IS THERE AN ASSOCIATION BETWEEN

ORAL SUBMUCOUS FIBROSIS

AND ABO BLOOD GROUPING?
VENU K. GOPAL REDDY,

NINAD J. MOON

VIJAYTA SHARVA

GURUPRASAD

ESHWAR K. REDDY Presented by:-

SUJITHA CHANDRALKALA Dr.Kailash Morya
1st Year PG
Journal of Cancer Research Oral Medicine & Radiology
and Therapeutics
INTRODUCTION

• Cancer is now one of the five main causes of death, in all societies.
• According to a World Health Organization (WHO) report, in India out
of ten cases of cancer, four are oral cancers and it is the 6th most
common cause of death.

• Over 90% of oral cancer lesions are oral squamous cell carcinomas
(OSCC).
• Majority of OSCCs are preceded by pre‑existing potentially malignant
disorders like Leukoplakia and Oral Submucous fibrosis (OSMF).

• This concept of a two‑step process of cancer development in the oral

mucosa, i. e., the initial presence of a precursor (premalignant,
precancerous) lesion subsequently developing into cancer is
well‑established.

• OSMF was first described by Sushrutha (2500–3000 BC) as Vidhari,

who had recognized it as a mouth and throat melady.
• Oral Submucous fibrosis (OSMF):- is an insidious, chronic
disease affecting any part of the oral cavity and sometimes the pharynx.
Although occasionally preceded and/or associated with vesicle
formation, it is always associated with juxta epithelial inflammatory
reaction, followed by fibro elastic change of lamina propria, with
epithelial atrophy leading to stiffness of the oral mucosa causing trismus
and inability to eat.

• It is result of the traditional use of Areca nut and its various

preparations endemic to these areas.
• Currently, 5 million people are suffering of OSMF, prevalence in India is in
the range of 0.03–3.2%.

• The worst affected are the youth between the age group of 20–40 years.
• Etiological factor- Areca‑nut chewing.
• The genetic predisposition exist.
• The rate of malignant transformation is between 7–14%.
• The precancerous nature of OSMF was first reported by Paymaster.
 Flash Back….
• The existence of blood groups in humans dates back to 20th century when
Karl Landsteiner in 1901 described the existence of serologic differences
between individuals, segregating people into one of the four groups
depending upon whether their red cells contained agglutinogen “A,”
agglutinogen “B,” neither A nor B (O) or both A and B (AB).

• This invention later led to a number of serological, immunological, and

genetical studies to investigate and to establish the relative susceptibility of
some blood group phenotypes to certain diseases.
• The blood group play an important role in immunogenetics as it is an
easily accessible factor in patient’s genetic make‑up.

• Till date, there are a plethora of studies reporting the association

between blood group antigens and various diseases. Surprisingly, no
data has been reported relating blood group phenotypes with the
OSMF.

• Hence, the present research was undertaken to evaluate whether ABO

blood group is related to OSMF risk.
AIM OF THE STUDY

To evaluate whether ABO blood group is related to OSMF risk.

OBJECTIVE

• To establish relationship between Oral Submucous Fibrosis and ABO blood

groups.
SUBJECTS AND METHODS
• The present cross‑sectional study was conducted in the department of Oral
Medicine and Radiology of a private dental institution in Bhopal city.

• Ethical clearance was obtained from Institutional ethical committee after

obtaining the approval from research approval committee.

• The examiner was trained and calibrated in the department of oral medicine
and radiology in diagnosing the patients of OSMF by examining 20 patients
using predetermined diagnostic criteria proposed by C. B. More.
• Study group:- A total of 164 patients with OSMF constituted the final
sample size.
• Control group:-A comparable sample of 180 individuals, who were free
from OSMF, constituted the comparison group.

• Statical analysis in this pilot study was done by using kappa value.

• Exclusions:- Patients with known blood dyscrasias were excluded from the
study.
• Consent :- An informed written consent was obtained from the subjects.
Blood Group Determination
• It was done using rapid slide method. This method was based on the principle of
presence or absence of blood group specific substances like A, B, and O in the red
blood cells (RBCs).

• The phenomenon of agglutination (Clumping) due to the interaction between

agglutinogens (antigens) present on the RBC membrane and agglutinins
(antibodies) present in the plasma forms the basis for this procedure.

