Pretransfusion Testing and Daratumumab: Assessing Interference Risks and Developing Solutions

Abstract

ABSTRACT Daratumumab is a monoclonal antibody; anti-CD38 is used for the treatment of multiple myeloma and other hematological disorders. Daratumumab, binds to CD 38 on red blood cells (RBCs), interfering with pretransfusion testing. This interference can lead to cross match incompatibility and panreactive indirect Antiglobulin tests (IAT).Panreactive IAT can mask presence of underlying clinically significant alloantibodies, especially in patient with history of multiple blood transfusions. This can lead to delays in transfusion, increased risk of transfusion reaction and potential risk for transfusion recipients. Daratumumab induced potential serological interference needs to be resolved by using appropriate methodologies like dithiotheritol (DDT) and enzymatic treatment of reagents or donors cells to overcome these incompatibilities. Effective communication between clinical practitioners and blood centre before starting daratumumab therapy can prevent unnecessary workload and delay in transfusion. Here, we describe the case of interference in prretransfuison testing caused by Daratumumab in the red cell compatibility testing of a patient with severe aplastic anemia and strongly positive DSA levels.