There is increasing evidence that the ABO blood group phenotypes modulates 
Plasmodium falciparum rosetting and may influence the clinical manifestation of 
severe malaria. Whether blood group phenotypes are associated with risk of 
severe falciparum malaria in Odisha, we analyzed 343 adult malaria patients. The 
results showed high prevalence of blood group B in both mild (n=110) and severe 
malaria (cerebral malaria [CM]; n=130 and non-cerebral severe malaria [NCSM]; 
n=103) categories among the non-O group and while type O is significantly 
associated with protection against CM, patients with type A and B group had 
increased risk for developing CM. Further, the strength of association for B 
group (p=< 0.0001) was high and has double the risk of (OR=5.0) of developing CM 
compared to blood group A (OR=2.5). Such findings may probably be due to strain 
specific blood group preferences of P. falciparum and high prevalence of B 
group. However, the ABO blood group distribution of mild malaria was comparable 
with that of the NCSM group of patients. The lack of association of ABO 
phenotypes with NCSM is evidence for the hypothesis that the underlying 
pathogenesis cascades are different in CM and NCSM clinical presentations.