|Year : 2018 | Volume
| Issue : 2 | Page : 85-89
Variations in activated partial thromboplastin time and prothrombin time in individuals of A, B, AB, and O blood groups
Chizoba Okechukwu Okeke, Uru Star Okoro, Abiodun Babatunde
Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
|Date of Submission||24-May-2018|
|Date of Acceptance||21-Jun-2018|
|Date of Web Publication||22-Aug-2018|
Mr. Chizoba Okechukwu Okeke
Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, PMB 5001, Anambra State
Source of Support: None, Conflict of Interest: None
Background: Differences in blood group have been associated with predisposition to some diseases. Activated partial thromboplastin time (APTT) measures the efficiency of the intrinsic and common coagulation pathways, whereas prothrombin time (PT) test assesses the extrinsic and common coagulation pathways.
Objective: The aim of this study was to assess the variations in PT and APTT among individuals of different ABO blood groups.
Materials and Methods: A research was conducted at College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, and a total of 200 students were recruited, consisting of 106 females and 94 males. Six milliliters of blood was withdrawn from each individual, after obtaining ethical clearance and informed consent. ABO blood grouping was done by the tile method while APTT, and PT were analyzed using the standard manual methods. Statistical analysis was carried out using Statistical Package for the Social Sciences version 21.
Results: The result shows that blood group O was predominant among the test individuals (45%) followed by blood groups A (31%) and B (15%), while blood group AB has the least percentage (9%). Blood group O showed a significantly higher APTT value (44.24 ± 15.10 s) compared to blood groups A (39.35 ± 12.12 s), B (35.93 ± 9.78 s), and AB (37.22 ± 8.15 s) (P < 0.05). Similarly, blood group A showed a significantly higher PT value (16.70 ± 2.53 s) compared to blood groups O (14.32 ± 2.37 s), B (13.53 ± 2.16 s), and AB (15.38 ± 1.79 s) (P = 0.05). Blood groups B and AB male individuals had a significantly higher PT and APTT levels, respectively, when compared with females (P < 0.05).
Conclusion: This study showed that APTT and PT levels differ among different ABO blood groups; therefore, variations in blood group of individuals may affect their intrinsic and extrinsic coagulation mechanisms.
Keywords: ABO blood group, activated partial thromboplastin time, prothrombin time
|How to cite this article:|
Okeke CO, Okoro US, Babatunde A. Variations in activated partial thromboplastin time and prothrombin time in individuals of A, B, AB, and O blood groups. Iraqi J Hematol 2018;7:85-9
|How to cite this URL:|
Okeke CO, Okoro US, Babatunde A. Variations in activated partial thromboplastin time and prothrombin time in individuals of A, B, AB, and O blood groups. Iraqi J Hematol [serial online] 2018 [cited 2018 Dec 17];7:85-9. Available from: http://www.ijhonline.org/text.asp?2018/7/2/85/239524
| Introduction|| |
Before ABO blood groups were discovered, lack of knowledge of the differences in blood composition observed between animals and humans and within the human population resulted in high rates of mortality. Blood group variations are of major clinical and medicolegal importance. Even though there are many blood group systems, the ABO blood group is of great clinical importance. ABO blood group system was discovered by Karl Landsteiner and also identified the O, A, and B blood group types in 1900 which served as the beginning of blood banking and transfusion medicine; Alfred von Decastello and Adriano Sturli discovered the AB blood group in 1902. The antigenic property of red blood cells forms the basis for ABO blood grouping.
The surface membrane of red blood cells contains antigens as complex oligosaccharides with different terminal sugar and their genes are located on the chromosome. The A, B, and H antigens are complex carbohydrate molecule found on the extracellular surface of red blood cell membrane. These A and B antigens differ in their terminal sugar, and the location of gene coding for these antigens is on chromosomes 9 and 19. These antigens are inherited as Mendelian dominants.
The clinical significance of the ABO blood group extends beyond immunohematology and transfusion medicine. The alterations in the major antigens of the ABO blood group, which are usually present on the surface of red blood cells and different epithelial cells, have revealed associations between ABO blood groups and disease, the most important being represented by infections and cardiovascular disorders,, and show an important involvement in the development of oncological and other diseases., Blood group type has been known to predispose individuals to certain diseases. This is supported by various research findings that have shown association of diseases such as gastric carcinoma, duodenal ulcer, peptic ulcers, diabetes mellitus, bleeding, malignancy, venous thrombosis, and urinary tract infection with ABO blood group types.,,
About a dozen of coagulation factors have been identified in the blood. These coagulation factors are known to be proteins that exist in the blood in an inactive state but are activated when tissues or blood vessels are damaged. Activated partial thromboplastin time (APTT) and prothrombin time (PT) are indices that give an insight into the coagulation status of individuals. They are common clinical tests used to screen generally for coagulation factor deficiencies.,
PT detects disorders of the extrinsic and common coagulation pathways. Abnormal result is usually seen when factor I (FI), FII, FV, FVII, and FX are deficient while the APTT screens for abnormalities of the intrinsic and common coagulation pathways. It monitors the activities of FI, FII, FV, FVIII, FIX, FX, FXI, and FXII. ABO blood group and gender are dependent variations in APTT and PT test.
