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 Table of Contents  
Year : 2021  |  Volume : 6  |  Issue : 1  |  Page : 86-88

Response to convalescent plasma is not influenced by patient blood type

1 Department of Anesthesiology, University of Wisconsin, Madison, Wisconsin
2 Department of Anesthesiology; Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin

Date of Submission03-May-2021
Date of Decision12-May-2021
Date of Acceptance12-May-2021
Date of Web Publication29-May-2021

Correspondence Address:
Dr. William R Hartman
Department of Anesthesiology, University of Wisconsin, Madison
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/gjtm.gjtm_36_21

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Background: SARS-CoV2 virus is associated with 580,000 deaths and 32.5 million cases of COVID-19 infection in the United States. Data exist suggesting a correlation between blood type and disease acquisition and severity. No such data exist between blood type and disease response to convalescent plasma therapy. Methods: Forty-four hospitalized COVID-19 patients who were transfused with type-specific convalescent plasma were followed to determine therapeutic response and disease survivability. Statistical significance was determined as to whether a correlation between blood type and convalescent plasma treatment exists. Results: No statistically significant correlation exists between blood type and hospital length of stay or disease survivability in hospitalized COVID-19 patients who received convalescent plasma. Conclusion: Blood type does not influence outcome response to convalescent plasma in hospitalized COVID-19 patients.

Keywords: Blood type, convalescent plasma, COVID-19

How to cite this article:
Hartman WR, Hess AS, Connor JP. Response to convalescent plasma is not influenced by patient blood type. Glob J Transfus Med 2021;6:86-8

How to cite this URL:
Hartman WR, Hess AS, Connor JP. Response to convalescent plasma is not influenced by patient blood type. Glob J Transfus Med [serial online] 2021 [cited 2022 Jan 25];6:86-8. Available from: https://www.gjtmonline.com/text.asp?2021/6/1/86/317171

  Background Top

COVID-19, the disease associated with the novel coronavirus SARS-CoV2, is responsible for over 580,000 deaths in the United States.[1] Significant debate exists whether blood type may signal the severity of disease associated with SARS-CoV2 infection.[2],[3] A recent genome-wide association study of severe COVID-19 patients with respiratory failure suggests that the blood group O was associated with less risk of acquiring COVID-19 compared to non-O groups, and the blood type A individuals were at higher risk of acquiring COVID-19 than non-A blood group patients.[4] A similar result was observed with SARS-COV1 in which blood type O individuals were less likely to acquire the disease.

Individual blood type is determined by the presence or absence of specific antigens on red blood cells that have the ability to trigger an immune response. Blood type A individuals have the A antigen on red cells and B antibodies on their plasma. An individual with type B blood has the B antigen on their red cells and A antibodies on their plasma. In a similar fashion, blood type AB individuals have both A and B antigens on their red cells, but neither A nor B antibodies on their plasma, blood type O individuals have neither A nor B antigens on their red cells but have both antibodies on their plasma.[5] COVID-19 convalescent plasma is collected sera from individuals who have recovered from COVID-19 infection and transfused into type-specific patients who are sick with the disease. It stands to reason that if blood type might influence the ability to acquire COVID-19 infection, blood type may also influence how well the patient responds to convalescent plasma. Here, we analyzed whether blood type influenced response to convalescent plasma in hospitalized patients.

  Methods Top

All appropriate regulatory, Institutional Review Board and patient care protocols were in place to begin transfusions by April 9, 2020. The first unit from our donor screening program was collected on April 10, 2020, with acceptable units available for patient transfusion on April 12, 2020. Hospitalized COVID-19 patients were categorized as having “severe” or “life threatening” disease according to the protocol set forth by the Mayo Clinic Expanded Access Program. Specifically, patients with severe disease had shortness of breath, a respiratory rate greater than 30/min, blood oxygen saturations of <93% on room air, a PF ratio <300, or chest X-ray findings consistent with COVID disease. Life-threatening disease patients had respiratory failure, required mechanical ventilation, or had multi-organ failure. Between April 12 and July 28, 2020, there were 75 inpatient admissions for COVID-19 with a severe or life-threatening disease. Of these, 44 met all inclusion criteria, gave consent, and received convalescent plasma. Prior to being transfused with convalescent plasma, all patients were typed and screened for appropriate plasma transfusion. While in hospital, patients were maintained on lactated Ringer's infusions and bloused for episodes of hypotension. Outcomes were observed based on whether the patient survived hospitalization to discharge, and hospital length of stay was determined.

