Ann Lab Med.  2013 May;33(3):208-211. 10.3343/alm.2013.33.3.208.

A Case of IgM Deficiency with B Cell Deficiency Detected by ABO Discrepancy in a Patient with Acute Osteomyelitis

Affiliations
  • 1Department of Laboratory Medicine, Seoul Seonam Hospital, Ewha Womans University Medical Center, Seoul, Korea.
  • 2Department of Nephrology, Seoul Seonam Hospital, Ewha Womans University Medical Center, Seoul, Korea.
  • 3Department of Orthopedic Surgery, Seoul Seonam Hospital, Ewha Womans University Medical Center, Seoul, Korea. dr_potato@hanmail.net
  • 4Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea. kshong@ewha.ac.kr

Abstract

ABO discrepancy refers to an inconsistency between red cell and serum typings and has various causes, including hypogammaglobulinemia. IgM deficiency is a rare disorder that may accompany several conditions such as infection and autoimmune disorders. Here, we describe a case of IgM deficiency discovered during the evaluation of an ABO discrepancy in a 16-yr-old Korean boy. ABO blood grouping showed that while his cell type was O+, serum typing detected only anti-A (3+). Anti-B was not detectable at room temperature but was graded at 1+ at 4degrees C. ABO genotyping revealed an O/O genotype. His serum IgG, IgA, and IgM concentrations were 770 mg/dL (reference range: 800-1,700 mg/dL), 244 mg/dL (reference range: 100-490 mg/dL), and 13.5 mg/dL (reference range: 50-320 mg/dL), respectively. He was diagnosed with acute osteomyelitis on the basis of clinical presentation and imaging studies. The symptoms gradually improved within 3 weeks of treatment. However, the ABO discrepancy and IgM deficiency persisted even 6 months after recovery and lymphocyte subset analysis revealed CD19+ B cell deficiency. To the best of our knowledge, IgM deficiency detected by ABO discrepancy in a patient with acute osteomyelitis has not been reported before.

Keyword

IgM deficiency; B cell deficiency; ABO discrepancy; Acute osteomyelitis
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