- Email: [email protected]
Blood groups in tuberculosis
April 1956
89
Blood Groups in Tuberculosis By ALLAN E. R. C A M P B E L L from RobroystonHospital, Glasgow T h e subject o f blood group distribution a m o n g tuberculous patients, a n d its modifying influence on susceptibility or the course o f infection, has a t t r a c t e d the attention o f m a n y investigators since I926. Sasano ( i 9 3 I ) , B r a d b u r y (I935) , a n d W e i n b e r g e r (I943), list between them 17 contributions in addition to their own. T h e findings can be summarized thus: a p r e p o n d e r a n c e of G r o u p A in 3 series, of G r o u p O in 4 series, no variation in 13 series; a b e t t e r prognosis for G r o u p A in 3 series, and increased hacmoptysis in G r o u p s A and AB in one series. T h e Rhesus blood groups do not a p p e a r to have been investigated in this connexion before. T h e object o f the present work was to find out the distribution o f A B O and Rhesus blood groups in tuberculous patients, a n d to ascertain a n y correlation between each g r o u p a n d sex, site o f disease and age o f onset. T h e prognosis in tuberculosis has changed rapidly, and it is not here considered, since a v e r y prolonged follow-up would be necessary. H a e m o p t y s i s occurs infrequently, and as the recorded d a t a wcrc i n a d e q u a t e it also has not been considered. Methods Tile case records of patients discharged from tile sanatorium section of the Robroyston Hospital in the three years previous to February I955 were scrutinized, as also were those of all in-patients. In the case of genito-urinary tuberculosis, all available records in the hospital Genito-Urinary Section were consulted. The following points were sought: blood group, (ABO and Rhesus) ; sites of disease; age of patient at time of onset. Care was taken that no patient was included more than once. The ABO blood groups of 56o patients and the Rhesus groups of 5oi were recorded. O f this series more than 9 ° per cent had been routinely grouped by the staff of the Blood Transfusion Service, Glasgow; the rest were blood-grouped pre-operatively. The sites of disease were determined by reference to the clinical notes, radiological and pathological reports, and were classified as follows: pulmonary, bone and joint, genito-urinary, and other. The number of patients with 'other' forms was small, and they are not considered as a separate group in the tables. One patient could appear in more than one group. The age at time ofonset was taken as the age at the beginning of the illness leading up to notification. The main difficulty found in classification was that some of the patients with extrapulmonary tuberculosis were known to have pulmonary lesions which did n o t in themselves require treatment. It was considered that they should also be included in tile pulmonary section if the radiologist had reported the lesion. The control series was formed from 5,898 consecutive new blood donors from Glasgow and district over the period I953 - I955, and represents the general population from which the tuberculous patients were drawn. Results
ABO Groups T h e p e r c e n t a g e distributions o f the A B O blood groups in each o f the system
9°
BLOOD GROUPS IN TUBERCULOSIS
A ~ i l 1956
groups, male and female, do not differ significantly from the distribution a m o n g the general p o p u l a t i o n ( T a b l e I). Rhesus Groups W h e n all patients, male and female, are considered, the p r o p o r t i o n who are Rhesus positive does not differ significantly from the p r o p o r t i o n in the control series ( T a b l e II). TABLE I.-
ABO
BLOOD OROUPS IN
560
TUBERCULOUS PATIENTS AND 5,898 BLOOD
DONORS Blood Group Total
Patients
A
%
B
%
AB
0
%
%
M F
269 29x
91 81
34 ~8
26 33
to x1
7 IO
2 4
145 167
54 57
Pulmona~
M F
218 232
73 6o
33 ~6
I6 29
7 t3
6 8
3 3
I23 I35
57 58
Bone and Joint
M F
45 55
12 I4
~7 26
6 6
I3 H
3 2
7 3
24 33
53 6o
Genitour~a~
M F
86 69
3° 25
35 36
12 i
;4 2
i 2
i 3
43 41
5° 59
5898
I9O6
Blood dono~
637
I78
32
3177
11
3
54
TABLE II. -RHESUS BLOOD GROUPS IN 501 TUBERCULOUS PATIENTS AND 5,898 BLOOD DONORS
To~l
Positive
Rh~us Wegat~e
%
%
Patients
M F
226 275
182 225
8o 82
44 5°
2o x8
