Module - Histocompatibility (SLS134)

STP

Aim of this module

This module will provide the trainee with knowledge and understanding of the causes of immunodeficiency. They will understand the clinical presentation and investigation of a range of immunodeficient conditions and the principles and practice of immunotherapy. They will become familiar with methods and strategies to investigate immunodeficiency and gain experience of the interpretation of patient results in a variety of clinical settings.

This module will provide the trainee with the practical application of knowledge and skills relating to the scientific and practical basis of Histocompatibility.

Work-based learning outcomes


  1. Select and perform laboratory tests for Human Leukocyte Antigen (HLA) antibody identification, definition and data analysis.
  2. Select and perform laboratory tests required for the clinical work up of patients awaiting solid organ transplantation, including cross matching for solid organ transplantation.
  3. Perform the clinical and laboratory work up of patients referred for investigation of platelet refractoriness.
  4. Work in partnership with other clinical specialisms in the investigation of patients referred for transplantation, platelet transfusion, and where appropriate, with other service users and support staff.
  5. Apply specific accreditation standards governing the use of serological practices.

Work-based Competencies


Learning outcome Title Knowledge
1 1, 2, 3

Receive samples for patients undergoing transplant workup or investigation of platelet refractoriness and enter onto Laboratory Information Management System (LIMS).

  • The local repertoire, source of requests and turnaround times for investigations performed by the training H&I laboratory.
  • Clinical indications for solid organ and haemopoietic stem cell transplantation and blood transfusion.
  • Minimum data set required for identification of laboratory samples.
  • Factors affecting sample integrity and appropriate corrective action.
  • Correct use of manual and computerised systems for entering laboratory samples.
  • How to assure the quality of personal practice.
2 1, 2, 3

Isolate serum/plasma from blood samples according to local protocol.

  • Safe handling of biological materials.
3 2

Isolate and quantify lymphocytes from anti-coagulated blood according to local protocol.

  • Principles involved in lymphocyte isolation methods.
  • Procedures available for T and B cell isolation.
  • Lymphocyte identification by microscopy.
4 2

Isolate and quantify lymphocytes from deceased potential donor spleen and lymph node according to local protocol.

  • Principles involved in lymphocyte isolation methods.
  • Lymphocyte identification by microscopy.
5 2

Perform the cryopreservation of lymphocytes from different sources

  • Principles involved in lymphocyte cryopreservation.
6 1, 2, 3,5

Perform laboratory methods for HLA antibody detection for example:

  • Complement dependent cytotoxicity
  • ELISA
  • Flow cytometry
  • X-MAP Technologies(Luminex)
  • Principles of HLA antibody production.
  • Sources of HLA sensitisation.
  • Selection and principles of laboratory methods for HLA antibody detection and definition.
  • Internal quality controls and external quality assessment measures appropriate to the methods used.
  • Correct and safe use of equipment used.
  • How to assure the quality of personal practice.
7 1, 2, 3,5

Perform laboratory methods for HLA antibody definition, including: 

  • Complement dependent cytotoxicity
  • ELISA
  • Flow cytometry
  • xMAP Technologies(Luminex)
  • Operational and performance characteristics of each assay technique.
  • Strengths and weaknesses of each assay technique.
  • Clinical significance of HLA and non- HLA antibodies in transplantation:
    • Class I and Class II
    • IgM allo/autoantibodies
    • red cell antibodies
    • endothelial cell antibodies
  • How to assure the quality of personal practice.
8 2,5

Select appropriate sera for the cross-matching of donor and recipients in accordance with local and national guidelines.

  • How to assure the quality of personal practice.
  • Principles of laboratory methods for crossmatching donors and recipients for solid organ transplantation
    • Complement dependent cytotoxicity
    • Flow cytometry
  • Internal quality controls and external quality assessment measures appropriate to the methods used.
  • Problems likely to be encountered in these assays, including
  • cellular/microbiological contamination
  • false negative and positive reactions
  • low/high cell yield
  • poor viability of cells
  • drug interactions
9 2,5

Perform according to local protocol, laboratory methods for crossmatching donors and recipients for solid organ transplantation by the following methods as appropriate

  • Complement dependent cytotoxicity
  • Flow cytometry
  • How to assure the quality of personal practice.
  • Principles of laboratory methods for crossmatching donors and recipients for solid organ transplantation
    • Complement dependent cytotoxicity
    • Flow cytometry
  • Internal quality controls and external quality assessment measures appropriate to the methods used.
  • Problems likely to be encountered in these assays, including
  • cellular/microbiological contamination
  • false negative and positive reactions
  • low/high cell yield
  • poor viability of cells
  • drug interactions
10 3,5

Perform laboratory testing for a patient referred for investigation of platelet refractoriness, including:

  • HLA typing
  • Antibody testing
  • How to assure the quality of personal practice.
  • The clinical significance of HLA and non-HLA antibodies in blood transfusion:
  • HLA antibodies
  • HPA antibodies
11 4

Work in partnership with other clinical specialisms in the investigation of patients referred for transplantation, platelet transfusion and where appropriate, with service users and support staff.

  • The need to build and sustain professional relationships as both an independent practitioner and collaboratively as a member of a team.
  • Methods of effective communication.
12 4

Communicate effectively with the healthcare team, recognising and responding appropriately to situations where it is necessary to share information to safeguard service users or the wider public.

  • How communication skills affect assessment of, and engagement with, service users and how the means of communication should be modified to address and take account of factors such as age, capacity, learning ability and physical ability.
  • Situations where it is necessary to share information to safeguard service users or the wider public.
  • The limits of the concept of confidentiality.

Work-based assessment


Complete 2 Case-Based Discussion(s)
Complete 2 of the following DOPS and/or OCEs
Type Title
DOPS Prepare blood samples for HLA antibody detection and identification
DOPS Prepare blood samples for donor recipient crossmatching
DOPS Perform the cryopreservation of lymphocytes from patient and or donor samples
DOPS Perform tests to detect HLA specific antibodies
DOPS Undertake a test for the definition of HLA specific antibodies
DOPS Prepare an interpretive HLA antibody profile report
DOPS Perform testing for HPA antibodies
DOPS Prepare an interpretive patient antibody profile report
OCE Take a patient history
OCE Explain procedure and the risks and benefits of the investigation to obtain written and informed consent
OCE Attend a multidisciplinary review meeting at which laboratory results are presented - Prepare a case study, including learning points and clinical outcomes.