T6Chapter-1 INTRODUCTION

1.1-Blood Group

In human beings, blood is highly important fluid, which circulate all necessary chemicals, like

enzymes, hormones, nutrients and other critical substances across the whole body. Red blood

cells (RBC,s) are the most abundant blood cell, which contain inherited antigen on their

surface. These antigen are made of protein, carbohydrate, glycoprotiens and glycolipids etc. The

antigen are present on the surface of red blood cells (RBC,s) while the antibodies are present in

the blood serum (Sultana et al., 2013).

Blood group are classified on the base of presence or absence of antigens, found on the surface

of red blood cell. The blood group of a person may be either A, B, AB, and O, depending upon

their antigen. Antigen are controlled genetically, which remain unchanged throughout the life.

The discovery of ABO blood group system has contributed great deal of development to blood

banking services, blood transfusion and in solving many heredity and genetic problems and

issues etc, which help lot in reducing the morbidity and mortality rate both in children and adults.

Number of studies have reported high frequency of death amongs people due to incompatible

mating. Therefore identification of blood group is highly important in modern medicine

(Srikumari et al., 1987).

The ABO and Rh system is one of the significant blood group system and found clinically very

important, versus Rh system of blood group among 400 blood group collected (Khan et al.,

2004).

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The study on ABO blood grouping is therfore important in determination of hereditary characters

in analysis of population genetics, resolving medical legal conflict especially in paternity.The

blood group is determined by genetic make-up of the alleles of a system. Human being consist of

three alleles among which A and B alleles are co-dominant while O allele are silent and recessive

(Gupta, 1999).

Modern techniques like micro plate method, FMC (flinders medical Centre), enzyme linked

immunosoirbent assay (ELISA) and polymerase chain reaction (PCR) have greatly improved

blood testing methods (Khan et al., 2006).

1.2- Discovery of ABO Blood group.

ABO blood group system was first discovered by Karl Landsteiner in 1901 and was later

followed by the discovery of the Rhesus system. The Rh factor is genetically complex but simply

described in term of single pair of allele, (D) and (d). Rh (+ve) person are either homogenous

having DD allele or heterogeneous having Dd allele and Rhesus (-ve) are homogeneous

recessive dd allele (Alemu, 2014).

According to ABO and Rh blood grouping systems a person can belong to either of the

following eight blood groups; A+, A-, B+, B-, O+, O-, AB+, AB-, (Fathima, 2013). In human, it

was found that majority of cell types also have A, B, or O antigen on their surfaces for examples

tissues like platelets, lung tissues, mucosa cell intestinal mucosa, epidermis nervous receptors

and vascular epithelium (Nagariya, 2013).

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1.3- The Rh-System

After ABO, the Rh system is the second most important blood group system. At present, 50

different blood group antigen has been identified in Rh-system of blood. Among which D, C, c,

E and e antigen are highly important. D-antigen indicates the Rh factors, and considered as vital

fact in determination of risk for hemolytic disease in newborn (Reid and lomas, 2004). The D-

antigen when present on surface of red blood cell, it will be Rh- positive if not present the Rh-

factor will be negative. The genes of ABO and Rh (D) are located on chromosome 1 and 9

respectively (Rajshree and Raj, 2013).

It has also been found that Rh- factor has association with many disease like anemia, jaundice,

brain damage and often death, either before or shortly after birth. To get ride from all these

complication, the testing for Rh-factor in both man and women before marriage are also very

useful (Alemu, 2014).

1.4-Association of blood group with character

There are many evidences that ABO blood group have association with characters like

personality, intelligence and disease etc For example in Japan this is popular belief that a

person’s group is predictive of their personality, character and compatibility with others. This

belief is also widespread elsewhere in Asia, notably and South Korea and Taiwan (Nergis et al.,

2011).

1-People with blood group (O) are considered to be social, energetic, very self-confident,

creative and popular. In Japan this type of blood is considered as one of the best type (Narkhede,

2013). Lester and Gatto, 1987 also reported that People with blood group (O), are fairly

consistent, active, and are highly optimistic.

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2- People with blood group (B) are considered to be active, frank, cheerful, light-hearted,

sociable, and attentive (Furukawa, 1927).

3- People with blood type AB are considered to be inconsistent, aggressive, and extraverted.

4- People with blood type are considered to be passive, tender-minded, shy, docile, introverted

and emotionally vulnerable (Urteager, 1983).

1.5-Association of blood group with disease

It has been found in number of studies that many diseases are also associated with blood group

for example blood group A has greater association with breast cancer (Shiryazi et al., 2013). The

patient with blood group positive are at great risk to upper gastric and duodenal ulcer than other

type of blood group (Abdulridha, 2013). It has been found that the level of total cholesterol,

glucose and systolic diastolic blood pressure are always higher in male and female patient with

blood group O verses having other blood group, with a decreasing level from group A to B then

AB (Ibraheem, 2006).

