Interference of Monoclonal Antibody Therapy in Transfusion: An Update

Author:

Solves Alcaina Pilar12ORCID,Asensi Cantó Pedro12ORCID

Affiliation:

1. Haematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain

2. CIBERONC, Instituto Carlos III, 28029 Madrid, Spain

Abstract

Monoclonal antibody (MoAb) therapy has been increasingly used in recent years for hematologic malignancies. The MoAbs anti-CD38 and anti-CD47 are immunoglobulins directed against epitopes that are highly expressed not only on cancer cells, but also on red blood cells (RBCs), as well as platelets. Additionally, producing an off-target effect interferes in pre-transfusion testing, having the potential to unchain hemolytic anemia. Blood banks must assure the availability and safety of blood products for patients in need. Thus, MoAbs have become a challenge for blood banks, since methods to overcome interferences must be adopted. Several strategies have been proposed to mitigate pan-reactivity in pre-transfusion indirect antiglobulin tests, such as the treatment of reagent RBCs with enzymes or reducing agents, allogeneic RBC adsorptions, and drug-specific neutralization assays. All of these have some kind of limitation. This review summarizes the interferences of MoAbs in pre-transfusion testing, focusing on the available strategies to mitigate them in order to provide a safe transfusion.

Publisher

MDPI AG

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