INF136/8 – User Guide for Histocompatibility and Immunogenetics Diagnostics Services Copy No: Effective date: 15/11/2020 HISTOCOMPATIBILITY AND IMMUNOGENETICS DIAGNOSTIC SERVICES USER GUIDE Controlled if copy number stated on document and issued by QA (Template Version 03/02/2020) Page 1 of 45 CONTROLLED INF136/8 – User Guide for Histocompatibility and Immunogenetics Diagnostics Services Copy No: Effective date: 15/11/2020 Contents CONTENTS ............................................................................................................................................. 2 LIST OF FIGURES .................................................................................................................................. 4 LIST OF TABLES ................................................................................................................................... 4 CHAPTER 1: GENERAL INFORMATION.............................................................................................. 5 1.1 THIS GUIDE ................................................................................................................................. 5 1.2 QUALITY STATEMENT ............................................................................................................... 5 1.3 COMPLIMENTS AND COMPLAINTS ......................................................................................... 5 CHAPTER 2: H&I LABORATORIES AND MANAGEMENT ................................................................. 6 2.1.1 OUT OF HOURS ...................................................................................................................... 7 2.1.1.1 SOLID ORGAN TRANSPLANT PROGRAMMES................................................................ 7 2.1.1.2 OUT OF HOURS ORDERING OF HLA SELECTED PLATELETS ..................................... 7 CHAPTER 3: SAMPLE REQUIREMENTS & REPORTING .................................................................. 8 3.1 SAMPLE REQUIREMENTS ........................................................................................................ 8 3.2 REQUEST FORMS ...................................................................................................................... 8 3.3 SAMPLE COLLECTION AND LABELLING ............................................................................... 8 3.4 KEY FACTORS THAT MAY AFFECT TESTING ...................................................................... 10 3.5 ACCEPTANCE LIMITS FOR SAMPLE AGE ............................................................................ 10 3.6 TIME LIMITS FOR REQUESTING ADDITIONAL EXAMINATIONS ........................................ 11 3.7 VOLUME AND TYPES OF SAMPLE ........................................................................................ 11 3.8 TYPE OF REQUEST .................................................................................................................. 13 3.9 CONSENT .................................................................................................................................. 13 3.10 PACKAGING AND TRANSPORT.......................................................................................... 13 3.10.1 SENDING SPECIMENS BY POST/ NHSBT TRANSPORT .................................................. 14 3.11 WHERE TO SEND SAMPLES ............................................................................................... 15 3.11.1 URGENT SAMPLES .............................................................................................................. 15 3.12 REPORTING TIME ................................................................................................................. 15 3.13 COMPUTER RECORDS AND REPORTS ............................................................................. 16 3.13.1 COMPUTER RECORDS ........................................................................................................ 16 3.13.2 REPORTING ........................................................................................................................... 16 3.13.3 ANTIBODY CARDS ............................................................................................................... 17 CHAPTER 4: H&I SERVICES .............................................................................................................. 17 4.1 H&I SERVICES RELATING TO TRANSFUSION & TRANSFUSION REACTIONS ................ 17 4.1.1 PLATELET REFRACTORINESS AND THE PROVISION OF HLA / HPA SELECTED PLATELETS . 17 4.1.1.1 CMV NEGATIVE SELECTED PRODUCTS ....................................................................... 17 4.1.1.2 ALLOIMMUNISATION AGAINST PLATELETS ................................................................ 18 4.1.1.3 PLATELET REFRACTORINESS ....................................................................................... 18 4.1.1.4 WHEN TO REQUEST HLA CLASS I SELECTED PLATELETS ....................................... 18 4.1.1.5 INCREMENTS WITH HLA CLASS I SELECTED PLATELETS ........................................ 20 4.1.1.6 HLA & HPA SELECTED PLATELETS .............................................................................. 20 4.1.1.7 ORDERING HLA & HPA SELECTED PLATELETS .......................................................... 20 4.1.1.8 NEW REQUESTS FOR HLA SELECTED PLATELETS ................................................... 20 4.1.2 SERIOUS HAZARDS OF TRANSFUSION (SHOT) .............................................................. 21 4.1.2.1 REPORTING ADVERSE REACTIONS TO TRANSFUSIONS .......................................... 21 4.1.3 TRANSFUSION ASSOCIATED GRAFT VERSUS HOST DISEASE (TA-GVHD) ................ 21 4.1.3.1 INVESTIGATIONS .............................................................................................................. 21 4.1.4 TRANSFUSION RELATED ACUTE LUNG INJURY (TRALI) ............................................... 22 4.1.4.1 INVESTIGATIONS .............................................................................................................. 22 4.1.4.2 FUTURE TRANSFUSIONS ................................................................................................ 22 4.1.5 SEVERE NON-HAEMOLYTIC FEBRILE TRANSFUSION REACTIONS (NHFTR) ............. 23 4.1.5.1 NON-HAEMOLYTIC FEBRILE AND ALLERGIC TRANSFUSION REACTIONS WITH AN IMMUNOLOGICAL CAUSE ................................................................................................................. 23 4.2 PLATELET IMMUNOLOGY (PI) ................................................................................................ 23 4.2.1 NEONATAL ALLOIMMUNE THROMBOCYTOPENIA (NAIT) .............................................. 23 Controlled if copy number stated on document and issued by QA (Template Version 03/02/2020) Page 2 of 45 CONTROLLED INF136/8 – User Guide for Histocompatibility and Immunogenetics Diagnostics Services Copy No: Effective date: 15/11/2020 4.2.1.1 INVESTIGATIONS FOR NAIT ............................................................................................ 24 4.2.1.2 THERAPY ........................................................................................................................... 24 4.2.1.3 COUNSELLING AND CLINICAL QUESTIONNAIRES ...................................................... 24 4.2.1.4 FOETAL HPA GENOTYPING IN FUTURE PREGNANCIES IF THE PARTNER IS HETEROZYGOUS ................................................................................................................................ 24 4.2.2 POST-TRANSFUSION PURPURA (PTP) ............................................................................. 24 4.2.2.1 INVESTIGATIONS .............................................................................................................. 25 4.2.2.2 THERAPY ........................................................................................................................... 25 4.2.2.3 TRANSFUSION SUPPORT ................................................................................................ 25 4.2.2.4 DELAYED ENGRAFTMENT OF PLATELET LINEAGE FOLLOWING STEM CELL TRANSPLANTATION ........................................................................................................................... 25 4.2.3 AUTOIMMUNE THROMBOCYTOPENIA (AITP) ................................................................... 25 4.2.3.1 BONE MARROW FAILURE AND IMMUNE-MEDIATED THROMBOCYTOPENIA .......... 25 4.2.3.2 AITP PATIENTS REFRACTORY AND FIRST OR SECOND LINE TREATMENT ........... 25 4.2.3.3 MONOCLONAL GAMMAGLOBULINOPATHIES .............................................................. 26 4.2.4 DRUG-DEPENDENT IMMUNE THROMBOCYTOPENIA (DDITP) ....................................... 26 4.2.4.1 HEPARIN INDUCED THROMBOCYTOPENIA (HIT)......................................................... 26 4.2.4.2 OTHER DRUGS .................................................................................................................. 27 4.2.5 THROMBASTHENIA .............................................................................................................. 27 4.2.5.1 ACQUIRED THROMBASTHENIA ...................................................................................... 27 4.2.5.2 GLANZMANN’S THROMBASTHENIA (GT), BERNARD SOULIER SYNDROME (BSS), COLLAGEN RECEPTOR DEFICIENCIES ........................................................................................... 28 4.2.5.3 INVESTIGATIONS .............................................................................................................