The relationship of ABO group with certain pathological condition has also been reported in

many studies for example a higher prevalence of stomach cancer has been found among people

with blood group A, similarly higher malaria infection found in person with blood group O.

Although blood group O individuals have 14% reduced risk of squamous cell carcinoma and 4%

reduced risk of basal cell carcinoma and also associated with pancreatic cancer at minimum risk.

It was also reported that antigen-B has link with ovarian cancer while antigen-A link with gastric

cancer (Xie et al., 2010). The ABO blood group system is also one of the strong predictor of

national suicide rate and genetic marker of obesity (Akhighbe et al., 2011).

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1.6-Compatibility of blood group

Compatibility of blood group is also important characters. A person with AB blood group can

receive blood from any blood group but cannot donate blood to either A or B blood group due to

absence of antibodies on surface of RBCs. Therefore they are called as universal recipients. The

person with blood group A can receive blood from A and O blood group and can donate blood

to individual with blood group A or AB. The person with blood group B can receive blood only

from person with blood group B or O, and can donate blood to individuals with blood group B or

AB. Individuals with blood group O can receive blood from O group only, but can donate blood

group to all of blood group. They are hereby called as universal donors (Hillier, 2008).

1.7- General Properties of Human Blood

Red blood cells (RBCs), are also known as erythrocytes, which are about 7.5 μm in diameter

and have thickness about 2.4 um (Tsinopoulos et al., 2002). The composition of blood is made

of about 40 –50% of red blood cells. One cubic millimeter of blood contain about five million of

RBC,s in normal human being. The red blood cell is composed of about 64% water, 28% of

hemoglobin, 7% lipids or fatty materials, and the rest consists of sugars, salts, enzymes, and

other proteins. The chief function of RBCs is to transport O2 throughout the body and return CO2

to the lungs, and also to maintain a protein known as hemoglobin. They are made in the red bone

marrow of ribs, sternum and vertebrae, when mature, they enter into blood stream where they

have a life time of about 120 days. When become, dead the RBCs break down in to spleen and

liver and are removed by cells of the reticuloendothelial system (Prakash and Arara, 1998).

1.8- Antigen and Antibodies of ABO blood groups.

Antigens are glycolipids in nature which are attached to the surface of red blood cell and inherit

from parents to offspring. People with blood group A has antigen A on red blood cell and

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antibody-B in serum, while blood group B has antigen B and antibody A. People with blood

group AB have both antigen A & B, but no antibody in the serum. People with Blood group O

has no antigen but antibody A and B are present in the serum (Laura, 2005).

Antibodies against A or B antigen are produced naturally, which are also found in certain

bacteria, like Escherichia coli. (Avent and Raid, 2000). These naturally born antibodies are

mainly immunoglobulin M (IgM). They attack and destroy red cells carrying the corresponding

antigen e,g, Anti-A attacks red cells of Group A or AB while Anti-B attacks red cells of Group B

or AB. (ISBT, 2008).

Table 1.1- ABO blood group, antibody and antigen

Blood type Antigen Antibody

A Antigen-A Antibody-B
B Antigen-B Antibody-A
O No antigen Antibody-A or antibody-B
AB Both A & B antigen No antibody

1.9-Inheritance of blood groups

The inheritance of blood group are controlled by a single gene with three alleles, IA, IB and IO.

The gene encodes by a glycosyltransferase enzymes that modifies the carbohydrate content of

RBC. The gene is located on the long arm of the 9th chromosome. The IA allele produce antigen

A, IB allele produce antigen B, and Io allele produce no antigen. Both IA and IB allele are

completely dominant over Io allele, The homozygous allele IoIo produce blood type O. If

Individuals have homozygous allele IA IA or heterozygous allele IA Io produce blood type A, and

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if individuals have homozygous allele IBIB or heterozygous allele IBIO, produce blood type B.

while Individual with heterozygous allele IAIB both produce blood type AB (Yazer et al., 2006).

All human population share the same blood system, although they vary in the frequencies if

specific types. Greater variation are found even in small population (Enosalease, 2008).The

following three allele which produce four phenotype and six genotype which are

Phenotype Genotype
O IoIo
A IAIA or IAIo
B IBIB or IAIo
AB IAIB (Mandal, 2002)

1.10-The Role Of H-Gene that express ABO antigen

The most important precursor of ABO antigen are H-antigen. Which are located on chromosome

9. This gene encode different transferase enzyme, which further encode L-fucose and produce H

antigen that remain present on surface of red blood cells as well. The A-gene encode N-acetyl-

D-galatoctosamine transferase, which are added to H-antigen and produce blood group A, while

the B gene encode D-galactose, which are added the H antigen and produce blood group B

antigen. The O gene produce passive enzyme and thus H-antigen remain unchanged and produce

no antigen. (Boorman et al., 1988).

