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Blood group O patients require more blood transfusion in orthotopic liver transplantation

  • Gil Cunha De Santis
    Correspondence
    Corresponding author. Address: Centro Regional de Hemoterapia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Rua Tenente Catão Roxo, 2501, Campus Universitário, CEP: 14051-140, Ribeirão Preto, SP, Brazil. Tel.: +55 1621019300; fax: +55 1621019309.
    Affiliations
    Center for Cell-Based Therapy, Regional Blood Center, Medical School of Ribeirao Preto, University of São Paulo, Brazil
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  • Karen Lima Prata
    Affiliations
    Center for Cell-Based Therapy, Regional Blood Center, Medical School of Ribeirao Preto, University of São Paulo, Brazil
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  • Roberta Braga Rodrigues
    Affiliations
    Center for Cell-Based Therapy, Regional Blood Center, Medical School of Ribeirao Preto, University of São Paulo, Brazil
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  • Ajith Kumar Sankarankutty
    Affiliations
    Digestive Surgery Division, Department of Surgery and Anatomy, Medical School of Ribeirão Preto, University of São Paulo, Brazil
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  • Orlando de Castro e Silva
    Affiliations
    Digestive Surgery Division, Department of Surgery and Anatomy, Medical School of Ribeirão Preto, University of São Paulo, Brazil
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  • Dimas Tadeu Covas
    Affiliations
    Center for Cell-Based Therapy, Regional Blood Center, Medical School of Ribeirao Preto, University of São Paulo, Brazil
    Hematology Division, Department of Internal Medicine, Medical School of Ribeirao Preto, University of São Paulo, Brazil
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Published:February 03, 2014DOI:https://doi.org/10.1016/j.transci.2014.01.013
      The ABO blood group has been associated with risk of thrombosis. There is strong evidence on the positive association between non-O blood group and higher risk of thrombotic events [
      • Muellner S.K.
      • Haut E.R.
      • Streiff M.B.
      • Holcomb J.B.
      • Cotton B.A.
      ABO blood group as a potential risk factor for venous thromboembolism in acutely injured patients.
      ]. However, it is not known whether blood group O individuals are at higher risk of bleeding, as has been suggested by some papers recently published [
      • Garcia A.A.
      • van der Heijden J.F.
      • Meijers J.C.
      • Rosendaal F.R.
      • Reitsma P.H.
      The relationship between ABO blood group and the risk of bleeding during vitamin K antagonist treatment.
      ,
      • Reddy V.M.
      • Daniel M.
      • Bright E.
      • Broad S.R.
      • Moir A.A.
      Is there an association between blood group O and epistaxis?.
      ,
      • Bayan K.
      • Tuzun Y.
      • Yilmaz S.
      • Dursun M.
      • Canoruc F.
      Clarifying the relationship between ABO/Rhesus blood group antigens and upper gastrointestinal bleeding.
      ]. A possible explanation for these findings is that individuals of blood group O have lower levels of von Willebrand factor (VWF) and factor VIII, and increased bleeding time [
      • Caekebeke-Peerlinck K.M.
      • Koster T.
      • Briet E.
      Bleeding time, blood groups and von Willebrand factor.
      ]. End-stage chronic liver disease (CLD) affects both primary and secondary hemostasis because it is associated with thrombocytopenia and reduced levels of procoagulation factors (and anticoagulation factors as well). These alterations confer to the patient a fragile equilibrium of hemostasis [
      • Roberts L.N.
      • Patel R.K.
      • Arya R.
      Haemostasis and thrombosis in liver disease.
      ]. Orthotopic liver transplantation (OLT) is a challenge to hemostasis, as patients with CLD present alterations of both primary and secondary hemostasis through a number of mechanisms [
      • Senzolo M.
      • Burra P.
      • Cholongitas E.
      • Burroughs A.K.
      New insights into the coagulopathy of liver disease and liver transplantation.
      ]. There were identified some factors associated with increased blood components requirements after OLT [
      • De Santis G.C.
      • Brunetta D.M.
      • Nardo M.
      • Oliveira L.C.
      • Souza F.F.
      • Cagnolati D.
      • et al.
      Preoperative variables associated with transfusion requirements in orthotopic liver transplantation.
      ]. The aim of this study was to evaluate the impact of ABO blood group on bleeding in patients with CLD submitted to OLT. Our hypothesis was that patients with type O blood group present a higher risk of bleeding.
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