|Year : 2017 | Volume
| Issue : 2 | Page : 166-167
Daratumumab affecting the pre-transfusion testing: Approach to finding compatible RBC unit!
Aseem K Tiwari, Geet Aggarwal
Department of Transfusion Medicine, Medanta-The Medicity, Gurgaon, Haryana, India
|Date of Web Publication||11-Sep-2017|
Aseem K Tiwari
Department of Transfusion Medicine, Medanta-The Medicity, Gurgaon, Haryana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Tiwari AK, Aggarwal G. Daratumumab affecting the pre-transfusion testing: Approach to finding compatible RBC unit!. Glob J Transfus Med 2017;2:166-7
|How to cite this URL:|
Tiwari AK, Aggarwal G. Daratumumab affecting the pre-transfusion testing: Approach to finding compatible RBC unit!. Glob J Transfus Med [serial online] 2017 [cited 2021 Jun 25];2:166-7. Available from: https://www.gjtmonline.com/text.asp?2017/2/2/166/214286
Daratumumab (DARA) is a novel anti-CD38 monoclonal antibody that is now being increasingly used in patients with refractory multiple myeloma. CD38 is expressed not only on the plasma cells but also on the red blood cells (RBCs); albeit weakly so. The presence of DARA in the patient's serum may pose a challenge in pre-transfusion testing since it gives pan-reactivity in antibody screening, antibody identification, and anti-human globulin (AHG) cross-match; mimicking an autoantibody. However, unlike autoantibody case, these problems are not resolved with usual adsorption studies and results in difficulty in finding compatible RBC units for the patient.
If the patient has an unexpected antibody or develops one during treatment, the reaction pattern is masked due to the pan-reactivity pattern of DARA. It is, therefore, recommended to perform extended phenotype (eighteen antigens: D, C, c, E, e, K, k, Jk a, Jk b, Fy a, Fy b, Le a, Le b, M, N, S, s, and P1) of the patient along with initial antibody screen even before initiating the DARA therapy. This “point” underlines the importance of communication between treating physician and Transfusion Medicine physician in ensuring accurate and timely patient care.
However, if the recommended tests (extended phenotyping and antibody screen) have not been performed in a patient before initiation of treatment with DARA, it may still be possible to detect and identify an unexpected antibody by either neutralizing the DARA molecules (by soluble CD 38 or anti-idiotype antibody) or treating the reagent red cells with dithiothreitol (DTT). The latter is easier and inexpensive; destroys CD38 surface marker on RBC membrane and thus negates the interference caused by DARA. Positive control would comprise of K + and E + cell and negative control would be K + and E − cell. DARA destroys K antigen and has no effect on E antigen. Known antibody (e.g., anti-E, anti-s) spiked in an aliquoted patient's sample may serve as a positive control in antibody screening test.
As mentioned in [Table 1], “Approach 1” is the recommended approach that includes group and antibody screen followed by crossmatch type depending on the presence or absence of unexpected antibody. However, “approach 2” is a “stop-gap” arrangement until the center acquires the capability of performing DTT treatment and is based on the fact that DARA does not interfere with ABO, Rh, and Kell grouping and matching for these antigens would at least prevent development of the “most-likely” antibody(s).
|Table 1: Pretransfusion testing approaches for finding compatible red blood cell units for patients on daratumumab|
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Conflicts of interest
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| References|| |
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Resolving the daratumumab interference with blood compatibility testing. Transfusion 2015;55(6 Pt 2):1545-54.
Fung MK, Grossman BJ, Hillyer CD, Westhoff CM. Treating Red Cells Using DTT or AET, Methods Section 3-18, AABB Technical Manual. 18th ed. Bethesda (MD): American Association of Blood Banks; 2014.