(Matsushita et al., 1983) investigated that the blood group of an individual as same for life , but

very rarely change to addition or suppression of antigen infection, malignancy or autoimmune

disease, Another common cause of this blood group change is transplant of bone. A person who

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receive bone marrow from someone who is different ABO type, the patient blood type will

eventually will convert to the donor type.

1.11- Hemolytic disease of the new born

Hemolytic disease of the newborn child , are clinically known as erythroblastosis fetalis, which

results from blood group incompatibility between mother and fetus. When Rh-negative mother

have a baby of Rh positive blood group like the father can creat a problem. At that time the

mother immune system react the fetus Rh (+ve) red blood cells as a foreign, developed antibody

to destroy the foreign cells. As the antibody destroy the fetal red cells the baby become sick and

cause hemolytic disease of new born (Louise, 1995).

Increased destruction of red blood cells cause anemia and jaundice in fetus from the breakdown

of hemoglobin product, called bilirubin. If this bilirubin reaches high levels in blood circulation

of newborn or infant it causes mental retardation or death. HDN is mainly caused by Rh blood

group incompatibility (Louise, 1995)

Hemolytic disease can be prevented by giving drug called Rhogam to mother having Rh-

negative blood group. Rhogam is a gamma globulin containing antibodies against the Rh-

negative factor. Rhogam prevents the mother from building up immunity to Rh (-ve) factor. That

is reason that Rh (-ve) women is given injection called Rhogam immediately after the birth of

children. This procedure has largely eliminated Rh disease (Sanni and Mannir, 2014).

1.13-Necessary conditions for blood transfusion

The study of blood transfusion is called hematology. The success of blood transfusion require

compatibility of blood group, between donors and recipient. If there is no compatibility in blood

group matching, hemolytic reaction will take place, which will destroy the RBC as a result death

may occur. (laura and dean, 2005).

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1.13-The secretor trait

It has been also investigated that some antigen are also present in body secretion for example in

secretion of eyes, nose, salivary gland and mammary gland, there found antigen A and B. These

antigen are water soluble. There are called secretor trait which are inherited as dominant trait (S).

(Mandal, 2002).

1.14-Population Genetics and the Hardy–Weinberg principle

Population genetics is branch of genetic in which the frequencies of alternative state of genes in

population are studied, how it is maintained and change from generation to generation.

According to Hardy-Weinberg law, if there is no mutation, no migration, no selection and there

is random mating in population, there exist mathematical relationship between frequencies of

genotype and phenotype. For example genotype IAIA with frequency P2, genotype IAIB with

frequency 2pq, genotype IAIO with frequency 2pr, genotype IBIB with frequency q2. Genotype

IBIO with frequency 2qr, genotype IOIO with frequency r2 are calculated by appropriate

multinomial (p + q + r)2 = p2+2pq +2pr + q2+2qr + r2 (Kalmes and Huret, 2001).

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1.15-Aims and Objective

• The aim and objective of present study are to find out the frequencies and distribution of

ABO and Rh blood group in four tehsils of district swat, Barikot, Babozai, Kabal and

Matta respectively.

• The output of present study will help in providing valuable information about blood

group database in district swat in general and in study area in particular.

• The present study will also produce valuable data’s for safe blood transfusion in district

swat especially in preventing hemolytic disease of newborn and fetus due to ABO and Rh

blood system

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 Chapter- 2

METHODOLOGY
2.1-Study Area

District Swat was selected as area of research for present study. Swat is beautiful hill locked

valley situated in the North Zone of Khyber pakhtunkhwa, (CPPR, 2010), lies between the

Suleiman mountain range in the west and the Indus river in the east. The Total covering area of

Swat is about 5337 square kilometer. Swat is a beautiful valley of alush green mountains,

ranging from 600 to 6000 meters above the sea level. The latitude of swat is 34o-37/-34o-43/N and

longitude72o-19/-72o-26/ East (Bangash, 2012). Four tehsils of districts swat (Barikot, Babozai,

Kabal, and Matta) was selected for field work. Data was recorded on prescribed proforma, using

blood group test method.

Source (from google swat map)

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2.2-Sample collection

Total of 1000 blood sample both male and female were taken from houses, schools, hospitals,

community center, and foundations in four tehsil of district swat, to know exactly about ABO

blood group system and their frequency in the area.

2.3-Questionnare

The development of questionnaire was the first step for the survey. The questionnaire for the

survey developed in the following question/information were included with aim as under.

1-The area was taken as one of the most important question in the survey with aim to know the

exact distribution and frequency of ABO-blood group system in each area So, that in future

different medical related studies are planned properly.

2-Gender was taken as another next important question in the survey with aim to know weather

which sex have greater frequency of ABO blood group system.

3-Disease was also taken as one of important question in the survey to know the appropriate

relationship of both congenital and non-congenital disease with ABO blood group system.

4-The parental relationship in the survey was also taken as one of the indicator to find out the

genetic relation of disease with different blood group system.

