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Safić Stanić H, Kruhonja Galić Z, Lukić M, Bingulac-Popović J, Jukić I. Risk of new alloimmunization in patients on anti-CD38 treatment using tube LISS-IAT method. Transfus Apher Sci 2024; 63:103873. [PMID: 38267327 DOI: 10.1016/j.transci.2024.103873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/30/2023] [Accepted: 01/09/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Daratumumab is a monoclonal antibody that targets CD38, a transmembrane protein expressed on many cells including RBCs and to a greater extent on myeloma cells. It has been used for treatment of multiple myeloma and autoimmune diseases. Transfusion management of patients on such therapy can be challenging as these drugs cross-react with RBC surface antigens and cause panreactivity. MATERIAL AND METHODS A retrospective study of the 68 patients treated with anti-CD38 from 2018-2023 was carried out. Data regarding transfusion history and antibody screens were analyzed. Depending whether they had immunohematological work-up before or during the treatment- DAT, antibody screen (CAT and tube), RBC pheno/genotyping and serologic cross-matches (CAT and tube) were performed for each patient. All cases with positive CAT IAT were retested in LISS-tube and cross-matches were performed with phenotypically matched units in LISS-tube. RESULTS Antibody screen has shown panagglutination with all panel cells with low and variable agglutination intensity (weak to 2 +). Panagglutination remained positive for 1 - 6 months after drug cessation. Positive DAT was seen in 60,6% patients, while autocontrol was negative. Ficin treated panel-cells eliminated nonspecific reactivity. LISS-tube antibody screen and cross-matches were negative for all patients, apart from 3 patients who had preexisting antibodies. No new antibodies were detected during the course of the study. CONCLUSION Among study group there were no newly identified alloantibodies, meaning that the policy of transfusing them with matched RBCs and performing IAT/cross-matches in tube is a safe and effective policy according to the findings of this study.
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Affiliation(s)
- Hana Safić Stanić
- Department of Immunohematology, Croatian Institute of Transfusion Medicine, Zagreb, Croatia.
| | - Zrinka Kruhonja Galić
- Department of Immunohematology, Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - Martina Lukić
- Department of Immunohematology, Croatian Institute of Transfusion Medicine, Zagreb, Croatia; Clinical Hospital Merkur, Zagreb, Croatia
| | - Jasna Bingulac-Popović
- Department of Molecular Diagnostics, Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - Irena Jukić
- Medical Department, Croatian Institute of Transfusion Medicine, Zagreb, Croatia; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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2
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Li Y, Li C, Zhang L, Li J, Li Q, Ouyang H, Luo J, Zhu L, Cai K. Long-term storage protocol of reagent red blood cells treated with 0.01M dithiothreitol (DTT) for pre-transfusion testing of patients receiving anti-CD38 therapy, daratumumab. Hematology 2023; 28:2186037. [PMID: 36892250 DOI: 10.1080/16078454.2023.2186037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVE Use red blood cell stabilizer to store the antibody screening and antibody identification reagent red blood cells (RBCs) treated with 0.01 mol/L DTT and investigate its value in the pre-transfusion examinations of patients treated with daratumumab. METHOD Determined the optimal incubation time for the 0.01 mol/L DTT-treated RBCs method by evaluating the effect of treatment at different time points. Added ID-CellStab to store DTT-treated RBCs, determined the maximum shelf life of reagent RBCs by monitoring the hemolysis index, and assessed changes in the antigenicity of blood group antigens on the surface of RBCs during storage with antibody reagents. RESULT A protocol for long-term storage of reagent red blood cells treated with the 0.01 mol/L DTT method was established. The optimal incubation time was 40-50 min. RBCs could be stored stably for 18 days after adding ID-CellStab. The protocol was able to eliminate pan-agglutination caused by daratumumab, with no significant changes in the antigens of most blood group systems, except for some attenuation of K antigen and Duffy blood group system antigens during the storage period. CONCLUSION The storage protocol of reagent RBCs based on the 0.01 mol/L DTT method does not affect the detection of most blood group antibodies and retains a certain degree of detection ability for anti-K antibodies, allowing patients treated with daratumumab to quickly perform pre-transfusion examinations, making up for the shortcomings of currently commercial reagent RBCs.
