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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 32  |  Issue : 2  |  Page : 103-106

Effects of smoking on hemoglobin and erythrocytes sedimentation rate and its association with ABO blood groups


Department of Oral Medicine and Radiology, AME's Dental College and Hospital, Raichur, Karnataka, India

Date of Submission28-Feb-2020
Date of Decision10-May-2020
Date of Acceptance14-May-2020
Date of Web Publication27-Jun-2020

Correspondence Address:
Dr. P Manshi
AME's Dental College and Hospital, Raichur, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_30_20

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   Abstract 


Context: “Smoking causes variation in different parameters of blood like hemoglobin (Hb) and erythrocyte sedimentation rate (ESR).” Continuous exposure to carbon monoxide leads to the formation of carboxyhemoglobin, an inactive form of Hb with no oxygen-carrying capacity; carboxyhemoglobin also leads to shifting in the Hb dissociation curve on the left side, causing a reduction in the ability of Hb to deliver oxygen to the tissue. Aims: The aim of this study was to compare the effect of cigarette smoking on Hb and ESR between smokers and nonsmokers and its association with ABO blood groups. Settings and Design: A total of 100 subjects which included 50 smokers and 50 age-matched nonsmoker controls were included in this study. Material and Methods: 5 ml of venous blood was collected by venipuncture method and Hb was measured by cyanmethhemoglobin method, ESR by Westergren's method, and ABO blood grouping by slide method. Statistical Analysis Used: Statistical software SPSS version 20 (SPSS, Chicago, Illinois) was used. Student's t test was performed for parametric numerical data and Chi-square test was performed for nonparametric categorical data. A value of P < 0.05 was considered statistically significant. Results: The mean Hb was 16.83 g/dL in smokers and 14.42 g/dL in nonsmokers. The mean ESR was 5.36 mm in smokers and 3.96 mm in nonsmokers. Conclusions: A significant increase was seen in Hb and ESR in smokers when compared to nonsmokers. No significant association was seen between the ABO blood groups among smokers and nonsmokers.

Keywords: Carboxyhemoglobin, ESR (erythrocyte sedimentation rate), hemoglobin


How to cite this article:
Thriveni R, Manshi P, V Ramesh D N, Rachel B, Byatnal A, Kempwade P. Effects of smoking on hemoglobin and erythrocytes sedimentation rate and its association with ABO blood groups. J Indian Acad Oral Med Radiol 2020;32:103-6

How to cite this URL:
Thriveni R, Manshi P, V Ramesh D N, Rachel B, Byatnal A, Kempwade P. Effects of smoking on hemoglobin and erythrocytes sedimentation rate and its association with ABO blood groups. J Indian Acad Oral Med Radiol [serial online] 2020 [cited 2020 Jul 11];32:103-6. Available from: http://www.jiaomr.in/text.asp?2020/32/2/103/288133




   Introduction Top


Smoking causes variation in different parameters of blood such as hemoglobin (Hb) and erythrocyte sedimentation rate (ESR). Continuous exposure to carbon monoxide leads to formation of carboxyhemoglobin, an inactive form of Hb with no oxygen-carrying capacity. Carboxyhemoglobin leads to shift in the Hb dissociation curve on the left side, causing the reduction in the ability of Hb to deliver oxygen to the tissue. To compensate for the decreased oxygen delivering capacity, smokers maintain a higher Hb level than nonsmokers.[1]

The chemicals in cigarette and its smoke contain various carcinogens leading to oxidative stress which promotes a systemic acute-phase reaction, increasing inflammatory cytokines, C-reactive protein (CRP), fibrinogen, blood cell count, whole blood viscosity and rouleaux formation, and increasing the ESR.[2]

In certain studies, it was seen that the genotype of person and even blood groups have been said to determine characteristics like smoking.[3]

It was observed in various studies that a mild decrease in plasma volume may also contribute to the increased Hb levels observed among smokers.[4] Smoking was also found to be related to anemia in various studies.[5] The blood concentration of carboxyhemoglobin increases in proportion with the amount of smoked tobacco and whether the smoke is inhaled. The higher the carboxyhemoglobin levels, the lower the oxygen-transporting capacity of the Hb mass, a scenario corresponding to functional anemia.[6]

As smoking has been shown to have adverse effects on parameters like Hb and ESR, the following study was conducted to compare the effect of cigarette smoking on Hb levels and ESR between smokers and age-matched nonsmoker controls and also to know its association with ABO blood group.


