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How do I work up pretransfusion samples containing anti-CD38?

Waseem Q Anani1,2, Kathleen Duffer3, Richard M Kaufman3,4

  • 1Diagnostic Laboratories, Medical College of Wisconsin, Milwaukee, Wisconsin.

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Summary

Anti-CD38 therapies for multiple myeloma can interfere with blood tests by binding to red blood cells. This summary details methods to manage this interference, ensuring timely blood transfusions for patients.

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Area of Science:

  • Transfusion Medicine
  • Immunohematology
  • Oncology

Background:

  • Anti-CD38 monoclonal antibodies are crucial for treating relapsed/refractory multiple myeloma.
  • These antibodies can cause agglutination in red blood cells (RBCs), interfering with blood bank serologic tests.
  • Interference leads to delays in issuing RBC units, critical for anemic patients.

Purpose of the Study:

  • To present perspectives and testing practices for managing anti-CD38 interference in pretransfusion samples.
  • To highlight the challenges and tailored approaches required by different testing sites.
  • To discuss methods for mitigating serologic testing interference caused by anti-CD38.

Main Methods:

  • Review of testing practices at a hospital transfusion medicine service.
  • Analysis of strategies employed by an Immunohematology Reference Laboratory.
  • Management of pretransfusion samples from patients treated with anti-CD38 therapies.

Main Results:

  • Various methods exist to eliminate or bypass anti-CD38 interference, but no single solution is universally effective.
  • Each testing site must customize its approach based on specific needs and limitations.
  • Successful management requires collaboration between clinical services and reference laboratories.

Conclusions:

  • Managing anti-CD38 interference in pretransfusion testing is complex and requires site-specific strategies.
  • Effective protocols are essential to prevent transfusion delays and ensure patient safety.
  • Continued development and sharing of best practices are needed to address this ongoing challenge.