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Only around 0.2-2.0% of the patient population will have detectable RBC antibodies -- fewer still will have multiplePatients more frequently exposed to RBC antigens are more likely to have antibodies (multiply transfused sickle cell adult patients ~47%)So you've mastered the type & screen and antibody panels... but what do you do if an antibody panel is inconclusive?Selected Cell Panels - select cells with minimal overlap of antigens; helpful for patients with a known history of an antibodyEnzyme-treated panels - destroy certain antigens and enhance expression of others; modify RBC surface by removing sialic acid residues and by denaturing or removing glycoproteinsExamples: ficin, papain, bromelin, trypsinOne-step enzyme method: enzymes utilized in place of enhancement media (instead of LISS or PEG)Two-step enzyme method: panel RBCs are treated with an enzyme first, then the antibody ID panel is done with treated cells; should compare reactivity to antibody ID panel of same cells without enzyme treatmentA special case seen in blood banking: Daratumumab ("Dara") patientsDaratumumab is a drug used in treatment of Multiple MyelomaPlasmacytoma or plasma cell cancer - plasma cells express CD 38~30k new cases, ~12.5k deaths per yearAnemia is a key symptom (with calcium levels, renal insufficiency, bone lesions)CD 38 is a cyclic ADP ribose hydrolase - with roles in calcium signalling & NAD metabolismExpressed on all cell types: notably Plasma cells and RBCsOne option for treating Multiple Myeloma is the drug Daratumumab: a monoclonal antibody IgG1K anti-CD 38; kills myeloma cells through patient's own immune responseWhat does this have to do with blood bank?CD38 is found on RBCs -- including screen and panel cells, in crossmatchesDara patients show PANAGGLUTINATION in all AHG testing - positive screen, panel, crossmatch, variable/weak positive DAT (at IgG)Multiple myeloma patients need frequent transfusions - increased chance of developing alloAbEnzyme treated panel case studyDara patient case study
Health, Medicine and Nursing
College / Upper Division
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