Daratumumab, an anti-CD38 monoclonal antibody used in the treatment of multiple myeloma, has been found in some patients to interfere with pretransfusion immunohaematology testing and therefore potentially impact the transfusion laboratory's ability to provide timely support. The panagglutination which has been seen may mask underlying red cell alloantibodies.
Consensus recommendations for immunohaematology testing in patients prescribed this medication have been developed by a working group of experts from the Australian and New Zealand Society of Blood Transfusion and the Myeloma Scientific Advisory Group to Myeloma Australia, The recommendations include extended red cell phenotyping (or genotyping) prior to commencement of Daratumumab. If red cell transfusion is subsequently required, the use of dithiothreittol (DTT), treated red cells to overcome the interference by anti-CD38 in laboratory testing is recommended. The consensus recommendations can be found here.
Critical to best patient outcome is good communciation between the clinical team and transfusion laboratory prior to commencement of, and during treatment with, Daratumumab.