Amount of H antigen expressed on circulating von Willebrand factor is modified by ABO blood group genotype and is a major determinant of plasma von Willebrand factor antigen levels

To investigate whether the effect of ABO blood group on plasma von Willebrand factor (vWF) levels is mediated by the ABH antigenic determinants carried on N-linked glycans of vWF, we studied 158 group A and group O healthy volunteers. vWF antigen (vWF:Ag) and factor VIII antigen (FVIII:Ag) levels were highest in A(1)A(1) individuals and higher in A(1)O(1) than in A(2)O(1) or O(1)O(1) individuals. Plasma A transferase activity and the amount of A antigen expressed per unit vWF (AvWF) were significantly higher in A(1)A(1) than in A(1)O(1) individuals and higher in A(1)O(1) than in A(2)O(1) individuals. AvWF was correlated strongly with plasma levels of A transferase activity. Thus, we have clearly demonstrated a direct relationship between ABO genotype, A transferase expression, and the amount of A antigen expressed on circulating vWF. H antigen expression per unit vWF (HvWF) was highest in group O individuals. Among group A individuals, the pattern of HvWF expression was A(2)O(1)>A(1)O(1)>A(1)A(1). In group O and group A(2)O(1) individuals, HvWF was inversely correlated with plasma vWF levels. In contrast, among group A(1)A(1) and A(1)O(1) individuals, there was no relationship between AvWF and plasma vWF levels. These findings suggest that it is H antigen expression that mediates the ABO effect on plasma vWF concentration.