2.4-Collection of Data

Data was collected, based on questionnaire deigned for the purpose. There was two parts in

questionnaire. The first part, include basic information e.g. age, gender, area etc. while the

second part include information about different disease in relation with blood group.

Blood group data was collected randomly from different sources in above tehsils in district swat.

using sliding methods of blood group determination. Three drops of blood was obtained from

each donor by pricking the tip of index finger with sterile lancet. Each drop of blood was placed

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on a spot plate containing a blood type antiserum .For blood group phenotyping anti-sera A, anti-

sera B, and anti-sera D was used through slide method. The drop of anti-A, anti-B and anti-D

was placed on each labeled slide and was mixed for identification of blood group. The result of

agglutination was noted immediately after mixing. If the agglutination occur in blood drop A,

that as blood group A, and if the agglutination occur in blood drop B, that as group B. If no

agglutination occur in both anti-sera A and B, as blood group O. If Agglutination occur in blood

drop of both A and B, then it was considered as blood group AB. Agglutination in anti-sera D

indicates rhesus positive and no agglutination in anti-sera D indicates rhesus negative. The result

was recorded as A+, A-, B+, B-, AB+, AB+, AB- and O+, O-. The blood group data was

recorded on prescribed proforma.

Table 2.1-Agglutination reaction of the RBC ABO blood- typing anti sera and Rh factor.

Anti-sera A Anti-sera B Anti-sera D Blood

group
Agglutination No agglutination Agglutination A+
Agglutination No agglutination No agglutination A-
No agglutination Agglutination Agglutination B+
No agglutination Agglutination No agglutination B-
Agglutination Agglutination Agglutination AB+
Agglutination Agglutination No agglutination AB-
No agglutination No agglutination Agglutination O+
No agglutination No agglutination No agglutination O-

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2.5-Statistical method of data analysis

Data were recorded in computer programme Microsoft Excel (2010). Frequency distribution and

cross tabulation were used, to estimate the percentage and association with different factors /

information collected during this survey. Chi square test was used to check the significance and

p-value to check the level of insignificance and significance in relation with ABO blood group

system.

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CHAPTER-3 RESULTS

3.1- Frequency of ABO and Rh blood group

A total of 1000 blood sample were taken both from male and female in four tehsils of district

swat during the period from February 2017 up to January 2018. Out of 1000 samples 550 sample

were collected from male sex and 450 were collected from female sex. The frequency of ABO

blood groups and Rh blood groups among individuals of each four tehsils is presented in Table

3.1 and 3.2.

Table 3.1- Distribution of ABO blood group among the four tehsils

ABO blood group distribution in percent (%)

Tehsils Group A (%) Group B (%) group O (%) group AB (%)

Barikot 46 (18.4) 68 (27.2) 69 (27.6) 67 (26.8)

Babozai 44 (17.6) 80 (32) 91 (36.4) 35 (14)

Kabal 67 (26.8) 67 (26.8) 58 (23.2) 58 (23.2)

Matta 73 (29.2) 87 (34.8) 57 (22.8) 33 (13.2)

Total 230 (23.0) 302 (30.2) 275 (27.5) 193 (19.3)

Table 3.1- Show us frequency distribution of ABO blood group in four tehsils of district swat. It

is clear from the table that Blood group B has the highest frequency (30.2%) followed by O

(27.5%), A (23.0%), while blood group AB has the lowest frequency which is about (19.3%).

The relative frequency of blood groups AB is 26.8% in Barikot, 14% in Babozai, 23.2% in Kabal

and 13.2% in Matta respectively. The frequency of blood group A is 18.4% in Barikot, 17.6% in

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Babozai, 26.8% in Kabal and 29.2% in Matta, whereas the frequency of blood group O is 27.6%

in Barikot, 36.4% in Babozai, 23.2% in Kabal, and 22.8% in Matta respectively. The highest

frequency of blood group was recorded for blood group B which has value of 27.2% in Barikot,

32% in Babozai, 26.8.1% in Kabal and 24.8% in Matta.

Table 3.2- Rh- Frequency among four tehsils (Barikot, Babozai, Kabal and Matta)

Tehsils Rh-Positive Rh-Negative

n (%) n (%)

Barikot 229 (91.6) 21 (8.4)

Babozai 220 (88) 30 (12)

Kabal 206 (82.4) 44 (17.6)

Matta 214 (85.6) 36 (14.4)

Total 869 (86.9) 131(13.1)

100
90
80
70
60
series 3
50
Series 2
40
Series 1
30
20
10
0
Rh+ Rh-

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Table 3.2- show us the frequency distribution of Rh phenotypes in four tehsils of district swat.

The frequency distribution of Rh-positive blood group in Barikot is (91.6%), Babozai (88%),

Kabal (82.4%) and Matta (85.6%) was obtained in this study. The frequency of Rh-negative

blood group in Barikot is (8.4%), Babozai (12%), Kabal (17.6%) and Matta (14.4%)

respectively. The frequency of Rh-positive blood was noted as higher in Barikot followed by

Babozai, Matta and Kabal respectively. The frequency of Rh-negative blood was recorded higher

in Kabal (17.6%). The frequency of Rh-positive was noted as higher verses Rh-negative.