   Aims and Objectives Top


The aim of this study was to compare the effect of cigarette smoking on Hb and ESR between smokers and nonsmokers and its association with ABO blood groups.


   Subjects and Methods Top


It was a cross-sectional study conducted in the Department of Oral Medicine and Radiology in the period between January 2018 and July 2018. This study was a comparative cross-sectional study in which a purposive sampling technique was done. A total 50 subjects who were smokers and 50 age-matched nonsmoker controls were included in this study. Case history was recorded for each subject and written informed consent was obtained.

Inclusion criteria

Patients who are chronic male smokers with an average of minimum 10 cigarettes per day for minimum 5 years and between the age group of 20 and 60 years were included in the study group.

Exclusion criteria

The exclusion criteria of the study were patients with severe hypertension, endocrine disorder, hepatic disorder, cardiac, and respiratory diseases, patients on medications, and patients with other habits such as alcohol and tobacco. Patients with other systemic diseases and infections were excluded from the study.

Five ml of venous blood was collected by venipuncture method from each patient. Hb was measured by cyanmethhemoglobin method. 5 mL of Drabkin's solution was taken in a test tube and 20 μL of whole blood was added to it from the EDTA vial. The tubes were vortexed for 60 sec and then kept for 15 min. The absorption was read at 540-nm wavelength against the reagent blank. The absorption of the pure stock Hb standard was also recorded for each run. ESR was estimated by Westergren's method. The blood was drawn into a Westergren–Katz tube to the 200 millimeter (mm) mark. The tube was placed in a rack in a strictly vertical position for 1 h at room temperature, at which time the distance from the lowest point of the surface meniscus to the upper limit of the red cell sediment was measured. The distance of fall of erythrocytes, expressed as millimeters in 1 h, is the ESR. ABO blood group estimation was done by slide method. A glass slide was used and was divided into three parts, as for each part, a drop of donor or recipient blood was mixed with anti-A, anti-B, and anti-D separately. The agglutination or blood clumping pattern was evaluated and blood group estimation was done [Figure 1] and [Figure 2].
Figure 1: Withdrawal of blood by venipuncture method

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Figure 2: Determination of ABO blood group by slide agglutination method

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Statistical analysis

Data were entered in MS Excel sheet and consequently analyzed by using statistical software SPSS version 20 (SPSS, Chicago, Illinois). Student's t-test was performed for parametric numerical data and Chi-square test was performed for nonparametric categorical data. A value of P < 0.05 was considered statistically significant.


   Results Top


The mean Hb in smokers was 16.83 g/dL when compared to nonsmokers where mean Hb was 14.42 g/dL and was found to be statistically significant P < 0.0001 [Table 1].
Table 1: Comparison of hemoglobin level in smokers and nonsmokers

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The mean ESR was increased in smokers 5.36 mm when compared to nonsmokers who had a mean ESR of 3.96 mm and was statistically significant P < 0.0001 [Table 2].
Table 2: Comparison of erythrocyte sedimentation rate in smokers and nonsmokers

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The distribution of ABO blood group revealed the majority of smokers 25 (50%) belonged to blood group B, 10 (20%) to blood group A, 10 (20%) to blood group O, and 5 (10%) belonged to blood group AB. Among nonsmokers, majority of them 20 (40%) belonged to blood group O, 15 (30%) belonged to blood group B, 10 (20%) belonged to blood group A, and 5 (10%) belonged to blood group AB and not statistically significant with P = 0.12 [Table 3].
Table 3: Distribution of ABO blood groups among smokers and nonsmokers

