of antigens typed antenatal care patients for possible recruitment for blood donation in times of acute need. Although the practice of transfusing blood group O to nongroup O recipients are discouraged, cautious and controlled routine test for hemolysins  as well as the preparation of washed red cells and components preparation would complement routine ABO and compatibility tests in preventing complications of blood transfusion.
The frequency of Rh D positive was 97.1%, and that of Rh D negative was 2.9% is in agreement with reports on Nigerian pregnant women and students' populations.,,, The 2.9% Rh D negative women in the study stand the risk of developing anti-D antibodies, and this can result in both moderate and severe form of hemolytic disease of the newborn. However, inclusion of this test in antenatal care programs, especially for the primigravid mothers, followed by appropriate health education will aid in reducing the risk of the disease. Although pregnant women are frequent recipients, the knowledge about the prevalence of ABO and Rh D could be used to organize predeposit blood donation to prevent maternal mortality from obstetric hemorrhage and prevent or monitor iso-immunization and hemolytic disease of the newborn.
The observed frequency of Hb AA and AS among our antenatal women, being significantly higher than other Hb variants is in concordance with other studies that reported the normal Hb (Hb AA) in the range of 55–75%.,
The prevalence of the S phenotype in our study is similar to the prevalence of sickle cell trait (Hb AS) of 20–30% in Nigeria.,, It is important to note that HbCC was not found in this studied population. However, our finding on Hb variants varies significantly from other reports. For instance, Tamitayo and Timothy  who reported 0.00% and 0.00% for Hb SS and Hb SC, respectively, and Erhabor et al. report of 0.0% HbAC and 0.0% HbSC, knowledge of the blood groups and Hb phenotypes and genotypes are useful for medical diagnosis, genetic databases, genetic counseling, and control of common genetic diseases.
| Conclusion and Recommendation|| |
Information about the prevalence of blood antigens could be used to organize predeposit blood donation to prepare for obstetric hemorrhage and monitor iso-immunization and hemolytic disease of the newborn. The striking prevalence of HbSS and HbSC traits in the studied population warrants for the coverage of wider population to obtain more detailed information which could assist in the formulation of genetic counseling policies.
We wish to acknowledge the Management of the Federal Medical Centre, Yola. Our profound appreciation goes to Mr. Ezekiel Chagwa, Mr. Babatunde Fatai, and Mr. Henry Badung for careful preserving clients' data used in this work.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ukaejiofo EO, Togbo RN. Association between ABO blood groups and some carcinomas among Nigerians. Niger Postgrad Med J 1995;3:1-4.
Calhoun L, Petz LD. Erythrocyte antigens and antibodies. Free Medical Textbooks. Every People Has Explanation. Williams Hematology. Ch. 137; 2012. Available from: . [Last accessed on 2015 Nov 25].
Hoffbrand AV, Moss PA, Petit JE. Genetic Disorders of Haemoglobin: Essential Haematology. 5th
ed. UK: Blackwell Publishing Ltd.; 2006. p. 77-93.
Seeley RR, Stephens TD, Tate P. Anatomy and Physiology. 8 ed. Dubuque, IA: The McGraw Hill; 2008. p. 1116.
Ali N, Anwar M, Bhalti FA, Nadeem A, Ali M. Frequency of ABO and RH blood groups in major ethnic groups and casts of Pakistan. Pak J Med Sci 2005;21:26-9.
Flegel WA. The genetics of the rhesus blood group system. Dtsch Arztebl 2007;104:A651-7.
Lo YM, Hjelm NM, Fidler C, Sargent IL, Murphy MF, Chamberlain PF, et al.
Prenatal diagnosis of fetal Rh D status by molecular analysis of maternal plasma. N Engl J Med 1998;339:1734-8.
Hardison RC, Chui DH, Giardine B, Riemer C, Patrinos GP, Anagnou N, et al.
HbVar: A relational database of human hemoglobin variants and thalassemia mutations at the globin gene server. Hum Mutat 2002;19:225-33.
Wajcman H. Overview of Haemoglobin Variants. Thalassemia International Federation World Congress. 13th
International Conference on Thalassemia & Haemoglobinopathies. 15th
TIF International Conference for Parents & Patients. 20th
October, 2013-Abu Dhabi-UAE; 2013.
Tamarin RH. Principles of Genetics. 7th
ed. Boston: McGraw Hall; 2002. p. 609.
Barbara W, Barbara JB. Investigation of abnormal hemoglobins and thalassemia. In: Lewis SM, Bain BJ, Bates I, editors. Dacie and Lewis Practical Haematology. 10th
ed. London: Churchill Livingstone; 2006. p. 271-310.
Alexandre AA, Yahya E. Perioparative precautions and management of sickle cell anaemia: A literature review. Rep Opin 2015;7:9-17.
Modell B, Darlison M. Global epidemiology of haemoglobin disorders and derived service indicators. Bull World Health Organ 2008;86:480-7.
Poddar D, Maude GH, Plant MJ, Scorer H, Serjeant GR. Pregnancy in Jamaican women with homozygous sickle cell disease. Fetal and maternal outcome. Br J Obstet Gynaecol 1986;93:727-32.