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Table 3.3- Frequency of combined ABO and Rh blood group

Blood group
Rh and
blood Total
group Frequency
B O AB (%)
Tehsil A
frequency frequency frequency frequency
(%) (%) (%)
(%)

Positive 41(16.4) 60(24) 63(25.2) 65(26) 229(91.6)

Barikot
(n=250)
Negative 5(2) 8(3.2) 6(2.4) 2(0.8) 21 (8.4)

Positive 41(16.4) 75(30) 73(29.2) 31(12.4) 220 (88)

Babozai
(n=250)
Negative 3(1.2) 5(2) 18(7.2) 4(1.6) 30 (12)

Positive 54(21.6) 56(22.4) 49(19.6) 47(18.8) 206(82.4)

Kabal
(n=250)
Negative 13(5.2) 11(4.4) 9(3.6) 11(4.4) 44 (17.6)

Positive 58(23.2) 77(30.8) 48(19.2) 31(12.4) 214(85.6)

Matta
(n=250) Negative 15(6) 10(4) 9(3.6) 2(0.8) 36 (14.4)

Total Positive 196(19.6) 268(26.8) 233(23.3) 174(17.4) 869(86.9)

(n=1000 Negative 36 (3.6) 34(3.4) 42(4.2) 19(1.9) 131(13.1)

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Table 3.3- show us - the ABO blood group distribution based on Rh-factor. Greater proportion of

Rh-positive was recorded in tehsils Barikot followed by Babozai, Matta, and Kabal. The

frequency of blood group A+ was obtained to be (16.4%) in Barikot, (16.4%) in Babozai,

(21.6%) in Kabal and (23.2%) in Matta respectively.

The value of blood group B+ was noted to be (24%) in Barikot, (30%) in Babozai, (22.4%) in

Kabal and (30.8%) in Matta respectively while the value of blood group O+ was noted (25.2%)

in Barikot, (29.2%) in Babozai, (19.6%) in Kabal, and (19.2%) in Matta respectively. The

highest frequency was noted which is (29.2%) in Babozai. The value of AB+ was noted to be

(26%) in Barikot, (12.4%) in Babozai, (18.8%) in Kabal and (12.4%) in Matta respectively.

The frequency of Rh-negative is rare in four tehsil of Barikot, Babozai, Kabal and Matta. Blood

group A- is (2%) in Barikot, (1.2%) in Babozai, (5.2%) in Kabal and (6%) in Matta. The highest

frequency of blood A- was noted in Matta. The frequency Blood group B- is (3.2%) in Barikot,

(2%) in Babozai, (4.4%) in Kabal and (4%) in Matta respectively. Highest frequency were noted

in Kabal. The frequency of blood group O- was found as (2.4%) in Barikot, (7.2%) in Babozai,

(3.6%) in Kabal and (3.6%) in matta respectively. Highest frequency was noted in Babozai. The

frequency of blood group AB- is (0.8%) in Barikot, (1.6%) in Babozai, (4.4%) in Kabal, and

(0.8%) in Matta respectively. Highest frequency was noted in Kabal.

The frequency of ABO blood group were presented by using descriptive statistics and the

inferential statistics such as Chi square were presented. The detailed of results and finding are

given below

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Table 3.4- Frequency distribution

Variable Category Frequency Percent Comulative

percent
Gender Male 550 55.0% 55.0
Female 450 45.0% 100.0
A+ 194 19.4% 19.4
A- 36 3.6% 23.0
B+ 268 26.8% 49.8
Blood group
B- 34 3.4% 53.2
O+ 233 23.3% 76.5
O- 42 4.2% 80.7
AB+ 174 17.4% 98.1
AB- 19 1.9% 100.0
Barikot-swat 250 25.0% 25.0
Tehsil Babozai 250 25.0% 50.0
Kabal 250 25.0% 75.0
Matta 250 25.0% 100.0
Total 1000 100.0
Visual Congenital 61 6.1% 6.1
Non congenital 130 13.0% 19.1
disease
Normal 809 80.9% 100.0
Total 1000 100%
Ist cousin 113 11.3% 11.4%
mariges
Parent 2ndcousin 126 12.6% 24.0%
mariges
relation Non cousin 761 76.1% 100.0
mariges
Age 1-19 308 30.8% 30.8
20-29 536 53.6% 84.4
30-39 130 13.0% 97.4
40-70 27 2.7 100.0
Total 1000 100.0%

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Table 3.4- show us In this survey age, gender, area, visual disease and parental relationship were

used as a variable. Total of 1000 samples were collected from different donors, among which

male donors were about 550 (55.0%) and female donors were about 450 (45.0%). The age of the

donors from 1 to 29 years were 308 (30.8%), from 20 – 29 years were 536 (53.6%), from 30-39

years were 130 (13.0%) , and from 40-70 were 27 (2.7%).

