Blood type and COVID-19: a single center experience

Background. COVID-19 is a new human infectious disease due to a novel coronavirus SARS-CoV-2.COVID- 19-related anemia was not observed notably, but decrease in hemoglobin (Hgb) was frequent. Red Blood Cells (RBCs) from COVID-19 patients(pts) are characterized by increased levels of glycolytic intermediates and altered lipidomes and show increased oxidation and fragmentation of ankyrin, spectrin beta, and the N-terminal cytosolic domain of band 3.RBCs from COVID-19 pts may have an impaired ability to transport and deliver oxygen. Dearangement in O2 transport is an attractive hypothesis as this would explain why COVID-19 hypoxemia is refractory to supplemental oxygen. Cellular models have suggested an explanation for blood type-related modulation of infection, evidencing that spike protein/Angiotensin-Converting Enzyme 2-dependent adhesion to ACE2-expressing cell lines was specifically inhibited by monoclonal or natural human anti-A antibodies. Then pts with non-A blood types, specifically O, or B blood types, which produce anti-A antibodies, may be less susceptible to SARSCoV- 2 infection due to the inhibitory effects of anti-A antibodies. This study aimed to determine if there is an association between ABO blood type and severity of COVID-19 mainly defined by anemia, blood support and admission to the intensive care unit (ICU). Methods. In our single center experience, 150 pts (M: 98 F: 52;age range: 10-92y) who tested positive for COVID-19 were identified and included from March 1st 2020 to April 30th 2021. The parameters assessed at the beginning and at the end of the hospitalization in ICU and in 'Covid Department' were: blood type ABO system, Hgb level (normal range in adult males: 14-18 gr/dl, in adult females: 12-16 gr/dl) and need of blood support (Hgb <7 gr/dl).Hospitalization in ICU, anemia, and need of blood support were evaluated for association with blood type. Univariate analysis was conducted using standard techniques to determine the independent effect of blood type on anemia, and need of blood support in pts testing positive for COVID-19. Results. During the study period, all 150 pts were admitted to hospital with a known ABO blood type ABO.100 pts were admitted to ICU. Of these, 36 (36%) were blood type A of which 20 (55,5%) needed blood support, while 16 (44,4%)developed anemia;14(14%) were blood type B of which 5 (35,7%)needed blood support and 11 (78,5%) developed anemia;3 (3%) were blood type AB and none developed anemia;47 (47%) were blood type O of which 18 (38,2%) needed blood support, while 29 (61,7%) developed anemia.50 pts were admitted at to the 'Covid department'. Of these, 25 (50%) were blood type A of which 9 (36%) needed blood support, while 16 (64%) developed anemia;4 (8%) were blood type B of which 1 (25%) needed blood support and 3 (75%) developed anemia;4 (8%) were blood type AB and half developed anemia;17 (34%) were blood type O of which 9(53%) needed blood support. Conclusions. Blood type is not associated with risk of anemia, blood support and progression to severe disease requiring hospitalization in ICU in pts testing positive for COVID-19.