LABORATORY TESTING SERVICES

Immunohematology Services

There are a wide variety of immunohematology services available through United Blood Services. Some local United Blood Services centers offer an extended menu of reference services while others act as the liaison between the hospital and our nationally recognized Immunohematology Section at Blood Systems Laboratories. Please contact your local United Blood Services center to inquire about immunohematology services.

All reference testing requires completion of a test requisition. Click here for a Reference Laboratory Request Form (BS 313).

IHS SAMPLE REQUIREMENTS

Optimal sample size for red cell serological workups: 10-20 mL clotted; 5-10 mL EDTA.

Samples for red cell serological workups should be shipped in a container maintaining a temperature between 1C - 10 C.

Optimal sample size for platelet antibody testing and crossmatching: 7 mL EDTA.

Samples for platelet antibody testing should be shipped in a container maintaining a temperature between 1C -10C.

Samples for platelet testing including HPA-1a (PlA1) typing, Platelet Associated IgG (direct antiglobulin test) and source platelets should be shipped in a container maintaining a temperature between 18C - 25C.

TURNAROUND TIMES (TAT)

Depending on the complexity of the workup and the patient status, turn around times will vary. The following guidelines are used by United Blood Services and Blood Systems Laboratories:

Turnaround time listed above is from the time the sample is received in the testing laboratory.

The timeframes listed above are guidelines. TAT may vary by blood center. Please contact your local United Blood Services for area specific TATs.

GUIDELINES FOR EMERGENCY STATUS

The following questions are designed to help identify referrals for immunohematologic resolution that should be elevated to an emergency (STAT) workup.

1. Patient’s clinical symptoms:
   1. High output failure: heart failure-rapid beating with insufficient O2 delivery.
   2. Angina: coronary artery disease with persistent decrease in O2 delivery to myocardial muscle.
   3. Impending stroke: cerebral vascular disease with persistent decrease in O2 delivery to cerebrum.
2. Is the patient actively bleeding? Yes / No
   Note: a rapid drop in hemoglobin (> 1 gm/dL / 24 hours) places the patient at risk.
3. Does the patient require surgery during the next 24 hours? Yes / No
4. Are all units incompatible? Yes / No

Turn around time for reporting results (verbally or by fax) on a STAT request is, generally, within 8 hours of sample receipt. Please remember to complete, as thoroughly as possible, the Reference Laboratory Request Form (BS313), and contact United Blood Services laboratory personnel.

REPORTING AND BILLING

Preliminary reports (prior to final review) and billing information will be faxed at completion of workup.

Final reports will be faxed or mailed to the hospital after final review has been completed.

Billing will be done through the local blood center. Charges for testing services will be handled through the normal billing process.

ABOUT BLOOD SYSTEMS LABORATORIES
IMMUNOHEMATOLOGY SECTION

Blood Systems Laboratories Immunohematology Section (IHS) is an AABB accredited Immunohematology Reference Laboratory (IRL) for high complexity testing.

The IHS lab provides serological consultation and reference laboratory services to assist hospitals in solving patient antibody and typing problems.

IHS also offers platelet screening and platelet crossmatching to supply compatible platelet pheresis to patients who have become refractory to random donor platelets.

The Immunohematology Section (IHS-Reference Laboratory) is staffed 24 hrs/ 7 days a week. Holidays are staffed on an on call basis.

IHS participates in proficiency testing surveys from the AABB, American Association of Bioanalysts (AAB) and College of American Pathologists (CAP).

Routine testing performed by IHS uses in-date FDA licensed reagents and kits when available. Non-licensed reagents may be required in complex evaluations when licensed reagents are not available. Suitable controls are tested when using non-licensed reagents.

IHS is located at:

2424 West Erie Drive
Tempe, AZ 85282

Click here for more information about Blood Systems Laboratories.

Histocompatability Laboratory

The Blood Systems Laboratories Histocompatibility Laboratory is accredited by the American Society for Histocompatibility and Immunogenetics (ASHI) for:

• HLA typing by DNA in support of both related and unrelated hematopoietic stem cell transplantation
• Non-transplant clinical support
• Transfusion support
• CD34 enumeration
• Anti-HLA Class I antibody screening
• HLA Crossmatch testing
• DNA Relationship Testing

The Histocompatibility (HLA) Laboratory is staffed Monday through Friday from 7:30 AM to 5 PM. After hours, weekends and holidays the laboratory is staffed on an on-call basis for urgent requests.