Powars DR, Sandhu M, Niland-Weiss J, Johnson C, Bruce S, Manning PR. Pregnancy in sickle cell disease. Obstet Gynecol 1986;67:217-28.
Prakash S, Yadav K. Maternal anaemia in pregnancy: An overview. Int J Pharm Pharm Res 2015;4:164-79.
Serjeant GR. Sickle haemoglobin and pregnancy. Br Med J (Clin Res Ed) 1983;287:628-30.
Thame M, Lewis J, Trotman H, Hambleton I, Serjeant G. The mechanisms of low birth weight in infants of mothers with homozygous sickle cell disease. Pediatrics 2007;120:e686-93.
Wilson NO, Ceesay FK, Hibbert JM, Driss A, Obed SA, Adjei AA, et al.
Pregnancy outcomes among patients with sickle cell disease at Korle-Bu Teaching Hospital, Accra, Ghana: Retrospective cohort study. Am J Trop Med Hyg 2012;86:936-42.
Eissa AA, Tuck SM. Sickle cell disease and β-thalassaemia major in pregnancy. The Obstet Gynaecol 2013;15:71-8.
Koshy M. Sickle cell disease and pregnancy. Blood Rev 1995;9:157-64.
Jeremiah ZA. An assessment of the clinical utility of routine antenatal screening of pregnant women at first clinic attendance for haemoglobin genotypes, haematocrit, ABO and Rh blood groups in Port Harcourt, Nigeria. Afr J Reprod Health 2005;9:112-7.
Kim J, Seo BS. How to calculate sample size and why. Clin Orthop Surg 2013;5:235-42.
Babadoko AA, Takai IU, Kawuwa MB. Distribution of ABO, Rh D blood groups and haemoglobin phenotypes among antenatal clinic attendees in federal medical centre Nguru, Nigeria. Borno Med J 2014;11:86-91.
Uneke CJ, Sunday-Adeoye I, Iyare FE, Ugwuja EI, Duhlinska DD. Impact of maternal Plasmodium falciparum
malaria and haematological parameters on pregnancy and its outcome in Southeastern Nigeria. J Vector Borne Dis 2007;44:285-90.
Tamitayo OI, Timothy SO. Frequency distribution of haemoglobin variants and Rh blood groups among pregnant women. Am Med J 2013;4:78-81.
Pramanik T, Pramanik S. Distribution of ABO and Rh blood groups in Nepalese medical students: A report. East Mediterr Health J 2000;6:156-8.
Wagner FF, Kasulke D, Kerowgan M, Flegel WA. Frequencies of the blood groups ABO, Rhesus, D category VI, Kell, and of clinically relevant high-frequency antigens in south-western Germany. Infusionsther Transfusionsmed 1995;22:285-90.
Uko EK, Erhabor O, Ahmed HM, Isaac IZ, Abdulrahaman Y, Wase A, et al
. Prevalence of high titre alpha and beta haemolysins among blood donors in Sokoto, North Western Nigeria. Int J Med Sci Health Care 2013;1:1-8.
Jeremiah ZA, Buseri FI. Rh antigen and phenotype frequencies and probable genotypes for the four main ethnic groups in Port Harcourt, Nigeria. Immunohematology 2003;19:86-8.
Akigbe RE, Ige SF, Afolabi AO, Azeez OM, Adegunlola GJ, Bamidele JO. Prevalence of haemoglobin variants, ABO and Rh blood groups in Ladoke Akintola University of Technology, Ogbomosho, Nigeria. Trends Med Res 2009;4:24-9.
Nwafor A, Banigo BM. A comparison of measured and predicted haemoglobin genotype in a Nigerian population in Bonny, Rivers State, Nigeria. J Appl Sci Environ Manage 2001;5:79-81.
Egesie UG, Aji JP, Egesie OJ. Prevalence of haemoglobin S on the Jos Plateau. J Med Trop 2003;5:41-4.
Reid HL, Famodu AA. Spectrophotometric quantitation of haemoglobin S fraction in heterozygous sickle-cell trait (HbAS). Med Lab Sci 1988;45:143-5.
Adeyemo OA, Soboyejo OB. Frequency distribution of ABO, Rh blood groups and blood genotypes among the cell biology and genetics students of University of Lagos, Nigeria. Afr J Biotechnol 2005;5:2062-5.
Erhabor O, Adias TC, Jeremiah ZA, Hart ML. Abnormal haemoglobin variants, ABO and Rh blood group distribution among students in the Niger Delta of Nigeria. Pathol Lab Med Int 2010;2:41-6.
[Table 1], [Table 2], [Table 3]
|This article has been cited by|
||Relationship Between ABO Blood Group and Renal Disease Patients Attending Dee Medical Centre, Bukuru, Jos, Plateau State, Nigeria
| ||E.C. Onuoha,E.M. Ike,B.O. Eledo,F.E. Hallie,T.A. Diepreye,O.A. Adaka,L.A. Osuji,F.K. Edeh,N. Nelson-Ebi |
| ||Asian Journal of Scientific Research. 2020; 14(1): 1 |
|[Pubmed] | [DOI]|