International Journal of Advances in Medicine

Joshi AA et al. Int J Adv Med. 2019 Oct;6(5):1647-1651

http://www.ijmedicine.com pISSN 2349-3925 | eISSN 2349-3933

DOI: http://dx.doi.org/10.18203/2349-3933.ijam20194236
Original Research Article

Impact of blood group in dengue: a study

Anagha A. Joshi1, Fazeela Muneer1*, Gayathri B. R.1, Divyashree B. N.2

1
Department of Pathology, Kempegowda Institute of Medical Sciences, Research Centre, Bengaluru, Karnataka, India
2
Department of Pathology, PES Medical College, Kuppam, Andhra Pradesh, India

Received: 15 August 2019

Revised: 30 August 2019
Accepted: 05 September 2019

*Correspondence:
Dr. Fazeela Muneer,
E-mail: docfazeela@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Dengue can result in high mortality. Several studies have shown an association of blood groups with
the severity of dengue. In our study we attempt to associate the prevalence of blood groups with the known
hematological prognosticators and thus derive its impact on the severity of dengue. We aim to study the patterns and
prevalence of different ABO blood groups in dengue fever.
Methods: A total of 100 serologically proven dengue cases over a month’s period in November 2016 were recruited
for our study. Their relevant hematological data (obtained by automated haematology analyser and peripheral smears)
and blood grouping results were recorded and analyzed.
Results: The age range was 5 months to 65 years with a slight male predominance. Analysis of the blood group
patterns showed prevalence of O group (42%) followed by A and B group (27% each). B group was more prevalent in
children (34%) and females (31%) with dengue.
The patients with B group showed increased derangement in hematological parameters namely higher number of
cases with B group showed rise in haematocrit (59%), an increased number of cases with leucopenia (56%), higher
proportion of cases with lymphocytosis (45%) and severe thrombocytopenia (74%) when compared to the other
blood groups.
Conclusions: Our study shows that blood groups can impact severity of dengue and that B group is a risk factor for
severity hence, such individuals warrant close supervision especially in the presence of other risk factors.

Keywords: Blood counts, Blood group, Dengue, Prognosticator

INTRODUCTION Fever/Dengue Shock Syndrome.3 Dengue fever is self-

limiting but severe dengue may be lethal if not treated
Dengue is an arboviral infection (DENV 1-4) transmitted promptly. As currently there is no specific treatment or
by the Aedes mosquito. It has a wide clinical spectrum vaccine for dengue, early and rapid diagnosis is crucial
from asymptomatic to undifferentiated fever and Dengue for patient management and this is dependent on clinical
hemorrhagic fever.1 Also being categorized as Non features and laboratory tests which not only aid in the
severe Dengue with or without warning signs and Severe diagnosis but in the prognosis of the disease as well.1-6
Dengue (WHO 2009).2
Factors which could serve as prediction for severe dengue
It has been estimated that globally around 50-100 million include age, genetics, nutritional status, viral strain,
individuals get infected by dengue annually, with 2-5 secondary infections and certain laboratory tests.3,7
lakh cases being that of Dengue Hemorrhagic Genetic factors include HLA and ABO blood group.
Individuals with different ABO blood groups differ in

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their susceptibility or resistance to viral, bacterial Patients with concomitant infections like Malaria &
infections and other diseases. Kaipainen and Vuorinin in Typhoid were excluded from the study.
1960 first hypothesized the relationship between blood
groups and diseases.3 Many reports have suggested an RESULTS
association of blood groups with cardiovascular diseases,
cancers and infectious diseases.8 Our study analyzed 100 cases of dengue patients in the
age range of 5 months to 65 years with an average of 32
In 1917, the association of blood group with tuberculosis years. There was a slight male predominance with a male
was published.8 Since then various studies have linked to female ratio of 1.5:1 (Table 1).
blood groups with various bacterial, parasitic and viral
diseases like malaria, cholera, E. coli and H. pylori Table 1: Age and sex distribution of patients.
infections.9,10 Some studies have linked the severity of
infection to the blood group.3,7,8,10,11 A few studies have Age distribution Sex
focused on association of Dengue infection and blood ≤14 years >14 years Male Female
groups, while some have reported increased prevalence of Number 35 65 61 39
certain blood groups in dengue, others have noted an Percentage 35 65 61 39
association of certain blood group with severity of
Dengue.3,7,9,12-14
An analysis of blood group distribution showed increased
proportion of O blood group (42%) followed by A & B
However, reports are varied among the different studies,
(27% each) and AB with 4%. The age and gender related
none of which have correlated the blood group with each
distribution of blood groups is given in Table 2.
of the hematological parameters which are affected in
dengue. Our study focuses on the association of blood
Table 2: Blood groups association with age
group and dengue, its prevalence and severity as
and gender.
knowledge of risk factors can prove to be vital for
prevention and management.
Age Gender
Blood
The aim of our study was to analyse patterns and ≤14 >14 Total
group Male Female
prevalence of different ABO blood groups in dengue and years years
to find an association between ABO blood groups and A 06 17 21 32 17 28 10 26 27
severity of dengue. B 12 34 15 23 15 25 12 31 27
O 16 46 26 40 28 46 14 36 42
METHODS AB 01 03 03 05 01 01 03 07 04
35 100 65 100 61 100 39 100
This is a prospective study done on 132 patients with
positive Dengue serology in Hematology Department Our study showed increased prevalence of B group in
over a one month period during November 2016. those with a rise in Hematocrit, that is 16 cases or 59%
out of 27 cases (Table 3).
All patients with serological confirmation of Dengue
(NS1, IgM/IgG positivity) by Rapid Card Method Our study revealed that of the 27 cases with B blood
(Standard Diagnostics-Bioline Alera) with hematology group, 15(56%) cases showed leucopenia (<4000
data (obtained by hematology automated analyzer cells/cumm) (Table 4).
Sysmex 1800 c) that is blood counts, packed cell volume
(PCV) and peripheral smear examination stained by The association of blood groups with major differential
Leishman stain and blood grouping tests were included in white cell pattern categorised as normal pattern,
the study. lymphocytosis (>45%) and neutrophilia (>75%) was
analysed (Table 5).
Results of Dengue tests were retrieved from serology
department and tabulated. The results of hematocrit and Table 3: Association of blood group and rise
blood counts were also tabulated. The peripheral smears in hematocrit.
(done as per hospital protocol for visual check of platelet
counts) were examined and the differential count pattern Blood
was established along with analysis of atypical Total(n) Number Percentage
Group
lymphocyte count. A 27 10 37
B 27 16 59
Blood grouping results (done by Forward Blood grouping O 42 21 50
-Slide method with Anti-A, Anti-B sera from Tulip AB 04 02 50
diagnostics) were also recorded.