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   Discussion Top


In this study, the mean Hb was found to be increased in smokers when compared to nonsmokers. The mean Hb in smokers was 16.83 gm/dl where mean Hb was 14.42 gm/dl and was found to be statistically significant P < 0.0001. Similar results were seen in a study conducted by Shah BK et al. confirmed in his study that Hb level is significantly higher in smokers than nonsmoker P < 0.001.[1] In another study, Nordenberg et al. confirmed that Hb levels are significantly higher for smokers than for never-smokers and demonstrated that this increase is directly related to the number of cigarettes smoked daily.[4]

Tirlapur et al. found higher Hb concentrations in smokers of both sexes than in nonsmokers.[5] This raise in Hb among smokers is due to an increase in the level of carboxyhemoglobin to compensate for the decreased oxygen-carrying capacity of blood.

In this study, the mean ESR was significantly increased in smokers when compared to nonsmokers. The mean ESR was increased in smokers 5.36 mm when compared to nonsmokers who had a mean ESR of 3.96 mm and was statistically significant P value < 0.0001, similar results were seen by Sharma A et al. who found that smoking had a significant effect on ESR. A significant increase in ESR was observed in active smokers (>10 cigarettes/day).[2]

No significant relation was found between the distribution of ABO blood groups among smokers and nonsmokers P = 0.12 not significant which is similar to study conducted by Bourke GJ et al. Patients with blood group B were highest to be among smokers which were similar to study conducted by Cohen and Thomas [Figure 3].[3]
Figure 3: Comparison of ESR and hemoglobin levels in smokers and nonsmokers with distribution of ABO blood groups

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In this study, the primary results showed Hb level and ESR were significantly higher in smokers than nonsmoker which is in accordance with study conducted by Shah BK et al.[1] The mean ESR was significantly increased in smokers when compared to nonsmokers; similar results were seen in study conducted by Sharma A et al.[2]

In this study sample size was small and carboxyhemoglobin levels were not estimated. Further studies with larger sample size along with the estimation of carboxyhemoglobin level must be conducted among both males and females with various age groups.

As smoking has various ill effects on health, public health promotion programs and health checkup camps must be conducted to educate the people and motivate them to quit the habit.


   Conclusion Top


The results of this study confirm that smoking causes increase in Hb level and ESR due to various ill effects of on blood and may cause respiratory diseases such as asthma, bronchitis, lung cancer in later stages, and coronary heart disease, Hence, awareness must be created among the people through mass media, campaigns, and also regular health and dental checkup camps must be conducted to counsel the people about ill effects of smoking and motivate them to quit the habit. Further studies with larger sample size along with the estimation of carboxyhemoglobin level must be conducted.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Ethical considerations

The study was approved by the Ethical committee of our institution (Ethical committee approval number 270/2018-19).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Shah BK, Nepal AK, Agrawal M, Sinha AK. The effects of cigarette smoking on hemoglobin levels compared between smokers and non-smokers. Sunsari Tech Coll J 2012;1:42-4.  Back to cited text no. 1
    
2.
Sharma A, Yadav B, Pathak R, Singh K, Hussein M, Singh S. Effect of smoking on blood parameters. Nat J Med Allied Sci 2014;3:20-3.  Back to cited text no. 2
    
3.
Bourke GJ, O'riordan JP. Distribution of ABO and rhesus blood groups in relation to smoking habit. Brit J Prev Soc Med 1964;18:109-13.  Back to cited text no. 3
    
4.
Nordenberg D, Yip R, Binkin NJ. The effect of cigarette smoking on hemoglobin levels and anemia screening. J Am Med Assoc 1990;264:1556-9.  Back to cited text no. 4
    
5.
Tirlapur VG, Gicheru K, Charalambous BM, Evans PJ, Mir MA. Packed cell volume, haemoglobin, and oxygen saturation changes in healthy smokers and non-smokers. Thorax 1983;38:785-7.  Back to cited text no. 5
    
6.
Milman N, Pedersen AN. Blood haemoglobin concentrations are higher in smokers and heavy alcohol consumers than in non-smokers and abstainers—Should we adjust the reference range? Ann Hematol 2009;88:687-94.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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