Pulmona~
M F
i77 223
i48 182
84 82
29 41
x6 z8
Bone andJomt
M F
37 5°
26 37
7° 74
xl I3
3° 26
Geni~-urina~
M F
62 6o
4° 5°
65 83
22 Io
35 ;7
5898
4899
83
999
x7
Blood donors
A[3ril 1956
T U BER GL E
91
This is also true when pulmonary disease in both sexes, and genito-urinary disease in females are considered. But among males with genito-urinary disease a greater proportion are Rhesus negative, the difference from the population of Glasgow in general being statistically significant ( x ' = i 4 . 9 , P < o ' o I ) . Similarly for males with bone and joint disease significantly more are Rhesus negative (X~ = 4"3, o'o5 > P > o-o2). Females with bone and joint disease show the same tendency, but the difference is not significant. Table III shows the numbers in each sex with pulmonary disease, those with pulmonary disease only, and by subtraction those with pulmonary plus extrapulmonary disease. 4o of the I77 male patients with pulmonary disease also had extra-pulmonary lesions. The proportion of these who were Rhesus negative is significantly higher than the proportion among the general population (x 3 = I I "9, P < o.ol). There is, on the other hand, a higher proportion of Rhesus positive males among those with pulmonary lesions only (X2 = 4"3, o ' o 5 > P > ' o 2 ) . But such differences are not seen among the female patients. Age at Onset of Disease Only blood groups A, O, Rhesus positive and negative provide large enough numbers for analysis (Table IV). No significant differences between these blood groups were found in the mean ages of onset of the disease.
Discussion Rich (I95I), discussing the question of localization of tuberculosis states that mechanical factors and oxygen supply can account for many but not all of the local differences in resistance. Here it has been suggested that there may be an TABLE III.-RHESUS BLOOD GROUPS IN 400 PATIENTS WITtI PULMONARY TUBERCULOSIS AND 5,898 BLOOD DONORS
Rhesus
Total
Males Pulmonary Pulmonary only Pulmonary and extrapuhnonary
Females Pulmonary Pulmonary only Pulmonary and extrapulmonary
Blood Donors
Positive
%
aVegative
%
I77
x48
84
29
16
I37
i23
9°
14
to
4°
25
67
15
33
223
I82
8z
41
i8
172
x38
8o
34
2o
51
44
86
7
14
5898
4899
83
999
17
92
April I956
BLOOD GROUPS IN TUBERCULOSIS TABLE
I V . - AoE AT ONSET OF ILLNESS AND A, O AND RIIESUS BLOOD GROUPS Age years
Total
A
0
Males Rh+
Rh -
A
0
Females Rh+
Rh-
84
131
x6o
32
69
I4O
17o
42
I5 - 24 25 - 34 35 - 44 45 -
35 27 I8 4
6i 49 x8 3
70 58 25 7
I4 xo 7 I
49 Io 8 2
91 29 15 5
I°7 39 19 5
3° 5 6 I
Mean age
~8.8
o6.6
27.8
a7.8
24. 7
25.2
25.2
~4.6
association between the Rhesus blood groups, the sex of the patient, and the site of the disease. Extra-pulmonary disease, for instance, either alone or in association with pulmonary disease appears to occur more frequently in Rhesus negative than Rhesus positive males. I f these findings are confirmed they suggest that the localization of blood-borne tuberculosis depends to some extent on inherited characteristics of the blood.
Summary The distribution of ABO and Rhesus blood groups in a series of 560 patients with tuberculosis has been compared with tlle distribution among 5,898 healthy blood donors. Extra-pulmonary lesions with or without pulmonary disease appeared to be more frequent in Rhesus-negative than Rhesus-positive males. Bone and joint disease also seemed more common in Rhesus-negative women; but the distribution of Rhesus groups in women with genito-urinary disease or with both pulmonary and extra-pulmonary disease was not significantly different from the distribution in the non-tuberculous subjects. I wish to express my sincere thanks to Dr Foulis, Superintendent of Robroyston Hospital, Glasgow, for his generous assistance; and to Dr Borthwick and Dr McIntyre for allowing me access to their patients. I am also indebted to Dr Robb, Department of Mathematics, University of Glasgow, Dr Wallace of the Blood Transfusion Service, Glasgow and Dr Gemmell. References
Bradbury, F. G. S. (i934) Tubercle, Lond., 16, g 13. Rich, A. R. (x95t) The Pathogenesis of Tuberculosis, Blaekwell Scientific Publications, Oxford. Sasano, K. T. (193 Q Amer. Rev. Tuberc., 23, ~o 7. Weinberger M. 0943), Brit. 07. Tuberc., 37, 7o.
