Blog of Bloodworks Northwest



What's Blood Got to Do With it? - Dr. Jill Johnsen (S1 E14)

Is there a connection between blood type and risk factors for COVID-19? That’s what Dr. Jill Johnsen from the Bloodworks Northwest Research Institute wants to find out. This episode explores that question and others as the search for answers in the COVID-19 pandemic continues.   

Listen below or read on for a full transcript.

Dr. Johnsen: We don’t understand right now why some people get sick and why some people don’t, and that’s really the key. I mean, we wanna know both ends. We wanna know who is gonna be very sick, but we also wanna know who’s gonna be walking around not knowing they’re sick. These are the things that we would really like to know.

John: Hi. I’m John Yeager and this is “Bloodworks 101.” Here’s a question for you. How long will this last? Anybody’s guess, right? We’re all looking for answers to the COVID-19 dilemma and that includes the hardworking scientists here at the Bloodworks Northwest Research Institute. Since we have world-renowned leaders in the field of blood science, here’s a question that they’d really like an answer to.

Is blood type a risk factor for COVID-19? In other words, can your blood type indicate whether you’ll get it? And if you are infected, will having a certain blood type indicate the severity of the virus in your case?

I spoke to Dr. Jill Johnsen from the Bloodworks Northwest Research Institute via Skype. First question, what will this study, it’s called the ABO study named for the three of the basic blood types, what will this ABO study look at?

Dr. Johnsen: This ABO study is about looking to see if blood types really matter in who gets very sick with COVID and who doesn’t seem to get so sick. So, that’s a pretty important thing by itself. But knowing if blood type matters can also be really useful for people who are trying to make models or people who are trying to triage who they really need to pay attention to when they get sick so that we can understand who’s at high risk and who isn’t.

John: Jill says it’s still a virus that we really don’t know that much about.

Dr. Johnsen: Yeah. We’ve had very little time to learn about this thing, and it clearly has a pattern of infection and different ways that it makes people sick that are really unique. And that’s why it’s called a novel coronavirus. We just have never seen it before, and the whole scientific community is really coming together in a way that I would say is pretty unprecedented to try and tackle this from every angle, from mechanism, to figuring out how to take care of people better, to now beginning to look at what are the long-term effects of this.

John: Johnsen says there have been other studies.

Dr. Johnsen: Yeah, there are some early reports that aren’t published yet but they’re out in the literature. And I would expect they’ll end up being peer-reviewed and published at some point that implicated ABO pretty early on. There was a paper out of China in March that said that, that was the first one that I’m aware of that implicated ABO. And in that study, people who were in the hospital were much likely, more likely to be blood group A and then the surrounding blood types of the population, and also people who had died were more likely to be blood group A.

And then about a month later, another paper came out of Columbia in New York. They looked at everybody who was in the hospital and whether or not they tested positive for the virus or negative. And in that study, again, blood group A but also B was more common in people who tested positive for the virus than people who tested negative, so, the same direction even though it was slightly different and in different countries.

Really recently, another paper came out that tried a genetic approach in Spain, in Italy. Patients who are really sick and often need a ventilator so they had respiratory failure. And in that case, they were also disproportionately blood group A. And there was a genetic signature around the gene that is responsible for your blood type. So, taking together, they are all kind of consistently in the same direction. And again, it’s a novel coronavirus. It’s super early. We don’t know that that’s true but it looks pretty suggestive.

And it was all plausible, you know. We have been studying ABO for a long time and the reason ABO is even different among different groups of people is infections. We know ABO plays a role in many other infections. But it was even already implicated in SARS which was a virus that’s very similar, or at least in the sequence of the virus to this one, where blood group A also looked like it was probably a little worse although of course the experience with SARS was very different than what’s going on now.

So, taken together, it looks plausible, certainly worth studying because the implications of understanding something like that would be pretty big. Whenever we have something that impacts this many people, it’s gonna be important. And a lot of people survive it, but the rate of people who don’t is pretty unacceptably high. And we need to do something about that. And to do that, we need to understand everything from mechanism to being able to better predict who’s not going to do well with this thing if they get exposed to it.

So, that’s a pretty actionable thing, understanding host risk factor, which is what we call that if you’re the host and the virus is infecting you. To know what about you as the host might make you higher risk. We already know some things like your age, your biological sex, whether or not you have other medical conditions. It looks like it’s possible that blood type is up there in the range of size of risks. And those are things that we are already paying attention to about knowing who’s at risk, people who might wanna self-isolate more, people who we wanna be careful with in group settings, people who come in positive, we’re gonna wanna watch them more closely.

So, it’s an important thing to understand who’s sick. And it’s also important when we look at treatments. Maybe treatments would be different. Maybe we should be looking at mechanism when we consider how does a vaccine gonna work? How does our testing for antibodies seeing these things? So, it has a broad implication, and that’s gonna be true of most COVID research right now. But particularly I mean I favor this one because it really looks like it’s plausibly gonna be a big part of the story.

John: This might be a good time to hit the pause button. Do you know your blood type? According to a study conducted by Harris Pole on behalf of Bloodworks, just a little more than half, 63% say they know their blood type. Now, giving blood helps. Those who have given blood are much more likely to have an answer for their blood type question. So I ask Dr. Johnsen for a refresher course on A, B, and O blood typing.

