Type III ABO discrepancy aiding in diagnosis of multiple myeloma

Abstract

Plasma cell myeloma is characterized by monoclonal proliferation of plasma cells, causing destructive bone lesions and other systemic manifestations. The disease spans a clinical spectrum from asymptomatic to highly aggressive disease. M protein caused by myeloma cells results in type III ABO discrepancy, in which rouleaux formation can be misinterpreted as agglutination. We present a case of a 54year old male admitted in our hospital with breathlessness, severe pallor and fever. Blood transfusions were advised as the haemoglobin was low. Initially there was a discrepancy between forward and reverse grouping which resolved with saline washes. On further investigations like peripheral smear and bone marrow examination, the patient was diagnosed as a case of plasma cell myeloma. In our case the blood grouping revealed type III ABO discrepancy which upon further investigation was found to be a case of plasma cell myeloma. Key Messages: Plasma cell myeloma has varied presentations. In our case, the patient presented with severe anaemia, plasma cells in peripheral blood and type III ABO discrepancy. Rouleaux formation should not be interpreted as agglutination. Careful vigilance by technicians in blood bank and thorough knowledge regarding various discrepancies will help in the management of the patient. Keywords: ABO discrepancy, Agglutination, Anaemia, Plasma cell myeloma, Rouleaux.