ABO blood group and COVID-19: a review on behalf of the ISBT COVID-19 working group

• Type of Material: Article
• Authors: Ruchika Goel, Johns Hopkins University; Evan M Bloch, Johns Hopkins University; France Pirenne, Hôpital Henri Mondor; Arwa Z Al-Riyami, Sultan Qaboos University Hospital; Elizabeth Crowe, Johns Hopkins University; Laetitia Dau, Johns Hopkins University; Kevin Land, Vitalant, Scottsdale; Mary Townsend, Vitalant, Scottsdale; Thachil Jecko, Manchester University NHS; Naomi Rahimi-Levene, Shamir Medical Center; Gopal Patidar, All India Institute of Medical Sciences; Cassandra Josephson, Emory University; Satyam Arora, Super Speciality Pediatric Hospital and Post Graduate Teaching Institute; Marion Vermeulen, The South African National Blood Service; Hans Vrielink, Sanquin Bloodbank; Celina Montemayor, Canadian Blood Services; Adaeze Oreh, Federal Ministry of Health; Salwa Hindawi, King Abdalaziz University; Karin van den Berg, South African Natl Blood Serv; Katherine Serrano, Canadian Blood Services; Cynthia So-Osman, Sanquin Bloodbank; Erica Wood, Monash University; Dana V Devine, Canadian Blood Services; Steven L Spitalnik, Columbia University
• Language: English
• Date: 2021-02-12
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2021 International Society of Blood Transfusion
• Final Published Version (URL): http://dx.doi.org/10.1111/vox.13076
• Title of Journal or Parent Work: VOX SANGUINIS
• Volume: 116
• Issue: 8
• Start Page: 849
• End Page: 861
• Grant/Funding Information: EMB’s effort is supported in part by the National Institutes of Health (K23 HL151826). SLS’s effort is supported in part by the National Institutes of Health (R01 HL133049, R01 HL139489, R01 HL148151 and N26819 HB00003R).
• Keywords: ASSOCIATION; disease severity; Life Sciences & Biomedicine; Science & Technology; FACTOR-VIII; HUMAN PARVOVIRUS B19; ABO blood groups; INFECTION; COVID-19; GROUP ANTIGENS; Hematology; RECEPTOR; SPIKE; DISEASE; HELICOBACTER-PYLORI; CELLULAR CORECEPTOR; SARS-CoV-2; disease susceptibility
• Research Categories: Health Sciences, Pathology; Biology, Cell

Abstract

Growing evidence suggests that ABO blood group may play a role in the immunopathogenesis of SARS-CoV-2 infection, with group O individuals less likely to test positive and group A conferring a higher susceptibility to infection and propensity to severe disease. The level of evidence supporting an association between ABO type and SARS-CoV-2/COVID-19 ranges from small observational studies, to genome-wide-association-analyses and country-level meta-regression analyses. ABO blood group antigens are oligosaccharides expressed on red cells and other tissues (notably endothelium). There are several hypotheses to explain the differences in SARS-CoV-2 infection by ABO type. For example, anti-A and/or anti-B antibodies (e.g. present in group O individuals) could bind to corresponding antigens on the viral envelope and contribute to viral neutralization, thereby preventing target cell infection. The SARS-CoV-2 virus and SARS-CoV spike (S) proteins may be bound by anti-A isoagglutinins (e.g. present in group O and group B individuals), which may block interactions between virus and angiotensin-converting-enzyme-2-receptor, thereby preventing entry into lung epithelial cells. ABO type-associated variations in angiotensin-converting enzyme-1 activity and levels of von Willebrand factor (VWF) and factor VIII could also influence adverse outcomes, notably in group A individuals who express high VWF levels. In conclusion, group O may be associated with a lower risk of SARS-CoV-2 infection and group A may be associated with a higher risk of SARS-CoV-2 infection along with severe disease. However, prospective and mechanistic studies are needed to verify several of the proposed associations. Based on the strength of available studies, there are insufficient data for guiding policy in this regard.