Panagglutination of red blood cells complicating blood typing: A Malagasy case report

Introduction: Blood grouping appears to be simple to perform and interpret. Recommendations have been established to ensure the accuracy of the results. However, there are cases that create difficulties and may distort the result. We report a case of blood grouping problem with panagglutination of red blood cells found in the laboratory of University Hospital Center (UHC) Andrainjato Fianarantsoa Madagascar.
Case description: A 63-year-old woman of Asian origin was hospitalized in the Internal Medicine Department for fever and physical asthenia. She had a family history of beta-thalassemia minor. The blood count showed pancytopenia (regenerative anemia at 31 g/L, neutropenia at 1.7 G/L, thrombocytopenia at 34 G/L), with a probable presence of cold agglutinin (MCHC = 400 g/L). The blood grouping by globular test allowed to find a positive rhesus group AB, but the serum test was in favor of group A. The repeat of the haemogram and the blood grouping after incubation of the sample for one hour at +37° C made it possible to correct the MCHC and to objectify a positive blood group A rhesus respectively. The latter was confirmed by the pre-transfusion compatibility test with the tested isogroup blood and the transfusions performed were without incident.
Conclusion: Panagglutination of red blood cells, probably related to the presence of cold agglutinin in our case, represents one of the sources of blood grouping errors that should be avoided by the application of strict blood grouping rules.