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Affiliation(s)
- Yuyuan Li
- Department of Blood Transfusion, The First People's Hospital of Foshan, Foshan, People's Republic of China.,Department of Transfusion Medicine, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, People's Republic of China
| | - Chengyao Li
- Department of Transfusion Medicine, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, People's Republic of China
| | - Ling Zhang
- Department of Transfusion Medicine, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, People's Republic of China
| | - Jiao Li
- Department of Laboratory, Shunde District Central Blood Station, Foshan, People's Republic of China
| | - Qixin Li
- Department of Clinical Laboratory, the First People's Hospital of Foshan, Foshan, People's Republic of China
| | - Haining Ouyang
- Department of Laboratory, Shunde District Central Blood Station, Foshan, People's Republic of China
| | - Jiaona Luo
- Department of Laboratory, Shunde District Central Blood Station, Foshan, People's Republic of China
| | - Linrui Zhu
- Department of Blood Transfusion, The First People's Hospital of Foshan, Foshan, People's Republic of China
| | - Kui Cai
- Department of Blood Transfusion, The First People's Hospital of Foshan, Foshan, People's Republic of China
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3
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Jacobs JW, Booth GS, Allen ES, Adkins BD. Commentary: Case report: Daratumumab treatment in pre-transplant alloimmunization and severe hemolytic anemia. Front Immunol 2023; 14:1133382. [PMID: 36776872 PMCID: PMC9912978 DOI: 10.3389/fimmu.2023.1133382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/18/2023] [Indexed: 02/14/2023] Open
Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Garrett S Booth
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, CA, United States
| | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, United States
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4
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Lee ES, Hendrickson JE, Tormey CA. RBC alloimmunization and daratumumab: Are efforts to eliminate interferences and prevent new antibodies necessary? Transfusion 2021; 61:3283-3285. [PMID: 34767268 DOI: 10.1111/trf.16736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/03/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Edward S Lee
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jeanne E Hendrickson
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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5
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Tauscher C, Moldenhauer S, Bryant S, DiGuardo M, Jacob EK. Antibody incidence and red blood cell transfusions in patients on daratumumab. Transfusion 2021; 61:3468-3472. [PMID: 34617617 DOI: 10.1111/trf.16687] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/16/2021] [Accepted: 09/14/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Daratumumab (Dara), an anti-CD38 monoclonal antibody for hematologic malignancies, interferes with routine blood bank testing, specifically affecting the antibody screen and identification panels. In 2016, the AABB recommended performing a baseline phenotype or genotype before a patient (Pt) begins taking anti-CD38 to avoid this interference and potential problems with transfusion. The objective of this study was to assess red blood cell (RBC) utilization and subsequent incidence of alloimmunization to the transfused RBCs in patients receiving Dara. METHODS AND MATERIALS We monitored 244 patients taking Dara to determine their red blood cell transfusions and incidence of clinically significant antibody formation before and following administration of Dara. Poisson generalized estimating equations with log link were used comparing the post-Dara incidence and prevalence to those prior, with significance defined as p < .05. RESULTS From September 1, 2015 to December 22, 2018, 244 patients on Dara were identified, of which 145 patients (59.4%) received a red blood cell transfusion. Antibody screens were performed on 97 of the 145 patients at least 2 weeks following RBC transfusion. Four of the total transfused patients (2.8% total, 4.1% patients with follow-up antibody screen testing) formed new clinically significant alloantibodies, which was not significantly different from Asare's hematologic incidence (p = .98/p = .49). CONCLUSIONS This study showed our patients on Dara did not form alloantibodies following RBC transfusion at a higher incidence than similar patient populations.
