Blood group O has been associated with an increased
bleeding tendency due to lower
von Willebrand factor (VWF) and
factor VIII (FVIII) levels. We explored whether
blood group O is independently associated with
bleeding severity in patients with mild-to-moderate
bleeding of unknown cause (BUC) in the Vienna
Bleeding Biobank cohort.
Bleeding severity was recorded with the Vicenza
bleeding score (BS).
Blood group O was overrepresented in 422 patients with BUC compared with its presence in 23 145 healthy blood donors (47.2% vs 37.6%; odds ratio, 1.48; 95% confidence interval [CI], 1.22-1.79). The BS and the number of
bleeding symptoms were significantly higher in patients with
blood group O than in patients with non-O after adjustment for VWF and FVIII levels and sex (least-square [LS] means of BSs: 6.2; 95% CI, 5.8-6.6 vs 5.3; 4.9-5.7; and of number of symptoms: LS, 3.5; 95% CI, 3.2-3.7 vs 3.0; 2.8-3.2, respectively). Oral mucosal
bleeding was more frequent in those with
blood group O than in those with other blood types (group non-O; 26.1% vs 14.3%), independent of sex and VWF and FVIII levels, whereas other
bleeding symptoms did not differ. Patients with
blood group O had increased clot density in comparison with those with
blood group non-O, as determined by rotational thromboelastometry and turbidimetric measurement of plasma clot formation. There were no differences in
thrombin generation, clot lysis, or platelet function. Our data indicate that
blood group O is a risk factor for increased
bleeding and
bleeding severity in patients with BUC, independent of VWF and FVIII levels.