• Agglutination is noted when various antiserum and blood mixed as per directions.
• The individual subjects with different blood groups were segregated accordingly.
RESULTS
• Distribution of ABO blood groups among cases and comparison group was
noted,which is shown in below table.
Table 1: Distribution of blood group antigens among cases and
comparison group.
B.Gp. A B AB O Total
Cases
Subject 33 (20.1%) 56 (34.1%) 11 (6.7%) 64 (39.0%) 164
cases

Control 42 (23.3%) 57 (31.7%) 12 (6.7%) 69 (38.3%) 180

cases

P value >0.05 >0.05 >0.05 >0.05 344

• When a comparison was made between blood groups and study subjects
(case and comparison group), the Chi‑square analysis could not establish
any significant relationship.

• Table 2 reveals the strength of association between ABO blood groups

and OSMF when assessed by odds ratio. It was found that people with
blood group A had 1.181 times higher risk of developing OSMF
compared to people with other blood groups.

• The relative risk for subjects with blood group AB was 1.012, followed
by subjects with blood group O with a relative risk of 0.971 and blood
group B having a relative risk of 0.944 (P > 0.05).
Table 2: Odds ratio showing the strength of association
between ABO blood groups and oral submucous fibrosis.

Blood groups Odds ratio 95% confidence interval P value

Lower Upper
A 1.181 0.668 2.085 >0.05

B 0.944 0.572 1.559 >0.05

AB 1.012 0.417 2.454 >0.05

O 0.971 0.629 1.500 >0.05

Age Predilection :- Majority of the OSMF cases (75%) were found in
the age‑group of 20–40 years, irrespective of the blood group they had.

Sex predilection :- The gender‑wise distribution of the disease reveals

that the male to female ratio is 5.3:1

Habits :- When the different types of habits were compared, majority of

the OSMF cases (i.e., 99% patients) had the habit of chewing Areca nut
and its various preparations. The remaining 1% of the study subjects had
given the history of consumption of spicy food.
DISCUSSION
• The attempts to establish a scientific association between ABO blood
group systems and various diseases dates back to 20th century following
the discovery of ABO blood group antigens by Karl Landsteiner.

• The first association between the ABO blood group and disease risk was
reported in English patients with stomach cancer where blood group A was
associated with increased risk of stomach cancer.

• It has opened new insights into oral disease research.

• In the present study, an attempt was made to explore whether ABO blood
group is related to OSMF risk in order to avoid potential complications
resulting from this premalignant condition in susceptible individuals.

• Although, chewing Areca nut was established as the most common

etiological factors in OSMF in this study.

• The present study demonstrates that ABO blood group is not

significantly associated with OSMF. However, when the strength of the
association was measured using odds ratio, it was found that blood group
A is at higher odds of developing OSMF compared to other blood
groups.
• It was reported that blood group O is caries immune.

• Denture wearers of blood group O were more susceptible to denture

stomatitis.

• Maxillofacial deformities were least in blood group A individuals and

greater with blood group B indicating the role of ABO blood groups in
various oral pathologies.
 CRITICAL EVALUATION
POSITIVE FINDINGS :-

 Found that majority of the OSMF cases (i.e., 99% patients) had the
habit of chewing Areca nut and its various preparations.

 By simple blood group determination, i. e., by slide method, during

community outreach programs, the individuals with blood group A
can be identified and can be counselled to quit the habit.
LIMITATIONS

• Despite of conducting a good research on one of the most common

premalignant conditions, the limitation in this study is found to be that
it was a hospital‑based study and the conclusions derived can not be
generalized. Further studies should be conducted at the community
level so as to achieve more definite conclusions.
CONCLUSION
This study reports that ABO blood group is not significantly associated
with OSMF. But, the subjects with blood group A have 1.18 times higher
risk of developing OSMF compared to other blood groups.

 Blood groups are easily accessible factor of human genetic make ‑up.
By simple blood group determination, by slide method, during
community outreach programs, the individuals with blood group A can
be identified and can be counselled to quit the habit, thereby avoiding
potential complications.
CROSS REFERENCES

• Ghooi AM, Kamalpuria SK, Jain PK, Tandon PL. Distribution of blood
groups in cancer. Indian J Cancer 1970;7:296‑305.
This study by Ghoii et al., found preponderance of blood group B in
oral cancer patients.
Thank You