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Affiliation(s)
- Craig Tauscher
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sheila Moldenhauer
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sandra Bryant
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Margaret DiGuardo
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eapen K Jacob
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Bullock T, Foster A, Clinkard B. Alloimmunisation rate of patients on Daratumumab: A retrospective cohort study of patients in England. Transfus Med 2021; 31:474-480. [PMID: 34405478 DOI: 10.1111/tme.12808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/07/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Whilst small-scale studies on rates of alloimmunisation of patients on Daratumumab have been undertaken, no large-scale study has been performed to date on this cohort of patients. BACKGROUND Patients with multiple myeloma (MM) who are relapsed or refractory to standard treatment are treated with the anti-CD38 therapeutic monoclonal antibody, Daratumumab. Due to the complexity of pre-transfusion compatibility testing, many MM patients in England are referred to Red Cell Immunohaematology (RCI) laboratories for investigation and provision of Red Blood Cell (RBC) components. METHODS Over a 4-month period, patients due to commence, or currently on anti-CD38 therapy were identified and flagged on the RCI Laboratory Information Management System (LIMS). Data was identified and extracted for further analysis. Interrogation of data was performed independently by two subject matter experts, with discrepancies resolved through further enquiry. RESULTS Of 734 English MM patients, we report an alloimmunisation rate of 0.4% whilst on an anti-CD38 TMAb. This is in line with other smaller cohort studies. CONCLUSION Given the low rate of RBC alloimmunisation, consideration should be given to revising the pre-transfusion testing regimen in this cohort. This may improve testing costs, turn-around times and evidence-based patient care.
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Affiliation(s)
- Tom Bullock
- Red Cell Immunohaematology, NHSBT, Filton Centre, Bristol, UK
| | - Amie Foster
- Red Cell Immunohaematology, NHSBT, Newcastle Centre, Newcastle, UK
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Ejaz K, Roback JD, Stowell SR, Sullivan HC. Daratumumab: Beyond Multiple Myeloma. Transfus Med Rev 2021; 35:36-43. [PMID: 34312046 DOI: 10.1016/j.tmrv.2021.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 12/01/2022]
Abstract
Daratumumab (DARA) is the biological name of an Immunoglobulin G1k human monoclonal antibody. DARA the first-in-class therapy targeting CD38 expressing- plasma cells (PC) and plasma blasts. It has been approved for the treatment of multiple myeloma. It is also being examined in the setting of other hematologic malignancies. As DARA targets PCs, it could potentially be used to treat many other disease processes that are antibody mediated. In fact, several case reports and case series report experiences of using DARA to treat a variety of antibody-mediated disorderss. The aim of this review is to present a summary of the literature thus far regarding the application of DARA beyond its uses in multiple myeloma and other hematologic diseases. Specifically, we address uses of DARA as an immunologic modulator in various antibody mediated processes.
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Affiliation(s)
- Kiran Ejaz
- Department of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - John D Roback
- Department of Laboratory Medicine and Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sean R Stowell
- Department of Laboratory Medicine and Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Harold C Sullivan
- Department of Laboratory Medicine and Pathology, Emory University School of Medicine, Atlanta, GA, USA.
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Nedumcheril MT, DeSimone RA, Racine-Brzostek SE, Chaekal OK, Vasovic LV. Overcoming Drug Interference in Transfusion Testing: A Spotlight on Daratumumab. J Blood Med 2021; 12:327-336. [PMID: 34079412 PMCID: PMC8164699 DOI: 10.2147/jbm.s213510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/29/2021] [Indexed: 12/01/2022] Open
Abstract
Daratumumab, a monoclonal antibody therapeutic, is highly efficacious and widely used in all stages of multiple myeloma and amyloidosis and has promising activity in other hematologic disorders. Daratumumab interacts with red blood cells, interfering with pre-transfusion testing. This interference can lead to compromising transfusion safety, extensive blood bank work ups and delays in provision of compatible units. Several methods have been developed to negate daratumumab interference with indirect antiglobulin testing. They are based on i) standard blood bank techniques including dithiothreitol and enzymatic treatment of reagent cells, using reagent red blood cells negative for CD38, ii) blocking CD38 antigens on reagent or donor cells, iii) neutralization of anti-CD38 antibody in patient plasma prior to testing, and iv) extended antigen typing of patient red blood cells in conjunction with provision of phenotypically matched units for transfusion. Implementation of those methods by the blood bank should be a planned effort coordinated with the patient’s clinical team. Timely involvement of blood bank and transfusion services and educational efforts by both blood banks and clinical providers can improve the overall daratumumab safety profile in regard to blood transfusion.
