Document Type: Original Research


1 Department of Pathology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Laboratory, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Pathology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

4 Department of Infectious Diseases and Tropical Medicine, School of Medicine, Imam Hospital complex, Tehran University of Medical Sciences, Tehran, Iran



Background & Objective: Coronavirus disease 2019 (COVID-19) is the most recent emerging viral disease. Defining the epidemiological aspects and factors influencing the susceptibility of the patients to COVID-19 has been an ongoing struggle. In the present study, we have investigated the connection between ABO histo-blood group phenotypes and the COVID-19.
Methods: This study was conducted on 397 patients with confirmed diagnoses of COVID-19 admitted to our center. Also, 500 individuals were selected to form the controls, all of whom had been disclosed to the same medical center in June 2019, before the onset of the outbreak.
Results: Our results demonstrated ABO histo-blood phenotypes are correlated with patients’ susceptibility to the infection. A higher rate of infection was observed among patients with the AB histo-blood group, while patients with the O histo-blood group have shown a lower rate of infection. The Rh blood group phenotype was not statistically significant in determining a patient’s vulnerability.
Conclusion: Similar to several previous studies about other viral diseases’ association with ABO histo-blood groups, we have concluded that an individual’s ABO histo-blood group phenotype and his/her susceptibility to COVID-19 are indeed connected. So far, only one research has been conducted about this association. Interestingly, while we observed a decreased vulnerability to the disease among patients with an O histo-blood group, we have reached discordant results regarding the increased susceptibility among individuals with an AB histo-blood group, unlike A histo-blood group in the previous study.


