IgA plasma cell myeloma presenting as cold agglutinin-induced haemolytic transfusion reaction

Authors

Maryam Mehdipour Dalivand, Pathology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Navitha Woddor, Pathology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Addisalem Makuria, Department of Pathology, Brody School of Medicine, Greenville, NC, USA.
Anita Aggarwal, Hematology and Oncology, DC VA Medical Center, Washington, District of Columbia, USA.
Victor Eduardo Nava, Department of the Pathology, George Washington University Medical Faculty Associates, Washington, District of Columbia, USA victor.nava@va.gov.

Document Type

Journal Article

Publication Date

2-28-2024

Journal

BMJ case reports

Volume

17

Issue

2

DOI

10.1136/bcr-2022-251638

Keywords

Cancer; Haematology (incl blood transfusion); Malignant and Benign haematology; Medical management; Pathology

Abstract

Cold agglutinins produced in the setting of B cell neoplasms, such as lymphoplasmacytic lymphoma and plasma cell myeloma, can mediate autoimmune haemolytic anemia. Transfusion of these patients can exacerbate cold agglutinin-mediated haemolysis. Moreover, the workup for these reactions represents a diagnostic challenge due in part to false negative direct antiglobulin tests (DATs). Here, we report an anaemic patient who after a red blood cell (RBC) transfusion performed without blood warming, experienced a DAT-negative haemolytic transfusion reaction, and was later diagnosed with IgA-multiple myeloma, which showed an uncommon granular pattern by CD138 immunohistochemistry. Extensive workup excluded other diagnostic possibilities, including the presence of Donath-Landsteiner antibodies and cryoglobulins. Successful treatment with CyBorD (cyclophosphamide, bortezomib and dexamethasone) achieved complete remission, and additional RBC transfusions using warmers were completed uneventfully.

APA Citation

Mehdipour Dalivand, Maryam; Woddor, Navitha; Makuria, Addisalem; Aggarwal, Anita; and Nava, Victor Eduardo, "IgA plasma cell myeloma presenting as cold agglutinin-induced haemolytic transfusion reaction" (2024). GW Authored Works. Paper 4295.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4295

Department

School of Medicine and Health Sciences Resident Works