The ABO blood group is known to influence hemostasis because it is a major determinant of the von Willebrand factor (vWF) and FVIII plasma levels. Research shows that non-O blood group individuals are more predisposed to venous thromboembolism (VTE) than individuals of O blood group and have greater levels (approximately 25%) of vWF and FVIII,,, which makes it one of the most significant disease associations described for non-O blood group individuals. Similarly, according to Liu et al. and Wang et al., plasma vWF levels and FVIII activity were significantly increased in individuals with non-O type blood compared with those with type O blood in the two groups. Thus, non-O blood groups constitute a risk factor for increased vWF and FVIII in the plasma.
With this established association between blood group and hemostasis, this research was aimed at assessing ABO blood group-dependent variations in PT and APTT which are basic coagulation tests.
| Methodology|| |
This study was conducted at College of Health Sciences, Nnamdi Azikiwe University, Nnewi. The college comprises Faculty of Health Sciences and Technology, which is made up of Medical Laboratory Science, Medical Radiography and Radiological Science, Medical Rehabilitation and Physiotherapy, and Nursing Science; Faculty of Basic Medical Science, which comprises the Department of Human Anatomy and Human Physiology; and Faculty of Medicine. The college has a population of over 2000 students.
This research is a cross-sectional study designed to assess the levels of APTT and PT in students of different ABO blood groups in the College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus.
Study population and sampling technique
The sample population was 200 undergraduate students drawn from various faculties and departments in the College of Health Sciences, Nnewi. The individuals were recruited using a convenience sampling technique.
The ethical clearance to conduct this research was obtained from the Ethics Committee of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, with reference number NAUTH/CS/66/VOL.10/67/2017/038.
Informed consent was obtained from all participants recruited for the study.
All healthy undergraduate students of College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, were included.
Those excluded from this research work include:
- Individuals with known bleeding disorders
- Individuals who were sick
- Individuals who have been transfused with blood in the previous 3 months
- Individuals who refused to give their consent.
Sample collection and analysis
Six milliliters of venous blood sample was collected by venepuncture from the individuals aseptically; 4.5 ml was dispensed into a 0.5 ml of 3.2% trisodium citrate sample bottle and the anticoagulated samples were spun at 4000 rpm for 10 min and platelet-deficient plasma was separated for PT and APTT analysis, while the remaining 1.5 ml was dispensed into ethylenediaminetetraacetic acid containers for blood grouping.
ABO blood grouping
The ABO blood grouping was done by the tile method. A drop of anti-A, -B, and -AB was placed on a white-pitted tile, and a drop of blood was placed on each of the antisera and mixed with a glass rod. The white tile was rocked gently for 4 min and was observed for agglutination.
Prothrombin time assay
PT was determined using the manual method as follows. The required volume of PT reagent to be used was removed from the vial and incubated for 10 min at 37°C. Hundred microliters of the test plasma was added into a tube and incubated at 37°C for 3 min. Two hundred microliters of the preincubated PT reagent was rapidly added and the timer was started. The time taken for clot to form was recorded.
Activated partial thromboplastin time assay
APTT was determined using the manual method as follows. The required volume of calcium chloride reagent was removed and incubated for 10 min at 37°C. The required volume of APTT reagent was removed from the vial and brought to room temperature. Hundred microliters of the sample was added to a test tube and incubated at 37°C for 2 min. Hundred microliters of the APTT reagent that is at room temperature was added, and the mixture was incubated for 3 min at 37°C. Hundred microliters of calcium chloride reagent was added rapidly and the timer was started immediately. The time for clot formation was observed and recorded.
