ABO Discrepancy in a Multiple Myeloma Patient: A Case Study

Jo Ann Wilson; Angel Jacobs

doi:10.29074/ascls.15.4.204

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Jo Ann Wilson, PhD⇑
1. is an associate professor in the Department of Environmental Health, Molecular and Clinical Sciences at Florida Gulf Coast University, Fort Myers FL
Angel Jacobs
1. is a Clinical Laboratory Science Program graduate from the Department of Environmental Health, Molecular and Clinical Sciences at Florida Gulf Coast University, Fort Myers FL and is a clinical laboratory scientist at Florida Cancer Specialists, Fort Myers FL

Address for correspondence: Jo Ann Wilson PhD, Department of Environmental Health, Molecular and Clinical Sciences, Florida Gulf Coast University, 10501 FGCU Blvd South, Fort Myers FL 33965-6565, (941) 590-7481,(941) 590-7474 (fax). jwilson{at}fgcu.edu

Extract

The hospital transfusion services received an order for three units of red blood cells for a 45-year-old Caucasian male. His most recent hematological study revealed a hemoglobin level of 7.0 g/dL (Table 1). Blood was obtained from the patient and the clinical laboratory scientist (CLS) proceeded with pre-transfusion testing of phenotype and antibody screening. The results of the forward typing of ABO and Rh indicated that the patient was phenotype A Rh positive (Table 2). However, a discrepancy was found in the reverse typing with A₁ cells and B cells producing agglutination. Using antibody-screening cells, the patient's serum was tested. The results indicated agglutination upon immediate spin, but no agglutination in subsequent testing including 37 °C with LISS enhancement (Table 3).

The CLS requested additional history on the patient. The diagnosis was multiple myeloma; there had been no previous transfusions.

DISCUSSION Multiple myeloma is a hematological malignant neoplasm of the bone marrow. It is a neoplastic disease characterized by the infiltration of bone and bone marrow by myeloma cells forming multiple tumor masses.¹ Production of normal immunoglobulins is impaired with a significant increase in the number of abnormal plasma cells.² The condition is usually progressive and generally fatal. The disease causes pain, fractures, anemia, hypercalcemia, kidney failure, bacterial infections, nerve compression with paralysis, skeletal deformities, and changes in mental status ranging from mild to severe confusion.^{3, 4} According to the American Cancer Society, about 14,400 new cases will be diagnosed and about 11,200 Americans are expected to die of multiple…

ABBREVIATIONS: AHG = anti-human globulin; LISS = low-ionic strength solution.