Main Subjects

  1. Zhou P, Yang X-L, Wang X-G, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020:1-4. [DOI:10.1038/s41586-020-2012-7] [Article] [PMID] [PMCID]
  2. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020. [DOI:10.1001/jama.2020.2648] [PMID]
  3. World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID-19-11 March 2020. Geneva, Switzerland. 2020.
  4. Cui J, Li F, Shi Z-L. Origin and evolution of pathogenic coronaviruses. Nat Rev Microbiol. 2019;17(3):181-92. [DOI:10.1038/s41579-018-0118-9] [PMID] [PMCID]
  5. Jiang F, Deng L, Zhang L, Cai Y, Cheung CW, Xia Z. Review of the clinical characteristics of coronavirus disease 2019 (COVID-19). J Gen Intern Med. 2020:1-5. [DOI:10.1007/s11606-020-05762-w] [PMID] [PMCID]
  6. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet. 2020;395(10223):507-13. [DOI:10.1016/S0140-6736(20)30211-7]
  7. Wu C, Chen X, Cai Y, Zhou X, Xu S, Huang H, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020. [DOI:10.1001/jamainternmed.2020.0994] [PMCID]
  8. Evans AS, Shepard D, Richards V. ABO blood groups and viral diseases. Yale J Biol Med. 1972;45(2):81.
  9. Conton B, Gevao S, Sahr F, Kargbo O, Philip K. Do ABO and Rhesus blood groups affect susceptibility to, and prognosis of Ebola virus infection. J Virol Antivir Res 6. 2017;1:2. [DOI:10.4172/2324-8955.1000165]
  10. Cheng Y, Cheng G, Chui C, Lau F, Chan PK, Ng MH, et al. ABO blood group and susceptibility to severe acute respiratory syndrome. JAMA Intern Med. 2005;293(12):1447-51. [DOI:10.1001/jama.293.12.1450-c]
  11. Ramani S, Giri S. Influence of histo blood group antigen expression on susceptibility to enteric viruses and vaccines. Curr Opin Infect Dis . 2019;32(5):445-52. [DOI:10.1097/QCO.0000000000000571] [PMID]
  12. Hutson AM, Atmar RL, Graham DY, Estes MK. Norwalk virus infection and disease is associated with ABO histo-blood group type. Int J Infect Dis . 2002;185(9):1335-7. [DOI:10.1086/339883] [PMID]
  13. Cooling L. Blood groups in infection and host susceptibility. Clin Microbiol Rev. 2015;28(3):801-70. [DOI:10.1128/CMR.00109-14] [PMID] [PMCID]
  14. Shahverdi E, Moghaddam M, Talebian A, Abolghasemi H. Distribution of blood groups in the Iranian general population. J Blood Group Serol Mol Genet. 2016;32(4):135.
  15. Zoonotic Diseases: Centers for Disease Control and Prevention , National Center for Emerging and Zoonotic Infectious Diseases (NCEZID); [updated July 14, 2017. Available from:
  16. Dean L, Dean L. Blood groups and red cell antigens: NCBI Bethesda, Md, USA; 2005.
  17. Alemu G, Mama M. Assessing ABO/Rh blood group frequency and association with asymptomatic malaria among blood donors attending Arba Minch blood bank, South Ethiopia. Malaria research and treatment. 2016;2016. [DOI:10.1155/2016/8043768] [PMID] [PMCID]
  18. Ruvoën-Clouet N, Ganière JP, André-Fontaine G, Blanchard D, Le Pendu J. Binding of rabbit hemorrhagic disease virus to antigens of the ABH histo-blood group family. J Virol. 2000;74(24):11950-4. [DOI:10.1128/JVI.74.24.11950-11954.2000] [PMID] [PMCID]
  19. Issitt PD, Anstee DJ. Applied blood group serology: Montgomery Scientific Publications Durham, NC; 1998.
  20. Mollicone R, Caillard T, Le Pendu J, Francois A, Sansonetti N, Villarroya H, et al. Expression of ABH and X (Lex) antigens on platelets and lymphocytes. 1988. [DOI:10.1182/blood.V71.4.1113.bloodjournal7141113] [PMID]
  21. Harrington PR, Lindesmith L, Yount B, Moe CL, Baric RS. Binding of Norwalk virus-like particles to ABH histo-blood group antigens is blocked by antisera from infected human volunteers or experimentally vaccinated mice. J Virol. 2002;76(23):12335-43. [DOI:10.1128/JVI.76.23.12335-12343.2002] [PMID] [PMCID]
  22. Kocher JF, Lindesmith LC, Debbink K, Beall A, Mallory ML, Yount BL, et al. Bat caliciviruses and human noroviruses are antigenically similar and have overlapping histo-blood group antigen binding profiles. MBio. 2018;9(3):e00869-18. [DOI:10.1128/mBio.00869-18] [PMID] [PMCID]
  23. Lee B, Dickson DM, deCamp AC, Ross Colgate E, Diehl SA, Uddin MI, et al. Histo-Blood Group Antigen Phenotype Determines Susceptibility to Genotype-Specific Rotavirus Infections and Impacts Measures of Rotavirus Vaccine Efficacy. Int J Infect Dis. 2018;217(9):1399-407. [DOI:10.1093/infdis/jiy054] [PMID] [PMCID]
  24. Garratty G, Glynn SA, McEntire R, Study RED. ABO and Rh (D) phenotype frequencies of different racial/ethnic groups in the United States. Transfusion. 2004;44(5):703-6. [DOI:10.1111/j.1537-2995.2004.03338.x] [PMID]
  25. Zhao J, Yang Y, Huang H-P, Li D, Gu D-F, Lu X-F, et al. Relationship between the ABO Blood Group and the COVID-19 Susceptibility. medRxiv. 2020. [DOI:10.1101/2020.03.11.20031096]
  26. Guillon P, Clément M, Sébille V, Rivain J-G, Chou C-F, Ruvoën-Clouet N, et al. Inhibition of the interaction between the SARS-CoV spike protein and its cellular receptor by anti-histo-blood group antibodies. Glycobiology. 2008;18(12):1085-93. [DOI:10.1093/glycob/cwn093] [PMID] [PMCID]