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Affiliation(s)
- Marilyn T Nedumcheril
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.,New York Blood Center Enterprises, New York, NY, USA
| | - Robert A DeSimone
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Sabrina E Racine-Brzostek
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Ok Kyong Chaekal
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.,Department of Medicine/Division of Hematology-Oncology New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Ljiljana V Vasovic
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
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Phou S, Costello C, Kopko PM, Allen ES. Optimizing transfusion management of multiple myeloma patients receiving daratumumab-based regimens. Transfusion 2021; 61:2054-2063. [PMID: 33960433 DOI: 10.1111/trf.16425] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/23/2021] [Accepted: 04/05/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Daratumumab, a human anti-CD38 monoclonal antibody used to treat multiple myeloma, interferes with pretransfusion testing and can mask alloantibodies. Incidence of alloimmunization in patients on daratumumab has not been well characterized, and optimal transfusion guidelines regarding prophylactic antigen matching, accounting for both patient safety and efficiency, have not been well established for these patients. METHODS Records of patients who received daratumumab between January 1, 2014 and July 2, 2019 were reviewed. Daratumumab interference with pretransfusion testing was managed by testing with reagent red blood cells (RBCs) treated with 0.2 M dithiothreitol. When daratumumab was present during antibody testing, patients were transfused with RBC units prophylactically matched for D, C, c, E, e, and K antigens per hospital policy. RESULTS Out of 90 patients identified, 52 received a total of 638 RBC transfusions (average of 12.3 units per patient, SD 17.2, range 1-105, median 5 among those transfused). Alloantibodies existing before daratumumab initiation were identified in seven patients. No new alloantibodies were detected in any patients after starting daratumumab treatment. CONCLUSIONS The incidence of alloimmunization in patients receiving daratumumab is low. Whether this is due to the effect of daratumumab, underlying pathophysiology, or other factors, is unknown. Because these patients require a large number of RBC transfusions overall and have little observed alloimmunization, phenotype matching (beyond RhD) may be unnecessary. Since the use of dithiothreitol cannot rule out the presence of anti-K, we recommend transfusion of ABO-compatible units, prophylactically matched for the D and K antigens only.