Dr. Johnsen: So ABO blood type is, it’s a blood type. It’s the first blood type that was discovered that’s why it’s at the beginning of the alphabet. It was initially A, B, and C then they figured out C was actually a zero. So they used O. So what it is is, these are differences between people where something on the blood cell is present on one person and not present on another person. And so when you take the blood from the person who has that on the outside of their cell and you put it into another person, their immune system, their body rejects it. And that’s why blood types are important because we use blood and other tissues as treatments. So we’re constantly putting blood transfusions from one person into another person. We need to make sure that we’re doing it safely. And we use blood types to figure that out.

So, these ABO blood types are really commonly different. You’ve heard of blood type O, and A, and B and AB. Those are the four main types that we use for transfusion. So if you were gonna come give blood at Bloodworks for example, they would do your blood type test and they will tell you. But they’re gonna use that information to make sure that they give the safest unit compatible with the patient who needs that blood to save their life.

So these blood types didn’t come about because nature knew we were gonna be doing transfusions. They came about largely because of infections. And so infections and different bugs interact with our bodies, bacteria, and viruses, and even parasites interact with human beings differently based on their blood type. So studying ABO relative to coronavirus is really understanding why the virus makes some people sick and why it doesn’t make other people very sick.

You know, we don’t think it’s probably gonna be related to the vaccine, but we need to understand all these mechanisms in order to understand how various treatments will work because we don’t understand right now why some people get sick and why some people don’t. And that’s really the key. I mean, we wanna know both ends. We wanna know who is gonna be very sick but we also wanna know who’s gonna be walking around not knowing they’re sick. These are things that we would really like to know.

Every blood type is special. Honestly, every blood type is special, right? So if you’re a rare donor, you’re special because that rare donor can go and help that patient that we struggle to find blood for. But the common blood types are also super special because those are the ones that keep the whole system going. So, everyone is special in this scenario. And blood types are part of what makes everyone different. Your genetic information from your biological parents came together, got shuffled and made you you and part of that is these 300 plus blood types.

John: Dr. Johnsen feels that working for Bloodworks is an advantage that she feels that she can leverage for this study. That and a strong relationship with experts at the University of Washington.

Dr. Johnsen: So, at Bloodworks, we are a regional bloodbank. We’re also an academic institution. We do a lot of research and most of our research institute faculty are also joint faculty of the University of Washington as I am. So Bloodworks, together with the University of Washington, has been studying ABO blood group for years. We have developed new genetic tools to characterize it because the ABO blood groups really much more complicated than just blood type O or A.

It turns out there’s a lot of nuance to the blood groups that probably matters when it comes to infection. And that’s been something that we’ve been pretty interested to better define what are these blood groups doing. And so we have made some new genetic tools and formed some collaborations with glycobiologists at the University of Washington to really understand what does it mean to have differences within, for example, blood type A.

And each of those differences looks like it has mattered in other infections, so it’s reasonable to think it would matter here. So we were developing the tools for other reasons. Nobody knew coronavirus was coming, but we were very interested in ABO. And so when this virus came out, we were already primed to be looking for any evidence that ABO might be a problem already. We saw those early reports we were very encouraged that we should probably bring out tools to bear on this problem but none of us are virologists. So we formed new collaborations with the infectious disease experts at the University of Washington. Which I have to say is really one of the lovely things that has accidentally come out of this is that everyone is working together.

John: Of course she wants to do thorough research, but everybody wants an answer now.

Dr. Johnsen: This is the hard part about risk, right? Our brains want everything to be kind of easy where everything is gonna be a yes/no answer. And that’s not how risk works. Risk just makes things more likely or less likely but it doesn’t make anything certain. So, for example, age is a risk factor for how severe that COVID-19 might be if you get the virus. We all know that, but there are a bunch of older people who have gotten the virus and done relatively fine, there’s a bunch of younger people that have really struggled with this virus.

So, in large numbers, you really see that risk, right? Where on balance. But for any one person, it tells you how much you need to pay attention, who might need extra attention. But risk is just a combination with other things that all come together to determine whether or not someone’s gonna get really sick. We should never compromise our science. We should always do it the best we can because there’s a reason we do it with that structure so it increases the likelihood that we’re gonna get a correct answer and not pursue a false trail because nobody has time for that either.

Johnny: Then Jill Johnsen walked me through the timetable. How long from when she hears that starting gun to when she’ll have something that’s publishable.

Dr. Johnsen: That’s a great question. Well, it really does depend on the money. So, how quickly we go is almost entirely dependent on the money. Unfortunately, a lot of people have gotten sick, so, that also means there’s a lot of sick people that can help people who have recovered now from their histories in the hospital or their histories at home that would be eligible to help these kinds of studies. So, the main thing would be the money at this point, how quickly things go forward.

So I would say we could probably…Because let’s say we could go next week, I would say we’d have pretty good answers by the end of the summer.

Johnny: Dr. Johnsen says one of the best things you can do right now is to be part of the answer and donate either time, money, or blood. And of course, if you’ve had COVID-19 and recovered, the staff here would love to talk to you about donating that convalescent plasma for a study they’re part of.

Jill Johnsen is urging you to go to bloodworksnw.org and up there on the top right-hand corner of the page, you can click on either schedule a donation, volunteer, or give a gift. And remember, when you come in to make that donation, please wear your mask.

If you know someone who’d like to hear these kind of stories, please tell them about “Bloodworks 101.” We’re trying to build our subscriber list. Thanks. Well, that’s just about it for this episode of “Bloodworks 101.” I’m John Yeager. See you next time and stay safe.

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September 2, 2020 1:08PM

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