TRANSFUZIOLOŠKO ZBRINJAVANJE PACIJENATA SA MULTIPLIM MIJELOMOM LEČENIH ANTI-CD38 MONOKLONSKIM ANTITELIMA – PRIKAZI SLUČAJEVA

Abstract

Introduction. Daratumumab is a monoclonal antibody targeting CD38, commonly used in the treatment of newly diagnosed and relapsed multiple myeloma. The expression of CD38 on red blood cells poses a challenge as anti-CD38 can interact with red blood cells during the indirect antiglobulin test, complicating pre-transfusion testing and delaying the availability of antigen-negative blood units.

Case Report. The first case involved a 49-year-old woman with anemia secondary to multiple myeloma, who had received treatment with Darzalex® three months prior. The second case was a 66-year-old woman with relapsed multiple myeloma, undergoing treatment with Darzalex®, who required a blood transfusion as part of her therapeutic protocol. Both patients’ blood samples demonstrated complications during pre-transfusion testing, including panagglutination of red blood cells during the indirect antiglobulin test, affecting both antibody screening and cross-matching procedures. Following treatment of the red blood cells with Dithiothreitol, the indirect antiglobulin test results were rendered negative. However, since dithiothreitol destroys the Kell blood group antigen, both patients received Rh- and Kell-matched blood units to ensure compatibility.

Conclusion. Dithioerythritol remains the most commonly available and effective method for resolving pre-transfusion testing issued in patients undergoing anti-CD38 monoclonal antibody therapy. Ensuring antigen matching patient for clinically significant blood group antigens between patient and donor red blood cells is crucial. Future efforts should focus on enhancing coordination between clinical teams and blood transfusion laboratories, developing unified guidelines, and investing in advanced testing modalities to overcome these transfusion challenges.