89
Blood Groups in Tuberculosis By ALLAN E. R. C A M P B E L L from RobroystonHospital, Glasgow T h e subject o f blood group distribution a m o n g tuberculous patients, a n d its modifying influence on susceptibility or the course o f infection, has a t t r a c t e d the attention o f m a n y investigators since I926. Sasano ( i 9 3 I ) , B r a d b u r y (I935) , a n d W e i n b e r g e r (I943), list between them 17 contributions in addition to their own. T h e findings can be summarized thus: a p r e p o n d e r a n c e of G r o u p A in 3 series, of G r o u p O in 4 series, no variation in 13 series; a b e t t e r prognosis for G r o u p A in 3 series, and increased hacmoptysis in G r o u p s A and AB in one series. T h e Rhesus blood groups do not a p p e a r to have been investigated in this connexion before. T h e object o f the present work was to find out the distribution o f A B O and Rhesus blood groups in tuberculous patients, a n d to ascertain a n y correlation between each g r o u p a n d sex, site o f disease and age o f onset. T h e prognosis in tuberculosis has changed rapidly, and it is not here considered, since a v e r y prolonged follow-up would be necessary. H a e m o p t y s i s occurs infrequently, and as the recorded d a t a wcrc i n a d e q u a t e it also has not been considered. Methods Tile case records of patients discharged from tile sanatorium section of the Robroyston Hospital in the three years previous to February I955 were scrutinized, as also were those of all in-patients. In the case of genito-urinary tuberculosis, all available records in the hospital Genito-Urinary Section were consulted. The following points were sought: blood group, (ABO and Rhesus) ; sites of disease; age of patient at time of onset. Care was taken that no patient was included more than once. The ABO blood groups of 56o patients and the Rhesus groups of 5oi were recorded. O f this series more than 9 ° per cent had been routinely grouped by the staff of the Blood Transfusion Service, Glasgow; the rest were blood-grouped pre-operatively. The sites of disease were determined by reference to the clinical notes, radiological and pathological reports, and were classified as follows: pulmonary, bone and joint, genito-urinary, and other. The number of patients with 'other' forms was small, and they are not considered as a separate group in the tables. One patient could appear in more than one group. The age at time ofonset was taken as the age at the beginning of the illness leading up to notification. The main difficulty found in classification was that some of the patients with extrapulmonary tuberculosis were known to have pulmonary lesions which did n o t in themselves require treatment. It was considered that they should also be included in tile pulmonary section if the radiologist had reported the lesion. The control series was formed from 5,898 consecutive new blood donors from Glasgow and district over the period I953 - I955, and represents the general population from which the tuberculous patients were drawn. Results
ABO Groups T h e p e r c e n t a g e distributions o f the A B O blood groups in each o f the system
9°
BLOOD GROUPS IN TUBERCULOSIS
A ~ i l 1956
groups, male and female, do not differ significantly from the distribution a m o n g the general p o p u l a t i o n ( T a b l e I). Rhesus Groups W h e n all patients, male and female, are considered, the p r o p o r t i o n who are Rhesus positive does not differ significantly from the p r o p o r t i o n in the control series ( T a b l e II). TABLE I.-
ABO
BLOOD OROUPS IN
560
TUBERCULOUS PATIENTS AND 5,898 BLOOD
DONORS Blood Group Total
Patients
A
%
B
%
AB
0
%
%
M F
269 29x
91 81
34 ~8
26 33
to x1
7 IO
2 4
145 167
54 57
Pulmona~
M F
218 232
73 6o
33 ~6
I6 29
7 t3
6 8
3 3
I23 I35
57 58
Bone and Joint
M F
45 55
12 I4
~7 26
6 6
I3 H
3 2
7 3
24 33
53 6o
Genitour~a~
M F
86 69
3° 25
35 36
12 i
;4 2
i 2
i 3
43 41
5° 59
5898
I9O6
Blood dono~
637
I78
32
3177
11
3
54
TABLE II. -RHESUS BLOOD GROUPS IN 501 TUBERCULOUS PATIENTS AND 5,898 BLOOD DONORS
To~l
Positive
Rh~us Wegat~e
%
%
Patients
M F
226 275
182 225
8o 82
44 5°
2o x8
Pulmona~
M F
i77 223
i48 182
