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Ahmed Alotaibi: Monoclonal Antibodies Challenge Routine Pretransfusion Testing

Ahmed Alotaibi/LinkedIn

Oct 28, 2026, 03:38

Ahmed Alotaibi: Monoclonal Antibodies Challenge Routine Pretransfusion Testing

Ahmed Alotaibi, Senior Specialist (Blood bank and blood transfusion) at Afif General Hospital – Riyadh Third Health Cluster (Ministry of Health), shared a post on LinkedIn about a recent article by Philipp Trummer, published in Frontiers in Immunology, adding:

“The antibody screen is panreactive.

But the problem may be the patient’s medication.

Modern biologic therapies are creating a new challenge for blood banks.

A 2026 Frontiers in Immunology review highlights how therapeutic monoclonal antibodies can interfere with routine pretransfusion testing.

One of the best-known examples is daratumumab, an anti-CD38 therapy.

CD38 is not only found on plasma cells.

It is also present on reagent RBCs.

So when a patient receiving daratumumab undergoes antibody screening, the drug can react with the screening cells and produce:

Panreactivity in the IAT

That creates an important question:

Is this a true alloantibody, or just drug interference?

One commonly used solution is to treat reagent RBCs with DTT.

DTT disrupts CD38 and can remove the interference.

But there is a catch.

DTT also destroys or weakens several blood group antigens, including the clinically important Kell system.

So after DTT treatment, a negative screen does not mean every clinically significant antibody has been excluded.

That is why patients receiving anti-CD38 therapy often require careful planning, including:

Medication history

Baseline phenotype or genotype when possible
DTT-treated testing when needed
Appropriate antigen-negative blood selection

The review also highlights newer challenges from anti-CD47 therapies, which can interfere not only with antibody testing but also with other RBC-based serologic methods.

The blood-bank lesson?

Not every panreactive antibody screen is caused by a patient alloantibody.

Sometimes the medication is the reason every cell is reacting.

And knowing that before transfusion testing begins can save a lot of time and confusion.”

Title: Therapeutic biologics interference in serological and pre-transfusion testing

Authors: Philipp Trummer, Cora P. Habicht, Erwin A. Scharberg, Clemens Schneeweiß

Ahmed Alotaibi