In area distribution four tehsil were selected from distirct swat for collection of data, 250 sample

were collected from each tehsil. The parent relationship of donor, were also taken as one of

variable for tracing out the history of disease in relation with blood group. The parent using

relation observed as Ist cousin marriges were 113(11.3%), second cousin marriges were 126

(12.6%) and non cousin marriage’s as 761 (76.1%).

Relationship of disease with blood group were also taken as variable using visual observation the

data were collected as congenital 61 (6.1%), non-congenital 113 (11.3%), and healthy

conditioned were 869 (86.9%). All these variable were checked in relation with ABO blood

group distribution and frequencies of each group were recorded.

The chi-square table Show us the relationship between dependent and independent variable. The

P-value when found less then 0.05, it was declared as significant and if the P-value where found

greater, it was declared as insignificant and no association between dependent and independent

variable were noted.

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Table 3.5-Chi-square table to check the association between age

Blood Age Total Chi P

group 1-19 20-29 30-39 40-70 square value

n (%) n (%) n (%) n (%) value

A+ 68(35.0) 97(50) 25(12.8) 4(2.0) 194

A- 14(38.8) 20(55.5) 2(5.5) 0(0) 36
B+ 71(26.4) 153(57.0) 38(14.1) 6(2.2) 268
B- 7(20.5) 21(61.7) 6(17.6) 0(0) 34
O+ 60(25.7) 136(58.3) 29(12.4) 8(3.43) 233 23.701a .308
O- 17(40.4) 17(40.4) 7(16.6) 1(2.3) 42
AB+ 65(37.3) 80(45.9) 22(12.6) 7(4.0) 174
AB- 6(31.5) 11(57.8) 1(5.2) 1(5.2) 19
Total 308(30.8) 535(53.5) 130(13.0) 27(2.7) 1000

Table 3.5-Show us blood response to different age group. The chi-square value is 23.701 while

the p-value is 0.308 which is above 0.05. So, the age factor is insignificant and show no

association with blood group distribution, although the predominant blood group in age group

ranges from (1-19) is A+, in age group (20-29) and (30-39) are B+ while in age group (40-70)

O+ is the predominant blood group.

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Table 3.6-Chi-square table to check the association between gender

Blood Gender Total Chi P-

group Male Female square Value
n (%) n (%) valve
A+ 125(64.4) 69(35.5) 194 (19.4)

A- 20(55.5) 16(44.4) 36 (3.6)

B+ 141(52.6) 127(47.3) 268 (26.8)

B- 19(55.8) 15(44.1) 34 (3.4)

O+ 117(50.2) 116(49.7) 233 (23.3) 9.925a .193

O- 22(52.3) 20(47.6) 42 (4.2)

AB+ 96(55.1) 78(44.8) 174(17.4)

AB- 10(52.6) 9(47.3) 19 (1.9)

Total 550(55.0) 450(45.0) 1000 (100)

Table 3.6-Show gender wise distribution of ABO blood group distribution, for which the Chi-

square value is 9.925 while P value is 0.193 which is above 0.05. So, the gender association with

ABO blood group distribution is insignificant although the pre dominant blood group in Male is

A+ while pre dominant blood group in female is B+.

23
Table 3.7-Chi-square table to check the association between tehsils

Blood Tehsils Total Chi P-

group square value
Barikot Babozai Kabal Matta
value
n (%) n (%) n (%) n (%)
A+ 41(16.4) 41(16.4) 54(21.6) 58(23.2) 194

A- 5(2) 3(1.2) 13(5.2) 15(6) 36

B+ 60(24) 75(30) 56(22.4) 77(30.8) 268

B- 8(3.2) 5(2) 11(4.4) 10(4) 34

O+ 63(25.2) 73(29.2) 49(19.6) 48(19.2) 233 68.543a .000

O- 6(2.4) 18(7.2) 9(21.42) 9(3.6) 42

AB+ 65(26) 31(12.4) 47(18.8) 31(12.4) 174

AB- 2(0.8) 4(1.6) 11(4.4) 2(0.8) 19

Total 250(25.0) 250(25.0) 250(25.0) 250(25.0) 1000

Table 3.7-Show us tehsil wise distribution of ABO blood group distribution, for which the Chi-

square value is 68.543 while P value is 0.000 which is below 0.05 So the association with ABO

blood group distribution is significant although the pre dominant blood group is B followed by

O, A and AB .

