FRCPath Haem Part 1 EMQs- Transfusion 86 and 87

EMQ Theme: Managing transfusion investigations in patients receiving monoclonal antibody therapies

Option List

A. Perform testing using DTT-treated reagent red cells

B. Provide K-negative red cells unless patient is known to be K-positive

C. Refer sample to NHSBT Red Cell Immunohaematology laboratory

D. Use Capture methodology

E. Extended red cell genotyping

F. Group O red cells for transfusion

G. Perform alloadsorption studies

H. Inform transfusion laboratory before therapy commences

I. Use a different monoclonal anti-IgG reagent

J. Match red cells for Rh and K antigens

K. Patient should carry alert card for 6 months after therapy

L. Routine antibody screen without modification

M. Emergency transfusion only out of hours

N. Direct antiglobulin test (DAT) prior to therapy

O. Extended phenotype matching despite unresolved serology

Questions

Question 1

A 69-year-old man with relapsed multiple myeloma is due to commence daratumumab therapy. He received transfusion support 2 weeks ago. The transfusion laboratory wishes to establish a comprehensive antigen profile before treatment begins. Which is the SINGLE most appropriate investigation?

Question 2

A patient receiving isatuximab demonstrates panreactivity on indirect antiglobulin testing. The transfusion scientist wishes to minimise anti-CD38 interference during antibody screening. Which is the BEST approach?

Question 3

A 74-year-old woman receiving trial magrolimab develops severe anaemia requiring urgent transfusion. Her ABO group cannot be conclusively determined due to interference in serological testing. Which transfusion strategy is MOST appropriate?

Question 4

A patient on anti-CD47 therapy has persistent panagglutination despite routine investigations. The laboratory wants to identify underlying alloantibodies while avoiding interference from therapeutic antibody. Which investigation is MOST appropriate?

Question 5

A patient treated with daratumumab requires elective transfusion support. Antibody screening has been performed using modified methodology. Which blood selection policy is MOST appropriate?

Question 6

A transfusion practitioner is counselling a patient about to commence anti-CD38 therapy. What is the MOST important practical recommendation to minimise delays during future admissions?

Question 7

A patient previously transfused within the last month is about to commence anti-CD38 therapy. Extended serological profiling is required, but phenotyping may be unreliable. Which investigation is MOST appropriate?

Question 8

A patient on magrolimab has unresolved serology despite alloadsorption studies. The local laboratory lacks specialised methods for further evaluation. What is the MOST appropriate next step?

Question 9

A patient receiving monoclonal antibody therapy requires transfusion overnight for life-threatening haemorrhage. The local laboratory contacts the regional RCI service. Which statement BEST reflects NHSBT guidance regarding out-of-hours investigations?

Question 10

A patient with multiple myeloma completed daratumumab therapy 4 months ago and presents to another hospital requiring urgent surgery. The patient informs staff using a wallet card indicating prior treatment. Why is continued alerting necessary?