chupert

We store treated cells in Alsever's solution but wash and resuspend them in normal saline for testing. We have also tested these patients with freshly treated cells that haven't been in Alsever's and still get the reactions. Thanks for the input.

They are receiving anti-cd38, specifically daratumumab.

Has anyone else come across patients receiving daratumumab where the DTT treated screen is still reactive? I work at a reference lab in a large hospital with a very large population of multiple myeloma patients and have come across 3 such patients. We have tested DTT treated panels and usually see panreactivity give or take a cell or 2 every now and then. In all 3 the plasma was non-reactive with untreated cord cells, autologous cells and red cells from a few other patients receiving dara. Interestingly when we DTT treated the cord cells, AC and cells from other dara patients, we got positive results. All 3 had negative DAT's; an eluate was tested on one patient just because and it was negative. Titration studies with DTT treated cells varied from 8 to 2048. We did verify that the DTT treated cells were acceptable by testing them with other dara patients, all which resulted in negative screens. Some commonalities between the patients were they are all older African american females with history of rbc transfusion. In one scenario the DTT treated screen had been negative until she received a red cell, then her next sample was positive! All have since been transfused and tolerated the transfusions well. Any ideas what could be happening...crypt antigen being exposed by the DTT? I appreciate any input or hearing if anyone else has experienced this. Thanks : )

I am considering getting my master's and was looking for input. Has anyone been through GWU master's in immunohematology and biotechnology program or UTMB master's in transfusion medicine? I am also considering a more general master's in CLS. Thanks for any info you can send my way.

So just curious if anyone has any thoughts about this case...The patient is pregnant with no history of blood transfusions and types B neg with panagglutination in her antibody screen (all 3 cells 3+) by solid phase testing. A solid phase panel also shows panagglutination with scores ranging from 3-4. A PEG panel shows weak reactivity with some, but not all of the Rh positive cells and all Rh neg cells are negative. The patient did receive Rhogam about 2 months ago. All clinically significant aby's have been ruled out, so I'm thinking a Rhig-D and solid phase is just....well being solid phase, but the DAT is poly=W+ IgG=w+ C3=0. The eluate fits the pattern for anti-D perfectly with 2+ reactions, all other clinically significant aby's are R/O. Soooo, I'm thinking either anti-LW or mom is weak D positive. I did the weak D (despite the weakly pos DAT) and it was clean as a whistle negative. I figure if the cause was a feto-maternal bleed I would at the very least have picked up some mixed field in the D typing (baby isn't delivered yet so I don't know the Rh type) I tested the patient's plasma and eluate in PEG with O neg cord cells and the reactions were a less than impressive W+. I guess I would expect stronger reactions if it was an anti-LW with both Rh pos adult cells and Rh neg cord. I was thinking I might run the partial D kit...DTT treat....and so on and so forth. Thanks for any input : )