24
Table 3.8-Chi-square table to check association between parental relation

Blood Parent relation Total Chi P-

group square value
Ist cousin 2nd cousin Non cousin value
mariges marriges marriges
n (%) n (%) n (%)

A+ 28(14.4) 26(13.4) 140(72.1) 194 (19.4)

A- 2(5.5) 4(11.1) 30(83.3) 36 (3.6)

B+ 19(7.08) 30(11.1) 219(81.7) 268 (26.8)

B- 3(8.82) 5(14.7) 26(76.4) 34 (3.4)

O+ 26(11.1) 28(12.0) 179(76.8) 233 (23.3) 19.975a .132

O- 5(11.9) 3(7.1) 34(80.9) 42 (4.2)

AB+ 28(16.0) 31(17.8) 115(66.0) 174 (17.4)

AB- 2(10.5) 2(10.5) 15(78.9) 19 (1.9)

Total 113(11.3) 129(12.9) 758(75.8) 1000(100)

Table 3.8- Show us association of parental relation with ABO blood group distribution. For

which the Chi-square value is 19.975 while p-value is 0.132 which is above 0.05, So

insignificant.

25
Table 3.9-Chi-square table to check association between diseases

Blood Yes n (%) NO n (%) Normal n (%) Total Chi P-

group square value
value
A+ 10(5.1) 15(7.71) 169(87.1) 194

A- 0(0) 3(8.33) 33(91.6) 36

B+ 9(3.35) 31(11.56) 228(8.20) 268

B- 1(2.94) 3(8.82) 30(88.2) 34

O+ 7(3.00) 46(19.74) 180(77.2) 233 65.699a .000

O- 2(4.67) 7(16.6) 33(78.5) 42

AB+ 30(17.2) 23(13.2) 121(69.5) 174

AB- 2(10.5) 2(10.5) 15(78.9) 19

Total 61(6.1%) 130(13.0) 809(80.9) 1000

Table-3.9- Show us the association of diseases with ABO blood group distribution for which the

chi-square value is 65.699 while P-value is 0.00 which is below 0.05. So, the variable is

significant it mean that AB+ blood group have more congenital diseases followed by A+, B+,

O+ respectively, while blood group A- have less congenital diseases followed by B- .O- and

AB- respectively

The highest level of non congenital diseases was noted in O+ followed by B+,AB+ and A+

respectively, while blood group AB- have less congenital followed by B-, A- and then O-

respectively.

26
The most healthy people count in blood group B+ followed by O+, A+ and AB+ respectively

while O- have more healthier people followed by A+, B+ and then AB+ respectively.

3.2-DISSCUSION
ABO and Rh blood group are not only important in blood transfusion practices but also useful

in population genetic studies, solving certain medico legal issues and study of heredity diseases

etc. It has been reported in number of research paper that blood group have association with

many disease. In present studies, it was also found that blood group (A) have significant

association particularly with heart disease. This result is also in Conformity with work done of

Patel et al., 2012, in wastern Ahemedabad, who reported that blood group (A) have association

with cardiovascular diseases.

In present study it was also found that blood group (B) have association with thalassemia and

relationship with also with some genetic disorder like extra finger were obsereved. The

association of blood group (O) with thalassemia, Hepititas A and Hepatitis C were also noted.

This result is also in conformity with worke done by Mathew,s and Chan, 1979, reported that

blood group (O), patient have more resistance to Hepatitis.

In present study the association blood group (AB+) with skeleton problem, mangolism, leprosy

skin problem , deaf and mute, and pancreatic cancer were also observed This result is also in

conformity with work done of Greer et al., 2010, who reported that individual with blood group

A, AB and B have elevated risk of pancreatic cancer then individual belong to blood group O.

In current study no significant relation in distribution of blood group between female and male

was found, This result is in conformity with finding of Parkash et al., 2013.

27
In present study, the frequency of ABO and Rh-group also studied among donors of four tehsil in

district swat. It was found, that blood group B was the most dominant group (30.2%), followed

by group O (27.5%), group A (23.0%), and group AB (19.3%). The frequency of Rh-positive

was noted as (86.9%), while (13.1%) was for Rh-negative. The Comparison of work done in

different part of Pakistan are shown with in table no 12. This statement is also in conformities

with result reported by.

Table 3.10-Comparison of frequency percentage of ABO and Rhesus blood group in

different areas of Pakistan

Population A B O AB Rh+ Rh-

Punjab 22.4 32.4 30.5 8.4 93.0 7.0

Sindh 25.00 30.00 36.00 9.00 91.80 8.20

Baluchistan 21.12 34.32 37.07 7.59 94.75 5.25

Bannu 31.03 36.23 25.07 7.67 89.27 10.73

Skardu 30.62 26.80 26.60 15.98 94.83 51.5

Gilgit 24.2 40 25.5 10 59.8 10.2

Peshawar 28.00 34.00 31.00 7.00 94.60 5.40

Present 22.8 30.2 27.5 19.5 87.1 13.3

Study

Rahman and Lodhi 2004, reported blood group frequency as B>O>A>AB as (32.4%), (30.50%),

(22.60%) and (8.60%) in his study conducted in Punjab. This result is in conformity with work

done in our present study. Amjad et al., 2002, reported similar result in his studies carried out in