  Results Top

Of the 44 patients who have received COVID-19 convalescent plasma at our institution, the following blood types were determined: Twenty-six patients were blood type O, 15 patients were blood type A, two patients were type AB, and one patient was type B. Mortality of COVID-19 patients who received convalescent plasma was determined with respect to blood type [Figure 1]. We could not determine a statistically significant relationship between a patient's blood type and inhospital mortality following convalescent plasma treatment. No adverse events were noted in any patients during or following transfusion of convalescent plasma. We next sought to determine if blood type had any influence on hospital length of stay in patients who received convalescent plasma [Figure 2]. Similar to what was determined with mortality, we could find no statistically significant relationship between blood type and hospital length of stay. These same results were generated when we looked at only type O versus nontype O blood types, specifically, no relationship between the blood type of a patient who had received convalescent plasma and their outcomes.
Figure 1: In-hospital mortality by ABO type in COVID-19 patients who received convalescent plasma

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Figure 2: Hospital length of stay by ABO type in COVID-19 patients who received convalescent plasma

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  Discussion Top

SARS-CoV2 is associated with over 580,000 deaths and 32.5 million cases in the United States to date.[1] Significant work has been done to determine whether blood type might influence either ability to acquire COVID-19 infection or outcomes associated with the disease.[2],[3] In severely ill COVID-19 patients who have been hospitalized with respiratory failure, O type blood was associated with less risk of acquiring disease than non-O blood type patients, while type A patients were more likely to acquire the disease than non-A blood type individuals.[4] As the determination of blood type is based on red cell antigens and determines blood type antibodies in the plasma, we set to determine whether a correlation existed between hospitalized patient outcomes and blood type in COVID-19 patients who were treated with type-specific convalescent plasma. Our results indicate that no such relationship existed between hospital length of stay or mortality and an individual's blood type following treatment with convalescent plasma. Our results may not be able to detect a significant correlation as our number of convalescent plasma-treated hospitalized COVID-19 patients is not large. The number of patients likely under powers this study; however if we look at just type O patients and nontype O patients, we still determine no significant improvement on length of stay or survivability. While blood type may affect the ability to acquire disease or disease severity in sick individuals,[6] blood type did not seem to have any significant effect on recovery following type-specific convalescent plasma treatment.

  Conclusion Top

Based on the COVID-19-hospitalized patient population who have received convalescent plasma therapy at our tertiary care center, blood type had no significant influence on symptomatic improvement or survivability to discharge.

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  References Top

COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). Available from: https://Coronavirus. jhu. edu. [Last accessed on 2021 May 10].  Back to cited text no. 1
Latz CA, DeCarlo C, Boitano L, Png CYM, Patell R, Conrad MF, et al. Blood type and outcomes in patients with COVID-19. Ann Hematol 2020;99:2113-8.  Back to cited text no. 2
Tian S, Hu N, Lou J, Chen K, Kang X, Xiang Z, et al. Characteristics of COVID19 infection in Beijing. J Infect 2020;80:401-6.  Back to cited text no. 3
Severe Covid-19 GWAS Group, Ellinghaus D, Degenhardt F, Bujanda L, Buti M, Albillos A, et al. Genomewide association study of severe Covid-19 with respiratory failure. N Engl J Med 2020;383:1522-34.  Back to cited text no. 4
Zietz M, Zucker J, Tatonetti NP. Testing the association between blood type and COVID-19 infection, intubation and death. medRxiv 2020;[pre-print]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276013/ [Last accessed on2021 May 15].  Back to cited text no. 5
Liumbruno GM, Franchini M. Beyond immunohaematology: The role of the ABO blood group in human diseases. Blood Transfus 2013;11:491-9.  Back to cited text no. 6


  [Figure 1], [Figure 2]


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