An acute leukaemia augured before clinical signs by blood group antigen abnormalities and low levels of A and H blood group transferase activities in erythrocytes.

A mixed field agglutination pattern with anti-A reagents and very low levels of A and H blood group antigen specific transferase activities were found in the erythrocytes of a 4-year-old girl who presented no clinical signs of haematological disease. Blood and marrow examination displayed some features consistent with a moderate dysmyelopoietic state. 18 months later an acute myeloblastic leukaemia confirmed the suspected haematological malignancy.