CHAPTER ONE

 INTRODUCTION

 1.1 Background of Study

 Blood is defined as the red viscous fluid that circulates round the body supplying O2 and nutritive substances absorbed from the gastrointestinal tract to the tissues, returns CO2 to the lungs and other products of metabolism to the kidneys, functions in the regulation of body temperature, and distributes hormones and other agents that regulate cell function‖ (Saladin, 2003; Barrett et al., 2010). Blood has always had a special mystique. From time immemorial, people have seen blood flow in the body and with it, the life of individual depends. People thus presumed that blood carried a mysterious ―vital force, and Roman gladiators drank it to fortify themselves for battle. From ancient Egypt to nineteenth   Haemolytic Disease of the Newborn (Iyiola et al., 2011).The most famous blood groups are those of ABO and Rhesus (Rh) series (Khan et al., 2009). The ABO blood group are the first red cell antigens while the Rhesus blood group are the most immunogenic red cell antigens discovered (Chima et al., 2012). Both are routinely typed for in any blood bank or blood transfusion service (Bakare et al., 2006; Enosolease and Bazuaye, 2008). Blood-group antigens may be carbohydrate structures on red cell surface glycoproteins or glycolipids (Storry and Olsson, 2004; Akinnuga, 2011), or they may be determined primarily by the amino acid sequence of polypeptides or glycoproteins (Suzuki, 2005). At least 23 red cell surface proteins express blood-group polymorphism (Daniels, 2002; Yamamoto et al., 2012). The ABO blood group system of carbohydrate antigen expression on the surface of human red blood cells (RBCs) was first described by Karl Landsteiner in 1900 and represented an important step towards development of safer blood transfusions (Owen, 2000; Loscertales et. al., 2007; Iyiola et al., 2011; Chandra and Gupta, 2012). Alfred von Decastello and Adriano Sturli discovered the 4th type, AB, in 1902 (Eweidah et al., 2011) while Landsteiner and Weiner in 1940 discovered the Rhesus (Rh) blood group (Iyiola et al., 2011). Based on RBC agglutination patterns, individuals could be divided into 4 major groups A, B, AB, and O (Saladin, 2003; Suzuki, 2005; Yamamoto et al., 2012). ABO and Rhesus (Rh) blood group antigens are hereditary characters and are useful in population genetic studies, researching population migration patterns, as well as resolving certain medicolegal issues, particularly of disputed paternity and more importantly in compatibility test in blood transfusion practice (Enosolease and Bazuaye, 2008; Reddy and Sudha, 2009; Yamamoto et al., 2012). ABO and Rh genes and phenotypes vary widely across ethnic 3 groups, races and geographical boundaries despite the fact that the antigens involved are stable throughout life (Bhuvnesh et al; 2011; Iyiola et al., 2011; Chandra and Gupta, 2012). ABO gene is located on the long arm of the ninth human chromosome (9q34.1) while the Rh D and RHce genes encoding the Rh proteins (d and cc/ee, respectively) are located on chromosome 1p34-p36 (Rai et al., 2009; Iyiola et al., 2011). The ABO blood group gene is known to code for a glycosyltransferase, which acts at the last step of sequential extension of oligosaccharide chains attached to glycoproteins or glycolipids (Suzuki, 2005). The Rh blood group is named for the rhesus monkey, in which the Rh antigens were discovered in 1940. It is the most complex of the human blood-group systems with 52 well-defined antigens, the most immunogenic of which is D (RHD) (Daniels, 2002; Saladin, 2003). The Rh blood groups rank with ABO groups in clinical importance because of their relation to haemolytic disease of the newborn (HDN) and their importance in blood transfusion (Adeyemo and Soboyejo, 2006; Bakare et al., 2006). The Rh is genetically complex but it is simply described in terms of a single pair of alleles, D and d This group is determined by three genes called C, D, and E, each of which has two alleles: C, c, D, d, E, e. The Rh blood type is tested by using an anti-D reagent (Daniels, 2002; Saladin, 2003). Rh frequencies vary among ethnic groups just as ABO frequencies. Between 82% and 88% of Caucasians, about 95% of black Africans, and almost 100% of people from the Far East are D-positive (Iyawe et al., 1999; Daniels, 2002). The first discovery that the frequencies of the blood groups differed from one population to another was made in the early 20th century. Subsequent results from practically all countries of the world have 4 corroborated this, and have also shown that frequency figures are valid only for the specific population from which they are derived (Mourant et al., 1976). In contrast to the ABO group, anti-D antibodies are not normally present in the blood. They form only in Rh- individuals who are exposed to Rh+ blood (Saladin, 2003).The antigens of the Rh system are encoded by two genes, RHD and RHCE. They are highly homologous and have very similar genomic organization, each containing 10 coding exons arranged in opposite orientation on chromosome 1 (Daniels, 2002).