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Table 4: Association of blood group and total An analysis of blood group association with atypical
leucocyte count. lymphocytosis (≥10%) is shown in Table 6.

Blood Total <4000 cells/mm ≥4000 cells/ mm Thrombocytopenia’s were categorized as ≤0.5 lakhs /cu
group (n) Number Percent Number Percent mm (severe) and >0.5-1.5 lakhs /cu mm as non-severe.
A 27 10 37 17 63 Severe thrombocytopenia (≤0.5 lakh /cu mm) was present
B 27 15 56 12 44 in 74% of cases of B group, followed by A (67%), O
O 42 15 36 27 64 (62%) and AB (50%) (Table 7).
AB 04 02 50 02 50

Table 5: Association of blood group with differential count pattern.

Normal pattern Lymphocytosis Neutrophilia

Blood group Total (n)
Number Percent Number Percent Number Percent
A 27 12 44 11 41 04 15
B 27 07 26 18 67 02 07
O 42 12 28 27 64 03 08
AB 04 02 50 02 50 - -

Table 6: Association of blood groups with prevalent at all ages but with slightly higher
atypical lymphocytosis. predominance in males.

Atypical Atypical There was a variation in prevalence of A and B blood

Blood Total lymphocyte Lymphocyte count groups. B group was more prevalent in children and
group (n) (10-20 %) <20% ≥20 % females (34% and 31% respectively) in dengue in
Number Percent Number Percent comparison to adults and males (23 and 25%
A 27 23 85 04 15 respectively). A few studies have claimed increased
B 27 15 55 12 45 severity of dengue in females and children.17 A group
O 42 28 67 14 33 was found predominantly in adults (32%) and males
AB 04 03 75 01 25 (28%). An assessment of all the main hematology
parameters in association with blood group in dengue
Table 7: Blood groups association with platelet count. showed significant findings viz. 59% of cases with B
group showed a rise in hematocrit followed O & AB
Blood Platelet count ≤0.5 Platelet count >0.5 (50% each). Only 37% with A group showed a rise in
Total
group lakhs / cu mm lakhs / cu mm hematocrit.
(n)
% Number Percent Number Percent
A 27 18 67 09 33
Leucopenia was noted significantly in 56 % of those with
B 27 20 74 07 26
B group as against 37% and 36% in A and O groups and
O 42 26 62 16 38
50% in AB group.
AB 04 02 50 02 50
The analysis of differential counts showed that
DISCUSSION lymphocytosis was predominantly noted in B group
followed by O group. A Group was mostly associated
Our study shows an age range of 5 months to 65 years with normal patterns and neutrophilia. Atypical
with a slight male predominance, probably due to lymphocytosis (≥20%) was more prevalent in B group,
increased occupational exposure and recreational being 45% as against 33% in O group, 25% in AB and
activities in concordance with few studies.1 15% in A group.
The analysis of blood groups showed increased Our study included cases of thrombocytopenia with
prevalence of O group (42%) followed by A and B (27% counts less than 1.5 lakh /cu mm. We observed that
each) with few studies conducted in general population.16 severe thrombocytopenia (≤0.5 lakh /cu mm) was present
However a few studies have claimed increased in 74% of cases of B group, followed by A (67%), O
prevalence of O group in dengue patients.3 (62%) and AB (50%).
The analysis of demographic data in association with Several studies have reported consistent changes in
blood groups showed that O group was uniformly hematological parameters in dengue which aid as

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 Joshi AA et al. Int J Adv Med. 2019 Oct;6(5):1647-1651

diagnostic, prognostic and therapeutic tool and include ACKNOWLEDGEMENTS

mainly changes in hematocrit, total white cell count,
differential count reflected as lymphocytosis with Funding: No funding sources
presence of atypical lymphocytes and platelet counts Conflict of interest: None declared
(thrombocytopenia).1,5,18-20 Ethical approval: This study has been approved by
Hospital Ethical Committee
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