A patient with multiple myeloma shows rouleaux on ABO testing. What is the corrective action?

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Multiple Choice

A patient with multiple myeloma shows rouleaux on ABO testing. What is the corrective action?

Rouleaux formed by high levels of monoclonal proteins in multiple myeloma can masquerade as agglutination during ABO testing. The fix is to wash the red blood cells and replace the plasma with saline, which removes the interfering proteins and breaks up rouleaux. This reveals the true antigen–antibody reactivity and prevents a false interpretation of the ABO result. Increasing RBC numbers won’t remove the plasma proteins and won’t fix the rouleaux; heating the sample or changing anticoagulants doesn’t address the underlying cause of the rouleaux either.

Rouleaux formed by high levels of monoclonal proteins in multiple myeloma can masquerade as agglutination during ABO testing. The fix is to wash the red blood cells and replace the plasma with saline, which removes the interfering proteins and breaks up rouleaux. This reveals the true antigen–antibody reactivity and prevents a false interpretation of the ABO result. Increasing RBC numbers won’t remove the plasma proteins and won’t fix the rouleaux; heating the sample or changing anticoagulants doesn’t address the underlying cause of the rouleaux either.

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