Blood Type O Is a Risk Factor for Hyperfibrinolysis and Massive Transfusion After Severe Injury

Abstract

Background: Blood type O is the most common blood type and has lower von Willebrand factor (vWF) levels (25%–35% lower than non-O blood types). von Willebrand factor is important for initiating platelet attachment and binding factor VIII. We hypothesized that patients with type O blood are at an increased risk of trauma-induced coagulopathy and bleeding post injury. Study Design: Adult trauma activations with known blood type at a level I trauma center with field systolic blood pressure < 90 mm Hg were studied retrospectively. The relationships of blood group O versus non-O to coagulation assays, massive transfusion (MT), ventilator-free days, and mortality were adjusted for confounders. Hyperfibrinolysis (HF) was defined as thromboelastogram of percent lysis in 30 min > 3%, and fibrinolysis shutdown was defined as percent lysis in 30 min < 0.9%. von Willebrand factor activity was quantified on 212 injured patients using a STAGO apparatus. Results: Overall, 268 patients met criteria. Type O patients were more likely to develop HF than non–type O blood patients (43% vs. 29%, P = 0.06) and had significantly lower vWF activity (222% vs. 249%, P = 0.01). After adjustment for New Injury Severity Score and blunt mechanism, type O had higher odds of HF (odds ratio, 1.94, 95% confidence interval, 1.09–3.47) and increased odds of MT (odds ratio, 3.02; 95% confidence interval, 1.22–7.49). Other outcomes were not significantly affected. Conclusion: Type O patients with hypotension had increased HF and MT post injury, and these were associated with lower vWF activity. These findings have implications for the monitoring of HF in patients receiving type O whole-blood transfusions post injury.

Mortality and outcomes by blood group in trauma patients: A systematic review and meta‐analysis

“…One potential explanation for this lack of significant difference among trauma patients is that factor VIII and vWF are acute phase reactants. The intense physiologic stress of a severe trauma may boost their circulating levels more effectively than other contexts in which a difference in outcomes related to blood group has been previously observed, such as cardiac surgery [38–40]. This may negate the effect of baseline differences in factor VIII and vWF among blood groups.…”

Massive transfusion in trauma

“…]. Blood type O, the most common blood type, has lower von Willebrand factor (vWF) and FVIII levels (25-35% lower than non-O blood types); this might be associated with increased bleeding, hyperfibrinolysis, and MT post injury [29].…”

Injury-induced endotheliopathy: What you need to know

“…42 In a study of 268 patients, type O patients were more likely to develop hyperfibrinolysis than non-O patients and also had increased odds of massive transfusion after adjustment for injury severity score. 43 Preexisting conditions associated with hyperadhesive VWF could also exaggerate the detrimental activities of VWF. The role of coagulation factor VIII in trauma-induced endotheliopathy and coagulopathy is largely unknown, even though it circulates together as a complex with VWF and affects VWF cleavage.…”

“…ABO blood group could therefore be a confounding factor for VWF-associated pathologies in acutely injured patients 42 . In a study of 268 patients, type O patients were more likely to develop hyperfibrinolysis than non-O patients and also had increased odds of massive transfusion after adjustment for injury severity score 43 . Preexisting conditions associated with hyperadhesive VWF could also exaggerate the detrimental activities of VWF.…”