Statistical Package for the Social Science version 21.0 (IBM, Armonk, NY, United States of America)was used for the data analysis. Results were expressed as mean ± standard deviation, and comparisons between groups and among groups were analyzed using the independent t-test and the analysis of variance, respectively. The level of significance was set at P < 0.05.
| Results|| |
The individuals comprised 90 blood group O individuals (45%), 62 blood group A individuals (31%), 30 blood group B individuals (15%), and 18 blood group AB individuals (9%). Females with O blood group had the highest frequency of 55.5% (n = 50), and also generally, there were more female individuals (53.5%, n = 107) than males (46.5%, n = 93) [Table 1].
|Table 1: Frequency of ABO blood group among the test individual based on gender|
Click here to view
Blood group O has a significantly higher APTT when compared with blood groups A, B, and AB. Similarly, blood group A had significantly higher PT when compared with other blood groups (O, B, and AB). Furthermore, PT was significantly higher in blood group AB compared with B (P < 0.05) [Table 2].
|Table 2: Comparison of activated partial thromboplastin time and prothrombin time among the different ABO blood groups|
Click here to view
There was no significant difference in the mean values of APTT and PT when compared between males and females (P > 0.05) [Table 3].
|Table 3: Comparison of activated partial thromboplastin time and prothrombin time between male and female|
Click here to view
Both the mean APTT and PT values were significantly higher in males of blood group AB and B compared to the females (P < 0.05) [Table 4].
|Table 4: Comparison of activated partial thromboplastin time and prothrombin time among the different blood group based on gender|
Click here to view
| Disscusion|| |
PT and APTT are hemostatic indices that give an insight into the coagulation status of individuals, and these tests are usually utilized to screen for coagulation factor deficiencies., There are a limited number of studies on the effect of gender and ABO blood group on the levels of APTT and PT.
This study showed a significant variation in APTT and PT among individuals of different blood groups evaluated. Blood group O showed a significantly higher APTT when compared with non-O blood groups while blood group A showed a significantly higher PT when compared with other blood groups. This agreed with the works done by Choi et al. and Fourel et al. that APTT was significantly prolonged in those with type O blood group compared with those with type non-O. However, this disagreed with another findings of Choi et al. that PT was not significantly different between those with type O blood group and non-O blood group types.
A higher APTT or PT may suggest that the concerned individuals may be more likely to be predisposed to bleeding conditions. According to Robert et al., group O individuals have the tendency to bleed and non-O blood groups to thrombose; thus, individuals with O blood group have less risk of VTE when compared with the individuals of other blood groups (A, B, and AB). A lower APTT level on non-O blood group individuals may also be linked to the association of non-O blood group having an increased risk of coronary heart disease and VTE.
The connection of this finding to the established report that blood group O individuals have a lower plasma concentration of vWF than individuals with other blood group types is not clearly defined. The presence of ABH antigenic structures on circulating vWF has been identified as the molecular basis of this phenomenon, which modulate the activity of this protein through different degrees of glycosylation.
Fourel et al. reported that sex has a significant influence on APTT, with lower mean values in females (30.9 s) than in males (31.6 s), while Abdullah et al. and Aral et al. suggested that PT levels differ between ages and gender. Our study found no significant variations in APTT and PT when both genders were compared while blood groups AB and B males have a higher APTT and PT level compared to females.
The distribution pattern of the ABO blood antigen varies among different populations in the world. As expected, blood type O was the prevalent ABO blood group in the present study which agrees with the established findings of previous studies.
| Conclusion|| |
APTT and PT levels differ among individuals of different ABO blood groups, with blood group O and blood group A individuals having a significantly higher APTT and PT, respectively. This may suggest that blood group of individuals may affect their intrinsic and extrinsic coagulation mechanisms.
It is recommended that further research should be carried out with larger population and wider geographic coverage to take cognizance of racial, ethnic, and possible geographical variations that may enhance the findings.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Giangrande PL. The history of blood transfusion. Br J Haematol 2000;110:758-67.
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.
Ganong WF. Review of Medical Physiology. 23rd
ed. New York: McGraw Hill Medical; 2005. p. 245-55.
Storry JR, Olsson ML. The ABO blood group system revisited: A review and update. Immunohematology 2009;25:48-59.
Schleef M, Strobel E, Dick A, Frank J, Schramm W, Spannagl M, et al.
Relationship between ABO and secretor genotype with plasma levels of factor VIII and von Willebrand factor in thrombosis patients and control individuals. Br J Haematol 2005;128:100-7.
Suadicani P, Hein HO, Gyntelberg F. ABO phenotypes and inflammation-related predictors of lung cancer mortality: The Copenhagen male study – A 16-year follow-up. Eur Respir J 2007;30:13-20.
Franchini M, Favaloro EJ, Targher G, Lippi G. ABO blood group, hypercoagulability, and cardiovascular and cancer risk. Crit Rev Clin Lab Sci 2012;49:137-49.
Liumbruno GM, Franchini M. Beyond immunohaematology: The role of the ABO blood group in human diseases. Blood Transfus 2013;11:491-9.
Franchini M, Capra F, Targher G, Montagnana M, Lippi G. Relationship between ABO blood group and von Willebrand factor levels: From biology to clinical implications. Thromb J 2007;5:14.
Li CI, Malone KE, Daling JR, Potter JD, Bernstein L, Marchbanks PA, et al.
