Claudia I Chapuy1, Maria D Aguad2, Rachel T Nicholson3, James P AuBuchon4, Claudia S Cohn5, Meghan Delaney6, Mark K Fung7, Meredith Unger8, Parul Doshi9, Michael F Murphy10, Larry J Dumont11,12, Richard M Kaufman2. 1. Dana-Farber Cancer Institute at St Elizabeth's Medical Center, Boston, Massachusetts. 2. Brigham and Women's Hospital, Boston, Massachusetts. 3. Massachusetts General Hospital, Boston, Massachusetts. 4. Bloodworks Northwest, Seattle, Washington. 5. University of Minnesota, Minneapolis, Minnesota. 6. Bloodworks Northwest, Seattle Children's Hospital, University of Washington, Seattle, Washington. 7. University of Vermont Medical Center, Burlington, Vermont. 8. Janssen, Inc, Raritan, New Jersey. 9. Janssen Research & Development, Springhouse, Pennsylvania. 10. NHS Blood and Transplant, Oxford, United Kingdom. 11. Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. 12. Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire.
Abstract
BACKGROUND: Daratumumab (DARA) consistently interferes with routine blood bank serologic testing by directly binding to CD38 expressed on reagent red blood cells (RBCs). Treating RBCs with dithiothreitol (DTT) eliminates the DARA interference. We conducted an international, multicenter, blinded study aimed at validating the DTT method for use by blood bank laboratories worldwide. STUDY DESIGN AND METHODS: Paired plasma sample unknowns were sent to 25 participating blood bank laboratories. Sample 1 was spiked with DARA only (10 µg/mL), and Sample 2 with DARA plus a clinically significant RBC antibody (anti-D [n = 6], anti-Fya [n = 9], or anti-s [n = 10]). Sites were instructed to perform an antibody screen with and without DTT-treated RBCs and to use a DTT-treated RBC panel for antibody identification. Qualitative data about the DTT method were collected by online survey. The primary outcome was the proportion of study sites able to identify the antibody unknown in the presence of DARA. RESULTS: All sites observed the DARA interference with the antibody screen. The DARA interference was seen with all testing methods (gel, tube, or solid phase). Using the DTT method, 25 of 25 sites (100%) successfully identified the antibody unknown in the presence of DARA. Feedback on the DTT method was positive, with 17 of 19 (90%) sites responding to the survey indicating that they planned to use the DTT method to test clinical samples from DARA-treated patients. CONCLUSION: The DTT method is robust and reproducible and can be implemented by transfusion services worldwide to help provide safe blood products to patients treated with DARA.
BACKGROUND:Daratumumab (DARA) consistently interferes with routine blood bank serologic testing by directly binding to CD38 expressed on reagent red blood cells (RBCs). Treating RBCs with dithiothreitol (DTT) eliminates the DARA interference. We conducted an international, multicenter, blinded study aimed at validating the DTT method for use by blood bank laboratories worldwide. STUDY DESIGN AND METHODS: Paired plasma sample unknowns were sent to 25 participating blood bank laboratories. Sample 1 was spiked with DARA only (10 µg/mL), and Sample 2 with DARA plus a clinically significant RBC antibody (anti-D [n = 6], anti-Fya [n = 9], or anti-s [n = 10]). Sites were instructed to perform an antibody screen with and without DTT-treated RBCs and to use a DTT-treated RBC panel for antibody identification. Qualitative data about the DTT method were collected by online survey. The primary outcome was the proportion of study sites able to identify the antibody unknown in the presence of DARA. RESULTS: All sites observed the DARA interference with the antibody screen. The DARA interference was seen with all testing methods (gel, tube, or solid phase). Using the DTT method, 25 of 25 sites (100%) successfully identified the antibody unknown in the presence of DARA. Feedback on the DTT method was positive, with 17 of 19 (90%) sites responding to the survey indicating that they planned to use the DTT method to test clinical samples from DARA-treated patients. CONCLUSION: The DTT method is robust and reproducible and can be implemented by transfusion services worldwide to help provide safe blood products to patients treated with DARA.
Authors: Emma Castro Izaguirre; María Del Mar Luis-Hidalgo; Luis Larrea González; Cristina Arbona Castaño Journal: Blood Transfus Date: 2020-06-04 Impact factor: 3.443
Authors: Marilyn T Nedumcheril; Robert A DeSimone; Sabrina E Racine-Brzostek; Ok Kyong Chaekal; Ljiljana V Vasovic Journal: J Blood Med Date: 2021-05-25