Paraprotein-Induced Factitious Results on an Automated Haematology Analyzer

Main findings: Paraproteins, due to their precipitating nature are known to artifactually influence various results ranging from haemoglobin estimation to immunological assays. We describe herein a case of multiple myeloma on treatment and follow up, which on routine analysis showed a spuriously high total leucocyte and platelet count. After decanting the plasma, these parameters receded to normal levels. The immunoglobulin assay confirmed the paraproteins. Summary:  Analysis of blood and its components by auto analyzers have simplified many a complex test. But few variables have to be borne in mind while scrutinizing the suspect messages flagged by the analyser. Some of these variables may be inexplicably linked to the patient’s condition itself. And one of the most common variable is paraproteins seen in patients with multiple myeloma. This case aims to highlight some of the lesser known causes of pre-analytical errors concerning hemoglobin estimation by auto analyzers. Potential implications: Paraproteins have been shown to interfere with a number of clinical laboratory tests due to their precipitating quality. Although seldom observed in routine diagnostic parlance, the possible clinical implications of such phenomena must never be overlooked.