Asian Journal of Transfusion Science
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CASE REPORT
Year : 2017  |  Volume : 11  |  Issue : 2  |  Page : 209-211

Interference of daratumumab with pretransfusion testing, mimicking a high-titer, low avidity like antibody


1 Department of Laboratory Medicine, Division of Transfusion and Transplantation, National Taiwan University Hospital, Taipei, Taiwan
2 Department of Laboratory Medicine, Division of Transfusion and Transplantation, National University Hospital; Department of Laboratory Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

Correspondence Address:
Shyh-Chyi Lo
Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7 Chung-Shan South Road, Taipei
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-6247.214358

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Daratumumab is a monoclonal immunoglobulin against CD38 and has been approved for treating patients with refractory multiple myeloma. The presence of daratumumab in the sera can interfere with pretransfusion testing due to the weakly expression of CD38 on red cells. The reactivity could be mistaken as autoantibody (if autocontrol is positive) or alloantibody (if autocontrol is negative). We present a case that demonstrates daratumumab could mimic a high titer low avidity (HTLA) alloantibody. A 34-year-old male patient of refractory myeloma was recruited in phase three clinical trial involving daratumumab. Samples were sent to the blood bank for pretransfusion testing. Without knowledge of patient having used daratumumab, we mistook the reactivity in the patient's sera as an HTLA antibody due to the results of negative autocontrol and high titers of antibody activity. Antibody screen showed a panreactive pattern and the reactivity against screening cells was up to a titer of 1: 1240. The reactivity was weaker against cord cells than adult cells, became weaker against ZZAP-treated cells and became negative against DDT-treated cells. A discussion with attending physician finally revealed the reactivity was due to the interference caused by daratumumab. The case demonstrates good communication is essential in performing pretransfusion testing for patients receiving daratumumab and other new biological regimens that can interfere with compatibility test.


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2006 - Asian Journal of Transfusion Science | Published by Wolters Kluwer - Medknow
Online since 10th November, 2006