Services

Histocompatibility Testing for Solid Organ Transplantation

WHAIS provides laboratory testing and clinical advice for patients requiring a pancreas or kidney who are transplanted in Wales. The service supports transplant of various donor types including:

Laboratory testing encompasses HLA typing, crossmatching and HLA antibody detection/identification. HLA typing is performed by polymerase chain reaction (PCR)- based methods at the resolution required for patient registration and donor allocation by NHSBT ODT. Additional typing is performed using next generation sequencing to assist in antibody definition.

HLA antibody screening is routinely performed on potential transplant patients every 3 months, and following any sensitisation events, by Luminex based methods. Testing schedules for patients receiving antibody incompatible transplants are discussed and agreed with the transplant team on an individual basis. Donor specific antibody testing is performed for transplant patients where antibody mediated rejection is suspected and to monitor effectiveness of treatment.

Allogeneic and autologous crossmatching is performed by Flow Cytometry.

The Laboratory manages patient registration and updates with ODT. Clinical advice in relation to risk and donor selection is provided.

Histocompatibility Testing for Haematopoietic Stem Cell Transplants

WHAIS supports services to the local transplant centre for allogeneic stem cell transplants from related and unrelated donors. HLA-typing of patients and potential donors is performed by PCR-based methods, and next generation sequencing. If required, the patient is tested for HLA antibodies by Luminex based methods.

A graft identification advisory service is provided and WHAIS liaise with WBMDR staff to facilitate local, national and international unrelated donor searches, verification typing sample provision and stem cell products. WBMDR is licensed by the Human Tissue Authority to import haemopoietic stem cells.

Platelet Immunology Service

The laboratory provides investigations for a variety of immune thrombocytopenias which include:

• Platelet refractoriness
• Neonatal alloimmune thrombocytopenia
• Post transfusion purpura

HLA and HPA antibody screening is performed by Luminex based methods and the Monoclonal Antibody Immobilization of Platelet Antigen (MAIPA) test, respectively. HLA and HPA typing is performed by PCR-based methods.

The Laboratory works in close collaboration with the Welsh Blood Service, selecting suitable HLA/HPA selected platelets when clinically required.

The 'All Wales Guidelines for HLA and HPA Selected Platelets' and forms for requesting platelets and providing increment data can be accessed from the Blood Health Team Transfusion Resources.

Disease Diagnosis and Drug Hypersensitivity

HLA typing is provided to support disease diagnosis for a number of diseases e.g. HLA B27 and ankylosing spondylitis, DQA/DQB for coeliac disease and HLA-B*57:01 for Abacavir sensitivity.

Transfusion Related Acute Lung Injury

Investigations for this include HLA antibody screening of the implicated donors and the patient using Luminex technology and HLA typing where appropriate. Forms can be obtained from Blood Health Team Transfusion Resources. Investigations for HNA antibodies are referred to the NHSBT.

Miscellaneous

The laboratory is happy to discuss requirement for ad-hoc HLA typing or antibody definition e.g. for appropriate research projects.