Timing of menarche and first full-term birth in relation to breast cancer risk. Am J Epidemiol 2008;167:230-9.
Rasmi Y, Sadreddini M, Peirovi T, Jamali M, Khosravifar F, Dadkhah A, et al.
Frequency of ABO blood group in peptic ulcer disease in Iranian subjects. Pak J Biol Sci 2009;12:991-3.
Zhang H, Mooney CJ, Reilly MP. ABO blood groups and cardiovascular diseases. Int J Vasc Med 2012;2012:641917.
Alesci S, Borggrefe M, Dempfle CE. Effect of freezing method and storage at -20 degrees C and -70 degrees C on prothrombin time, aPTT and plasma fibrinogen levels. Thromb Res 2009;124:121-6.
Ng VL. Prothrombin time and partial thromboplastin time assay considerations. Clin Lab Med 2009;29:253-63.
Kitchen S, McCraw A, Echenagucia M. World Federation of Hemophilia (WFH); Montreal: Diagnosis of Hemophilia and Other Bleeding Disorders: A Laboratory Manual. 2nd
ed. World Federation of Hemophilia: Montreal Canada; 2010. p. 45-60.
Hinchcliff KW, Kaneps AJ, Geor RJ. Basic and clinical science of the equine athlete. In: Equine Sports Medicine and Surgery. Philadelphia, PA: W. B. Saunders; 2004. p. 1295-302.
Iazbik C, Couto CG, Gray TL, Kociba G. Effect of storage conditions on hemostatic parameters of canine plasma obtained for transfusion. Am J Vet Res 2001;62:734-5.
Moeller A, Weippert-Kretschmer M, Prinz H, Kretschmer V. Influence of ABO blood groups on primary hemostasis. Transfusion 2001;41:56-60.
Reddy VM, Daniel M, Bright E, Broad SR, Moir AA. Is there an association between blood group O and epistaxis? J Laryngol Otol 2008;122:366-8.
Wiggins KL, Smith NL, Glazer NL, Rosendaal FR, Heckbert SR, Psaty BM, et al.
ABO genotype and risk of thrombotic events and hemorrhagic stroke. J Thromb Haemost 2009;7:263-9.
Zakai NA, Judd SE, Alexander K, McClure LA, Kissela BM, Howard G. ABO blood type and stroke risk: The reasons for geographic and racial differences in stroke study. J Thromb Haemost 2014;12:564-70.
Liu X, Chen X, Yang J, Guo R. Association of ABO blood groups with von Willebrand factor, factor VIII and ADAMTS-13 in patients with lung cancer. Oncol Lett 2017;14:3787-94.
Wang Z, Dou M, Du X, Ma L, Sun P, Cao H, et al.
Influences of ABO blood group, age and gender on plasma coagulation factor VIII, fibrinogen, von Willebrand factor and ADAMTS13 levels in a Chinese population. PeerJ 2017;5:e3156.
Choi Q, Kim JE, Kim SY, Han KS, Kim HK. Influence of ABO type on global coagulation assay results: Effect of coagulation factor VIII. Clin Chem Lab Med 2015;53:1425-32.
Fourel V, Gabastou JM, Desroys du Roure F, Ehrhardt N, Robert A. Influence of age, sex and ABO blood group on activated partial thromboplastin time. Haemostasis 1993;23:321-6.
Robert A, Aillaud MF, Eschwòge V, Randrianjohany A, Scarabin Y, Juhan-Vague I. ABO blood group and risk of venous thrombosis in heterozygous carriers of factor V Leiden. Thromb Haemost 2000;83:630-1.
Ohira T, Cushman M, Tsai MY, Zhang Y, Heckbert SR, Zakai NA, et al.
ABO blood group, other risk factors and incidence of venous thromboembolism: The longitudinal investigation of thromboembolism etiology (LITE). J Thromb Haemost 2007;5:1455-61.
Franchini M, Mannucci PM. ABO blood group and thrombotic vascular disease. Thromb Haemost 2014;112:1103-9.
Abdullah S, Hatice B, Sedat A, Bahadir O, Husametin V, Ali U. Effect of gender and age on the prothrombin time (PT), activated partial thromboplastin time (aPTT) levels and international normalized ratio (INR). Adv Technol Sci Int J Mevlana Med Sci 2013;1:27-9.
Aral H, Usta M, Cilingirturk AM, Inal BB, Bilgi PT, Guvenen G, et al.
Verifying reference intervals for coagulation tests by using stored data. Scand J Clin Lab Invest 2011;71:647-52.
Smith S, Okai I, Abaidoo CS, Acheampong E. Association of ABO blood group and body mass index: A cross-sectional study from a Ghanaian population. J Nutr Metab 2018;2018:8050152.
[Table 1], [Table 2], [Table 3], [Table 4]