The disappearance of blood group antigens: A clue to the clinical diagnosis of leukemia

A 54-year-old male patient was admitted with low-grade intermittent fever not associated with chills. The cell grouping of the patient sample showed O Rh D positive and serum grouping as B, with a discrepancy to be resolved. Series of immunohematological workup was performed to rule out the discrepancy. Reviewing the past proxy history revealed that the patient blood group was B Rh D positive. Bone marrow aspirate showed hypercellularity with increased myelopoiesis and markedly suppressed megakaryopoiesis giving an impression of acute myeloid leukemia and was confirmed by flow cytometry. Based on the current results and past history the blood group of the patient was confirmed to be B Rh D positive with loss of B and H antigens expression on the red cell surface due to underlying leukemia. Correlating the lab results with the clinical details and the case history is an important step in resolving blood grouping discrepancy.