Punjab. Khan et al., 2004, worked on similar pattern in bannu who reported blood group

28
frequency as B>O>A>AB as 36.23%), (31.03%), (25.07%), (7.67%), Which is conformity to our

result of present study. Khurshid et al., 1994, also confirmated the result of our present studies in

his work conducted in Peshawar and the frequency of ABO as B>O>A>AB as (34.00%),

(31.00%),(28.00%) and (7.00%). Khaskheli et al.,1994, reported the frequency of blood group O

was (36%), group B (30%), blood group A (25%) and blood group AB was found to be (7.59%)

in his study carried out in Sindh, which is different from result of present study may be due to

different race. Hussain et al., 2001 , show that blood group O was dominant (37.07%), followed

by B (34.32%), blood group A (21.12%) and blood group AB (7.57%) in his study conducted in

Baluchistan. Alam, 2005, show in his study that most leading group in skardu is A (30.62%)

followed by group B (26.80%), O (26.60%) and AB (15.98%), which is defferent from result of

present study. Islam and Robert, 2010, carried out in his study in Gilgit and showed that blood

group O was commonest (40%), group O (25.5%), A(25.4%) and AB (10%).

In present study, the frequency of Rh-positive was noted as the most dominant group (86.9%),

Followed by Rh-negative (13.1%). The above result was confirmed by Khan et al., 2004, in his

studies conducted in bannu district.

Table 3.11-Comparison of frequency percentage of ABO and Rhesus blood group in

different countries of the world

Population A B O AB Rh+ Rh-

29
 Canada 42 9.0 46.0 3.0 83.1 14.9

USA 40.0 11.0 45.0 4.0 83.0 7.0

Turkey 27.0 30.6 30.4 12.0 83.9 14.1

Bangladesh 26.6 23.2 40.6 9.6 96.8 3.2

India 23.85 20.95 39.81 6.37 94.20 3.70

Niger 24.43 20.09 53.22 3.00 93.88 6.12

Saudi 24.0 17.0 52.0 4.0 93.0 7.0

arabia

In table 3.11-Showed the comparison between present study and other country of the world.

Periyavan et al., 2010, reported that blood group O was the most commonest (39.81%)

followed by group B (29.95%), group A (23.85%) and AB (6.37%) in his study carried out in

india. Garratty et al., 2004, carried out in his study in USA that blood group O was (46%),

followed by group A (41%), group B (9%), and group AB (4%). Bashwari et al., 2001, showed

that blood group O are (52%), group A (24%), group B (17%) and group AB (4%) in a study

conducted in Saudi Arabia, which is different from the result of present study.

Talukdar and Das, 2010, reported blood group B is the most common as (30.6%) followed by O

(30.4%), A (27.0%) and AB (12.0%) in Bangladesh which is conformity to the result of present

study. Enosolease and Bazuaye, 2008, found that Blood group O is commonest followed by B,

A and AB in a stydy dine in niger. Sang, 2010, reported blood group O are (46.0%) followed by

30
A (42%), B (9.0%) and AB (3.0%) in a study done in Canada, which is contrary from result of

present study. In Bangladesh the frequency of Rh positive is (96.8%) and Rh negative is (3.2%).

In the india, (94.20%) belong to Rh-positive and (3.70%) Rh-negative. While in Niger the Rh

positive is (93.88%) and Rh negative is (6.12%). The frequency of Rh positive and Rh negative

in Saudi Arabia, Bangladash, India and Niger, which is different to our study. The frequency of

turkey, Canada and USA show conformity with present study.

CONCLUSION

The distributions of ABO and Rh blood groups of this study have similar trends with the data

from the previous studies in Pakistan as well as with some other countries.

31
In present study it was found that blood group B has the highest frequency in the area followed

by blood groups O, A and AB , while the Rh+ has highest frequency followed by Rh-.

The study of distribution of blood group is very important for blood banks & transfusion services

so the workdone of present studies will provide valuable data about blood group in four tehsil

of district swat which will be very helpful in future reaserch and also in other issues related to

morbidilities and mortalities and in blood transfusion activities specially in district swat.

The data from presents study also provides information on the genetic variability and

polymorphism of the blood group and rhesus antigens among the population in Barikot, Babozai,

Kabal and Matta people.

Recommendation

32
  ABO and Rh blood group markers are very important for blood transfusion, therefore the

following is hereby made on basis of my studies titled “ Distribution of ABO AND Rh (D)

allelic polymorphisms in human population in district swat”.

 Blood group B is the most dominant blood group in district swat.

 AB+ blood group have more association with congenital disease in district swat

especially; leprosy, mental retardation, mangolism.

 The highest level of non congenital disease was found in blood group O+ followed by

AB+, B+ and A+.

 In age group (1-19) A+ is dominant , in age group age (20-20) and (30-39) are B+ while in

age group (40-70) O+ is the predominant blood group.

 In male the blood group A+ has dominant while in female the blood group B+ is

dominant.

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