Hepatitis B infection is a liver disease that results from infection with a virus called Hepatitis B virus (CDC, 2013). It is a DNA virus of the family Hepadnaviridae, genus Orthohepadnavirus and species Hepatitis B virus (Pungpapong et al., 2007; Willey et al., 2013). The viral particle consists of an outer lipid envelope and an icosahedral nucleocapsid core which is composed of protein. The outer envelope contains proteins that are involved in viral binding and entry into susceptible cells. The outer surface or envelope contains hepatitis B surface antigen (HBsAg) and surrounds the inner nucleocapsid core that contains hepatitis B core antigen (HBcAg) (Willey et al., 2013). The viral genome consists of a partially double stranded circular DNA, with up to 3020- 3320 nucleotides and viral isolates share 80-90% nucleotide homology (Brooks et al., 2013; Willey et al., 2013). WHO (2013) posited that people at high risk include prison inmates, IDUs, people who frequently require blood and blood products, mentally ill persons, people with multiple sexual partners and health-care workers. The virus is found in body fluids and blood and it is transmitted from person to person through sex, tattooing, body piercing with unsterilized equipment, sharing of equipment like razor, toothbrush and IDU. Transmission from mother to child during childbirth where equipment are not adequately sterilized can also occur (Ugbebor et al., 2011).

1.2 STATEMENT OF PROBLEM

 In the last five decades, numerous studies have been carried out on the genetic composition of various population groups around the world including some parts of Nigeria. However, genetic studies among the ethnic groups of Kaduna State are nonexistent. Hence, the need for the present study to determine the frequencies of ABO, Rhesus blood groups and Hepatitis B among blood donor in National Blood Transfusion Service, Kaduna  State. The present study attempts to provide initial data of genetic composition of blood donor in the study area, using ABO blood group system.

The National institute of Health (NIH) consensus conference in 1995 recommended that every donor blood should be screened for various infections including HIV, hepatitis B and C, malaria and syphilis (Agboola et al., 2010). However, the critical lack of convincing evidence about the clinical impact of transfusion-transmitted malaria and the absence of an approved effective and feasible screening method are preventing rational decision-making about whether or not to screen blood for Hepatitis and to check for blood group  in Nigeria (Owusu-Ofori et al., 2010).

1.3 Justification/Significance of Study

 The main purpose of the study is to establish the distribution of ABO and Rh blood groups and Hepatitis B  among  blood donors with National Blood Transfusion Service, Kaduna  State with a view to providing useful data for the government and health care providers in tackling health-related problems. The knowledge of the frequencies of ABO , Rh blood groups and Hepatitis B  are helpful in the effective management of blood banks and in blood transfusion services. Data from  this study will be of immense use to the geneticists, biologists, blood transfusion services, policy makers and clinicians. To create awareness for the Primary Health Care (PHC) Centres on the frequency distribution pattern of ABO and Rhesus (RHD) blood groups and associated traits in people of Kaduna State. The findings will add to the existing literature on gene frequencies of ABO and Rh blood groups in the Nigerian populations.

1.4 Aims and Objectives of the Study

 1.4.1 The aim of the study

This study aims to investigate the genetic structure and variation of blood donors in National Blood Transfusion  Service, Kaduna State, Nigeria , with respect to ABO blood group, Rhesus factor and Hepatitis .

1.4.2        Objectives of the study

The objectives of the study are to:

  I. Describe the genetic structure of blood donors  with respect to ABO, Rh blood groups and Hepatitis B in National Blood Transfusion Service, Kaduna.

 ii. Describe the pattern of distribution of ABO, Rh blood groups and Hepatitis B among blood donor in the sample area

iii. Investigate any association between blood groups and some disease and physiological traits.

 iv. Provide baseline data on ABO, Rh blood groups and Hepatitis B  for scientists, health professionals, health-care providers and policy makers in Kaduna State

1.5 Scope of Study

The study was design to assess the distribution of ABO, RH blood grouping and Hepatitis B among blood donors with National Blood Transfusion Service, Kaduna State.

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