The Impact of Human ABO Blood Groups on Thrombin Generation in Platelet-Poor Plasma

ABO blood group has been shown to influence plasma levels of von Willebrand factor (vWF) and factor VIII, contributing to individual variation in bleeding and thrombotic risk. Group O individuals typically present with lower vWF and factor VIII levels, associated with a higher bleeding tendency, whereas non-O groups tend to have elevated levels and an increased risk of thrombosis. However, it remains unclear whether ABO blood group also affects thrombin generation, a central parameter of coagulation potential.

We performed a retrospective analysis of 1,423 patients who underwent routine thrombin generation testing using a calibrated automated thrombogram (CAT) in platelet-poor plasma. Thrombin generation parameters, including lag time, peak thrombin, and endogenous thrombin potential (ETP), were compared across ABO blood groups (O, A, B, AB). Statistical differences between groups were assessed using ANOVA and post hoc com-parisons, with a focus on potential clinical relevance.

Statistically significant differences were observed in lag time and ETP between ABO blood groups. Group O individuals showed a slightly prolonged lag time and reduced total thrombin compared to non-O groups. However, the absolute magnitude of these differences was small, with median variations well within assay variability. Peak thrombin did not differ meaningfully between groups.

Although minor statistical differences in thrombin generation parameters were observed among ABO blood groups, their magnitude is unlikely to translate into clinically relevant effects. These findings suggest that the influence of ABO blood group on bleeding or thrombotic risk is not primarily mediated via changes in thrombin generation, but rather through vWF-related mechanisms such as platelet adhesion or clearance.