For lists of staff, contact phone numbers and email addresses please use the website: www.bloodsystemslaboratories.org.

Choose from the links below for information on the following topics:

When requesting testing from the Histocompatibility Laboratory, please complete the HLA Requisition Form (BS 320H), available from your local blood center.

TURNAROUND TIME

Turn around time of results will depend upon the urgency and nature of the request. Please contact HLA laboratory to coordinate testing.

A signed report of testing results is faxed after completion of testing. The hard copy original should be received within one week of the faxed report. Preliminary, unsigned reports of test results are available upon request.

REQUIREMENTS FOR COLLECTION

The Clinical Laboratory Improvement Amendment of 1988 (CLIA ’88) establishes sample labeling requirements. As well, CLIA accredited laboratories must identify sample collection and shipment requirements and notify submitting facilities. The following instructions will provide guidance to comply with CLIA ’88 regulations.

Sample labeling instruction:

1. Individual’s correct name, first and last. Make sure all tubes have correct, identical and legible name spelling.
2. Hospital identification number.
3. Date of collection.
4. Phlebotomist’s initials or signature.

Written Test Authorization for All Samples to be Tested for Clinical Purposes

1. Written authorization is documented on the Histocompatibility Requisition Form (BS 320H). See www.bloodsystemslaboratories.org.
2. If a BS 320H is not received with the sample, the laboratory will fax client a Test Authorization Form for signature by an authorized individual.

Minimum Sample Collection and Storage Requirements for CHILDREN:

• HLA Typing

1. Infant (<1 year): 3 mL EDTA (purple top) anticoagulated whole blood.
2. Child (1 year-10 years): 5 mL EDTA.
3. Child (>10 years): 10 mL EDTA.
4. Contact the HLA Laboratory when the WBC count is <4000/µL for required sample amount.
5. Samples may be refrigerated (4°C) or stored at room temperature.

Sample Collection and Storage Requirements for ADULTS:

• HLA Typing

1. Specimen: Collect 20 mL EDTA, mix thoroughly. When Class I and Class II are requested 20 mL EDTA will be sufficient.
   • Collect 40 - 60 mL EDTA when the WBC count is <4000/µL
2. Storage temperature: Refrigerated (4°C) or room temperature.

• HLA Single Locus (example: B27 typing or DQ2 and/or DQ8 typing)

1. Specimen: Collect 5 mL EDTA, mix thoroughly.
2. Storage temperature: Refrigerated (4°C) or room temperature.

Note: ACD may be substituted for EDTA anticoagulated samples for DNA molecular testing.

• Antibody Screen

1. Specimen: Collect 10 mL whole blood in a clot tube (red top). Store and transport at 4°C. If not shipped within 48 hours of collection, separate and freeze serum. Send on ice.

• HLA Crossmatch

1. Recipient Specimen: Collect 10 mL whole blood in a clot tube (red top). Store and transport at 4°C. If not sent with in 48 hours of collection, separate and freeze the serum. Send on ice.
2. Donor Specimen: Collect 30 mL ACD (yellow top) anticoagulated whole blood: Store and transport at room temperature.
   

Packing and Shipping Information

1. Place specimens and paperwork into the double box sample mailer. Place inner box into ziplock bag.
   1. Complete the Histocompatibility Laboratory Requisition Form (BS 320H), available from your local blood center representative.
2. Transport blood specimens as soon as possible to be received by the HLA lab within 48 hours from sample collection.
   1. Federal Express for overnight standard delivery Contact the HLA laboratory to arrange Saturday deliveries.
   2. Greater Phoenix area sample pick-up: call the HLA Laboratory at 1-866-342-4275, extension 7034.
      
   3. Ship specimens to:

      Blood Systems Laboratories
      Histocompatibility Laboratory
      2424 West Erie Drive
      Tempe, AZ 85282
      1-866-342-4275, ext. 7034

HLA LABORATORY LICENSING
AND PROFICIENCY TESTING

For current ASHI and CLIA certificates, see our website at: www.bloodsystemslaboratories.org

The Histocompatibility Section participates in proficiency testing surveys from:

• American Society for Histocompatibility and Immunogenetics
• College of American Pathologists
• UCLA DNA Exchange