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Status Replies posted by Mabel Adams
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Good Morning Malcolm,
My boss asked me an interesting question yesterday and I wanted to pick your brain about it. The question was, once an anti-M is determined to be clinically insignificant, is there a need to prove that again in future samples?
I told her that I believe it was. In my experience, I've learned that what may apply to one patient does not mean that another patient would not react differently. So... just because an anti-M is determined to be insignificant at a certain point in time, does not mean it there isn't a possibility of it converting in the future to a significant antibody and this could vary from patient to patient. Basically, I'm on the side of not making an assumption.
This resulted in my pondering what other labs are doing and it is difficult to find specific info regarding this scenario. There is plenty of articles on determining the clinical significance of anti-M, but not on the frequency of doing so for previously identified insignificant anti-M.
Anyway, I thought it would be interesting to see how this was treated under your guidance.
Steve
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Malcolm, do you have references close at hand for anti-M in pregnancy? We have an OB patient with an anti-M that reacts in gel but not a pre-warmed saline tube technique that we use to determine significance. The OB/GYN is anxious and wants to order titers even though we recommend against it. Also, I'd love a reference on the Japanese issue with anti-M HDFN if you have the time.
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Hi- do you remember where you saw the article about the Tango carryover? I would very much like to read that.
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It came via email from my reference lab. It is from a podcast on Blood Bank Guy.
"You might already know about the “Dara Effect” described by Dr. Kaufman at 00:38:23 of this podcast http://www.bbguy.org/2016/05/31/bbge-010-dr-rick-kaufman-daratumumab/
In Dr. Kaufman’s lab, one of the automated instruments they use is the Tango. They have realized that if you run a DARA patient sample through the machine, the rinse cycle is insufficient to get rid of the anti-CD38. In fact, the next patient sample that would be run through (a healthy patient who has NO HISTORY of DARA for example) will show a panagglutinin in their antibody screen! But really it is just carry-over."
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