Histocompatibility & Immunogenetics - General Information

The H&I Laboratory is located, together with the Clinical Immunology laboratory, on Level 8 of the Duncan Building at the Royal Liverpool and Broadgreen University Hospital NHS Trust.

The H&I Laboratory performs investigations in determination of donor and recipient compatibility for transplantation. These investigations are of two main types - ‘tissue typing’ which facilitates donor-recipient matching and serum screening/crossmatching, which determines recipient sensitisation against putative donor antigens. From results of these tests advice will be given to clinical colleagues regarding progression of patients to transplantation and on their post-transplant management.

H&I Laboratory enquiries 0151 706 4366
Calls to this number will be automatically re-routed if no-one is available to take the call.

Clinical Enquiries about H&I laboratory results should be made to 0151 706 4366

Laboratory Hours
Laboratory opening hours are 08:30 - 17:30 Monday to Friday and excluding bank holidays.

Out of Hours Service
The H&I laboratory operates 24 hours a day, 365 days a year for deceased donor HLA Typing and solid organ donor crossmatching in support of kidney transplantation at the Royal Liverpool University Hospital. The out of hours service is staffed by suitably trained HCPC registered Biomedical and Clinical Scientists. To contact the on-call scientist use main switchboard (0151 706 2000) and ask for the on- call Transplant Immunologist.

Clinical Advisory Service
Consultant advice can be obtained from the Consultant Clinical Scientists for H&I via the on-call scientist in the first instance for out of hours requests. During normal working hours the Consultant Clinical Scientist can be contacted as per below: Prof Derek Middleton 0151 706 4246

Samples
Samples for testing should be sent directly to the laboratory. Anti-coagulated samples should be received in the laboratory on the same day they are taken. ALL ANTI-COAGULATED SAMPLES MUST BE TRANSPORTED AT ROOM TEMPERATURE.
A schedule of sample requirements for particular tests is presented in the accompanying table.
Please ensure that all samples sent to the laboratory are labelled to provide, as a minimum the name (or other unique identifier) of the patient, their date of birth and date of sample collection. Note that addressograph labels should not be used for this purpose.

Renal patients samples
Patients requiring dialysis should have clotted serum samples taken BEFORE a patient dialyses.
For patients registered on the transplant waiting list, it is very important that clotted samples are received every 3 months or after a sensitising event has occurred to ensure suitable offers are received.
Some patients can also benefit from local schemes to improve access to transplantation, provided that regular samples are received.

Complaints procedure
Users can report complaints to staff either verbally or in writing via email. The following documents detail the complaint procedure and are available on request:

  • A Users Guide to the Hospitals Complaints Procedure (PIF 091).
  • Policy for Management of Complaints, Concerns, Comments and Compliments (EQMS 751)
  • LCL Policy for Management of Incidents, Complaints and Nonconformities (QMS-POL-7)

    Provision of patient and / or family information
    The availability of parental HLA typing data is useful for the unequivocal determination of familial haplotypes and helps the identification of sibling donors that are HLA matches.

    For HSCT patients being worked up for a related donor, the laboratory requests that all family members being considered as well as parents (where available) are notified on a family form I&I-H&I-GEN-FOR-4 (available on request).
    Once all samples are received and tested, the set of results will be released.
    Testing Requested
    Samples Required for Testing
      EDTA Clotted Other
    New Renal patient HLA typing and antibody screening 10ml 10ml  
    New renal patient confirmatory HLA typing 10ml    
    Renal patient antibody monitoring samples
    (pre/post transplant, DSA requests)
      10ml  
    Renal Donor testing-crossmatching Recipient 30ml 10ml  
    Donor - Live 60ml    
    Donor - Deceased 60ml   Spleen/lymph node
    Renal Donor Testing HLA typing Donor - Live 10ml    
    Donor - Deceased 10ml    
    HSCT Recipient 10ml (up to 40ml
    depending on WCC)
    10ml  
    Family member 10ml    
    Volunteer donor 10ml    
    Post HSCT Chimerism Monitoring Patient (post-HSCT) up to 40ml
    (dependant on WCC)
      Bone Marrow
    aspirate (2.5ml)
    Disease Association / Drug hypersensitivity testing up to 10ml    

    Sample Labelling
    MUST comply with LCL Minimum Data Standards Policy for labelling all samples and request cards when completing the H&I test request form and in the labelling of samples. Please note that unless the patient or donor name (or other identifier) plus hospital number and sample date are provided on the request card the laboratory may reject the sample.
    The request card should also clearly indicate the reason for the sample being sent to the laboratory. For renal transplant patient samples the laboratory requests that both the phlebotemist and patient signed the request card to verify identify.
    Sample tubes must be individually labelled with the patient/donor identifiers outlined above and also dated.
    Please ensure that samples for each patient are packaged separately along with the associated request form and comply with current blood sample packaging and transporting requirements (see sample transport).

    Sample Transport requirements
    Samples must be collected according to local trust policies and procedures and be delivered to the laboratory in as timely a manner as possible.
    Sample transport is the responsibility of the requestor and they must ensure that mode of transport is timely and appropriate in order to maintain the integrity of the sample.

    Consent
    In order to comply with the Human Tissue Act (2004) users are reminded that consent to testing must be obtained from all patients prior to the taking of the sample.
    The laboratory appreciates that it is not always practical for users to provide documented consent with every request and in those instances where this is not provided the laboratory will presume that consent has been obtained by the requester.

    Confidentiality
    The H&I laboratory has access to the data and information required to provide a service that meets the requirements of all customers, both internal and external. The laboratory information system (LIMS), and related paper storage facilities, caters for the proper collection, processing, recording, storage, and data retrieval.
    Liverpool Clinical Laboratories have documented procedures in place to ensure the confidentiality and security of patient information. Liverpool Clinical Laboratories comply with the Data Protection Act (1998) and the Calidicott principles.( Application of Caldicott and Data Protection Principles - I&I-VI-SOP-8. )

    Request Forms
    Please ensure that request forms (purple Immunology forms) are completed to provide patients name (or other unique identifier) unit number, date of birth, ward and sex. Please also remember to identify the requestors name and bleep number.

    Facilities
    The laboratory space is configured to support the undertaking of a variety of tasks which fall under the broad categories:

  • HLA typing.
  • HLA-specific antibody screening and characterisation.
  • Crossmatching (serological and flow cytometry).

    The laboratory utilises the Telepath LIMS system for booking in, worklisting and reporting test results, and this is able to interface with the Trust-wide ICE reporting system.
    In addition the laboratory has a bespoke Access database which has been developed locally on which current and historic test data are stored in support of the renal transplant programme.
    All laboratory records are stored using electronic and/or paper media in full compliance with the RcPath/IBMS guidelines for data storage.

    Frequency of Testing
    The volume and type of blood sample required depends on the test to be performed. Details of sample requirements are given in the accompanying table. For further information please contact the laboratory.
    The H&I laboratory performs testing daily but to facilitate workload management it is requested that for family studies for either Live Donor Transplantation or haematopoietic stem cell transplantation, if possible, contact is made with the laboratory to book in work in advance.
    HLA antibody screening and molecular typing for disease association are batched. Arrangements can be made with the laboratory to process samples urgently if justified by the clinical circumstance.

    Reporting of Results
    Within the hospital results may be viewed on the ICE system.
    Hard copies of results are sent out by post.
    Urgent reports may be sent by FAX to secure machines by special request or to other NHS hospitals with an NHSMail.net secure email account.