Journal of Blood Medicine (May 2021)
Overcoming Drug Interference in Transfusion Testing: A Spotlight on Daratumumab
Abstract
Marilyn T Nedumcheril,1,2 Robert A DeSimone,1 Sabrina E Racine-Brzostek,1 Ok Kyong Chaekal,1,3 Ljiljana V Vasovic1 1Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA; 2New York Blood Center Enterprises, New York, NY, USA; 3Department of Medicine/Division of Hematology-Oncology New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USACorrespondence: Ljiljana V VasovicDepartment of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 251, New York, NY, 10065, USATel +1 212 746 6106Fax +1 212 746 8435Email [email protected]: Daratumumab, a monoclonal antibody therapeutic, is highly efficacious and widely used in all stages of multiple myeloma and amyloidosis and has promising activity in other hematologic disorders. Daratumumab interacts with red blood cells, interfering with pre-transfusion testing. This interference can lead to compromising transfusion safety, extensive blood bank work ups and delays in provision of compatible units. Several methods have been developed to negate daratumumab interference with indirect antiglobulin testing. They are based on i) standard blood bank techniques including dithiothreitol and enzymatic treatment of reagent cells, using reagent red blood cells negative for CD38, ii) blocking CD38 antigens on reagent or donor cells, iii) neutralization of anti-CD38 antibody in patient plasma prior to testing, and iv) extended antigen typing of patient red blood cells in conjunction with provision of phenotypically matched units for transfusion. Implementation of those methods by the blood bank should be a planned effort coordinated with the patient’s clinical team. Timely involvement of blood bank and transfusion services and educational efforts by both blood banks and clinical providers can improve the overall daratumumab safety profile in regard to blood transfusion.Keywords: immunohematology, CD38, drug neutralization, dithiothreitol, incompatible crossmatch, indirect antiglobulin testing