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Affiliation(s)
- Samantha Phou
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Caitlin Costello
- Division of Blood and Marrow Transplantation, University of California San Diego, La Jolla, California, USA
| | - Patricia M Kopko
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, California, USA
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Jones AD, Moayeri M, Nambiar A. Impact of new myeloma agents on the transfusion laboratory. Pathology 2021; 53:427-437. [PMID: 33707006 DOI: 10.1016/j.pathol.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/15/2021] [Accepted: 01/17/2021] [Indexed: 12/11/2022]
Abstract
Monoclonal antibody (mAb) therapy targeting CD38 and CD47 antigens expressed on cancer cells has transformed therapy options for patients with multiple myeloma as well as other haematological and non-haematological malignancies. While the on target effects of these new drugs highlight the promise of precision cancer therapeutics, the unintended, off target binding of drugs to red blood cells (RBCs) and platelets has required transfusion service laboratories (TSL) and immunohaematology reference laboratories (IRL) to innovate and rapidly set up processes and testing protocols to overcome the significant interference in routine pre-transfusion tests caused by these agents. Binding of anti-CD38 and anti-CD47 drugs to reagent RBCs leads to false positive pan-agglutination during the antihuman globulin phase of testing, making it difficult to rule out underlying alloantibodies, and leading to delays in setting up compatible units for RBC transfusion. Anti-CD47 agents can also interfere with ABO/Rh typing studies. Several methods to successfully mitigate interference have been described, such as treatment of reagent RBCs with reducing agents or enzymes, allogeneic RBC adsorption studies and drug specific neutralisation assays; all methods have limitations. TSLs should select an approach that best fits their workflow and expertise and takes into consideration their level of access to specialised outside testing, local blood supplier capabilities, and the type of patient population served. For platelet refractory patients, samples should be tested by platelet antibody assays that are known to be unaffected by drug therapy. RBC transfusion support for multiple myeloma patients receiving anti-CD38 or anti-CD47 drugs can be optimised by establishing good communication between the clinical teams and TSLs, building electronic notification processes, and ensuring timely completion of baseline pre-transfusion testing and RBC phenotype/genotype prior to starting therapy. Staff education, standardisation of laboratory mitigation measures, and implementation of testing algorithms that consider mAb-induced interference when working up a pan-agglutinin help to significantly decrease delays that would otherwise result if standard methods were employed to complete antibody identification studies.
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Affiliation(s)
- Andrew D Jones
- UCSF Medical Center, Department of Laboratory Medicine, San Francisco, CA, USA.
| | - Morvarid Moayeri
- UCSF Medical Center, Department of Laboratory Medicine, San Francisco, CA, USA
| | - Ashok Nambiar
- UCSF Medical Center, Department of Laboratory Medicine, San Francisco, CA, USA
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Hirani R, Tarafdar S, Mondy P, Powley T, Daly J, Irving DO. Understanding the demand for phenotyped red blood cell units and requests to perform molecular red blood cell typing for Australian patients. Transfus Apher Sci 2020; 60:102968. [PMID: 33268304 DOI: 10.1016/j.transci.2020.102968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Australian Red Cross Lifeblood has seen a 50 % increase in demand for phenotyped red blood cell (RBC) units between 2016-2018 and a 30 % increase in demand in 2018 to perform molecular RBC typing on patient samples. Lifeblood conducted a survey to understand transfusion laboratory practices for requesting patient phenotyping and/or molecular RBC typing and for selecting phenotyped RBC units in various patient groups. STUDY DESIGN AND METHODS An electronic Qualtrics survey form was sent to 296 transfusion laboratories with questions designed to understand the practice of selecting phenotyped RBC units and reasons for requesting extended serology or molecular RBC typing. RESULTS 49 (16.6 %) transfusion laboratories provided data. Reasons to request extended phenotyping and/or molecular RBC typing for patients included; chronic transfusion (n = 31 laboratories), sickle cell disease (n = 25), Thalassemia (n = 23), requirement for anti-CD38 or other MAB therapy (n = 23) or Myelodysplasia (n = 22). Forty-seven transfusion laboratories provided responses with reasons for requesting molecular RBC typing which included: predicting phenotype in patients with multiple antibodies (n = 31), prior to administering anti-CD38 or other MAB therapies (n = 29), for pregnancy related transfusions (n = 28) or for confirming the phenotype of recently transfused patients (n = 18). CONCLUSION Transfusion laboratory practices indicated that phenotyped RBC units were selected for patients requiring chronic transfusion support and/or undergoing MAB therapy. Requests for molecular RBC typing occurred for more complex patient requirements where serological investigations were not suitable or possible due to reagent restrictions.
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Affiliation(s)
- Rena Hirani
- Australian Red Cross Lifeblood, Sydney NSW, Australia.
| | | | - Phillip Mondy
- Australian Red Cross Lifeblood, Sydney NSW, Australia
| | - Tanya Powley
- Australian Red Cross Lifeblood, Brisbane QLD, Australia
| | - James Daly
- Australian Red Cross Lifeblood, Brisbane QLD, Australia
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