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A 65-year-old woman, blood group A RhD positive, who had completed her first course of induction chemotherapy for acute myeloid leukaemia was transfused with apheresis platelets over a number of days. On three occasions she received group O RhD positive units, which had been screened and found not to contain high-titre anti-A,B isoagglutinins. Following the third unit, she developed a haemolytic transfusion reaction and died soon thereafter. This has led to change in policy of the supplying centre in testing for high-titre anti-A,B isoagglutinins. Blood group O apheresis platelets and fresh-frozen plasma units are now labelled as high titre with a cut-off of 1/50 as compared to the previous cut-off of 1/100 for anti-A,B isoagglutinins. A universal approach to testing donations for high-titre anti-A,B isoagglutinins, better compliance of guidelines and monitoring of patients is necessary.

A 74 year old man presented with a foreign body sensation in the right eye superimposed on a slowly growing enlarging lump in the right eyelid. He had no history of recurrent infections, bleeding, weight loss, or night sweats. His only other symptom was chronic backache secondary to osteoarthritis. Past medical history included cataract extraction from the right eye 4 years previously and excision of a basal cell carcinoma from the right pinna 5 years previously. Examination revealed a large firm lesion in the right upper eyelid with no palpable lymph nodes. The clinical diagnosis was of a chalazion. The lesion was removed surgically and histopathology (Fig 1) revealed an incompletely excised extramedullary plasmacytoma with a high proliferative index and amyloid change. Immunocytochemistry was positive for IgG kappa light chains. Further investigations including full blood count, liver function tests including lactate dehydrogenase (LDH), protein electrophoresis, skeletal survey, and bone marrow aspiration were normal with no evidence of multiple myeloma. Figure 1 Photomicrograph showing …

In the t(8;21) of acute myeloid leukemia (AML) M2, breakpoints are clustered on both chromosomes. The chromosome 21 breakpoint cluster region (bcr) falls within the runt locus, in the intron immediately downstream of the exons encoding an evolutionary conserved domain (the runt box). Transcripts in which the runt box is fused in frame to a novel sequence derived from chromosome 8 (MTG8) have been previously identified and have been assumed to constitute a critical leukemogenic event. Here we show physical linkage of the chromosome 8 bcr to the MTG8 locus. Unexpectedly, not only does the bcr map upstream of the most 5' MTG8 exon found in runt/MTG8 fusion transcripts, but it also maps upstream of a further 5' exon. In addition, we demonstrate the presence of alternative transcripts, originating from the der(8) chromosome, in which runt is out of frame with MTG8. Thus, runt truncation per se, rather than its fusion to MTG8, may be the crucial leukemogenic event.