84 82
29 41
x6 z8
Bone andJomt
M F
37 5°
26 37
7° 74
xl I3
3° 26
Geni~-urina~
M F
62 6o
4° 5°
65 83
22 Io
35 ;7
5898
4899
83
999
x7
Blood donors
A[3ril 1956
T U BER GL E
91
This is also true when pulmonary disease in both sexes, and genito-urinary disease in females are considered. But among males with genito-urinary disease a greater proportion are Rhesus negative, the difference from the population of Glasgow in general being statistically significant ( x ' = i 4 . 9 , P < o ' o I ) . Similarly for males with bone and joint disease significantly more are Rhesus negative (X~ = 4"3, o'o5 > P > o-o2). Females with bone and joint disease show the same tendency, but the difference is not significant. Table III shows the numbers in each sex with pulmonary disease, those with pulmonary disease only, and by subtraction those with pulmonary plus extrapulmonary disease. 4o of the I77 male patients with pulmonary disease also had extra-pulmonary lesions. The proportion of these who were Rhesus negative is significantly higher than the proportion among the general population (x 3 = I I "9, P < o.ol). There is, on the other hand, a higher proportion of Rhesus positive males among those with pulmonary lesions only (X2 = 4"3, o ' o 5 > P > ' o 2 ) . But such differences are not seen among the female patients. Age at Onset of Disease Only blood groups A, O, Rhesus positive and negative provide large enough numbers for analysis (Table IV). No significant differences between these blood groups were found in the mean ages of onset of the disease.
Discussion Rich (I95I), discussing the question of localization of tuberculosis states that mechanical factors and oxygen supply can account for many but not all of the local differences in resistance. Here it has been suggested that there may be an TABLE III.-RHESUS BLOOD GROUPS IN 400 PATIENTS WITtI PULMONARY TUBERCULOSIS AND 5,898 BLOOD DONORS
Rhesus
Total
Males Pulmonary Pulmonary only Pulmonary and extrapuhnonary
Females Pulmonary Pulmonary only Pulmonary and extrapulmonary
Blood Donors
Positive
%
aVegative
%
I77
x48
84
29
16
I37
i23
9°
14
to
4°
25
67
15
33
223
I82
8z
41
i8
172
x38
8o
34
2o
51
44
86
7
14
5898
4899
83
999
17
92
April I956
BLOOD GROUPS IN TUBERCULOSIS TABLE
I V . - AoE AT ONSET OF ILLNESS AND A, O AND RIIESUS BLOOD GROUPS Age years
Total
A
0
Males Rh+
Rh -
A
0
Females Rh+
Rh-
84
131
x6o
32
69
I4O
17o
42
I5 - 24 25 - 34 35 - 44 45 -
35 27 I8 4
6i 49 x8 3
70 58 25 7
I4 xo 7 I
49 Io 8 2
91 29 15 5
I°7 39 19 5
3° 5 6 I
Mean age
~8.8
o6.6
27.8
a7.8
24. 7
25.2
25.2
~4.6
association between the Rhesus blood groups, the sex of the patient, and the site of the disease. Extra-pulmonary disease, for instance, either alone or in association with pulmonary disease appears to occur more frequently in Rhesus negative than Rhesus positive males. I f these findings are confirmed they suggest that the localization of blood-borne tuberculosis depends to some extent on inherited characteristics of the blood.
Summary The distribution of ABO and Rhesus blood groups in a series of 560 patients with tuberculosis has been compared with tlle distribution among 5,898 healthy blood donors. Extra-pulmonary lesions with or without pulmonary disease appeared to be more frequent in Rhesus-negative than Rhesus-positive males. Bone and joint disease also seemed more common in Rhesus-negative women; but the distribution of Rhesus groups in women with genito-urinary disease or with both pulmonary and extra-pulmonary disease was not significantly different from the distribution in the non-tuberculous subjects. I wish to express my sincere thanks to Dr Foulis, Superintendent of Robroyston Hospital, Glasgow, for his generous assistance; and to Dr Borthwick and Dr McIntyre for allowing me access to their patients. I am also indebted to Dr Robb, Department of Mathematics, University of Glasgow, Dr Wallace of the Blood Transfusion Service, Glasgow and Dr Gemmell. References
Bradbury, F. G. S. (i934) Tubercle, Lond., 16, g 13. Rich, A. R. (x95t) The Pathogenesis of Tuberculosis, Blaekwell Scientific Publications, Oxford. Sasano, K. T. (193 Q Amer. Rev. Tuberc., 23, ~o 7. Weinberger M. 0943), Brit. 07. Tuberc., 37, 7o.