Overcoming Drug Interference in Transfusion Testing: A Spotlight on Daratumumab

Area of Science:

• Hematology
• Transfusion Medicine
• Immunology

Background:

• Daratumumab, a monoclonal antibody, is crucial for treating multiple myeloma and amyloidosis.
• Daratumumab interacts with CD38 on red blood cells, causing issues with pre-transfusion compatibility testing.
• This interference can compromise transfusion safety and delay patient care.

Purpose of the Study:

• To review methods for mitigating daratumumab interference in blood bank testing.
• To ensure safe and timely blood transfusions for patients treated with daratumumab.

Main Methods:

• Utilizing standard blood bank techniques (dithiothreitol, enzymatic treatment) with CD38-negative reagent cells.
• Employing methods to block CD38 antigens or neutralize daratumumab in patient plasma.
• Performing extended red blood cell antigen typing and providing phenotypically matched units.

Main Results:

• Multiple strategies exist to overcome daratumumab's interference with indirect antiglobulin testing.
• These methods allow for accurate compatibility testing despite daratumumab treatment.
• Successful implementation requires coordination between clinical teams and blood bank services.

Conclusions:

• Effective management of daratumumab interference is essential for transfusion safety.
• Collaboration and education between blood banks and clinicians are key.
• Proactive planning and implementation of these methods improve patient outcomes.