{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T21:17:43Z","timestamp":1790025463744,"version":"4.0.1"},"reference-count":13,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,2,15]]},"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2022-251638","type":"journal-article","created":{"date-parts":[[2024,2,29]],"date-time":"2024-02-29T01:15:14Z","timestamp":1709169314000},"page":"e251638","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["IgA plasma cell myeloma presenting as cold agglutinin-induced haemolytic transfusion reaction"],"prefix":"10.1136","volume":"17","author":[{"given":"Maryam","family":"Mehdipour Dalivand","sequence":"first","affiliation":[{"name":"Pathology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navitha","family":"Woddor","sequence":"additional","affiliation":[{"name":"Pathology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Addisalem","family":"Makuria","sequence":"additional","affiliation":[{"name":"Department of Pathology, Brody School of Medicine, Greenville, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Aggarwal","sequence":"additional","affiliation":[{"name":"Hematology and Oncology, DC VA Medical Center, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor Eduardo","family":"Nava","sequence":"additional","affiliation":[{"name":"Department of the Pathology, George Washington University Medical Faculty Associates, Washington, District of Columbia, USA"},{"name":"Washington DC VA Medical Center, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,2,28]]},"reference":[{"key":"2025082703430144000_17.2.e251638.1","doi-asserted-by":"crossref","first-page":"233","DOI":"10.4103\/ajts.AJTS_78_20","article-title":"Coomb\u2019s negative cold agglutinin disease: a rare report of an incidentally detected case","volume":"15","author":"Balraam","year":"2021","journal-title":"Asian J Transfus Sci"},{"key":"2025082703430144000_17.2.e251638.2","first-page":"460","article-title":"Primary chronic cold agglutinin disease: a population based clinical study of 86 patients","volume":"91","author":"Berentsen","year":"2006","journal-title":"Haematologica"},{"key":"2025082703430144000_17.2.e251638.3","doi-asserted-by":"crossref","first-page":"e63","DOI":"10.1016\/j.medcli.2016.09.010","article-title":"Enfermedad por crioaglutinina del subtipo IgA como manifestaci\u00f3n temprana de mieloma m\u00faltiple y resoluci\u00f3n tras tratamiento con nuevos f\u00e1rmacos anti-mieloma","volume":"147","author":"Chic Acevedo","year":"2016","journal-title":"Medicina Cl\u00ednica"},{"key":"2025082703430144000_17.2.e251638.4","doi-asserted-by":"crossref","first-page":"031001","DOI":"10.11613\/BM.2018.031001","article-title":"Effect of cold agglutinins on red blood cell parameters in a trauma patient: a case report","volume":"28","author":"Topic","year":"2018","journal-title":"Biochem Med (Zagreb)"},{"key":"2025082703430144000_17.2.e251638.5","first-page":"35","article-title":"Cold agglutinin disease: where do Westand, and where are we going","volume":"18","author":"Berentsen","year":"2020","journal-title":"Clin Adv Hematol Oncol"},{"key":"2025082703430144000_17.2.e251638.6","doi-asserted-by":"crossref","unstructured":"Roccatello D , Saadoun D , Ramos-Casals M , et al . Cryoglobulinemia. 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