AIMS FELLOWSHIP CURRICULUM TS 3 TRANSFUSION SCIENCE Reference Laboratory Immunohaematology. Reference Laboratory Immunohaematology

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1 Module Code: TS 3 Module Title: Module Convenor: Discipline Committee: Dr T Cobain SEALS Executive Unit Level 4 Campus Centre The Prince of Wales Hospital Baker St, Randwick, NSW, 2031 Ms Dianne Grey Dr D Roxby Ms D Stern Date Module Outline last reviewed: January 2016 Date Module Outline last modified January

2 A. Objectives This Module is designed to provide the candidate with a sound working knowledge of Transfusion Science as it pertains to the transfusion support of patients, and the investigation of immunohaematological states in a Reference Immunohaematology Laboratory. The Module assumes a basic knowledge of immunohaematological techniques and principles. B. Interrelationship of the Module to Other Modules This Module provides the basis for immunohaematological principles relating to reference laboratory immunohaematology and builds on the immunohaematological investigations covered in TS1. Module TS 1 Core Module: Patient Based Transfusion Science C. Brief Description This Module will provide a sound working knowledge of the immunohaematological principles for the operation of an immunohaematology reference laboratory. D. Content 1. Platelet Antigens and Antibodies 1.1 The genetic basis for platelet HPA-antigens including their gene frequencies. 1.2 The techniques used for HPA-antigen typing. 1.3 The techniques used for the detection of platelet antibodies. 1.4 The clinical consequences of platelet antibody formation, investigation protocols and the principles of treatment for the following clinical settings: a) Foeto-maternal alloimmune thrombocytopenia, b) Platelet transfusion support. c) Autoimmune thrombocytopenias,. d) Post transfusion purpura. 1.5 Drug associated antibodies and their detection. Objective: To understand the techniques and protocols used for platelet antigen and antibody detection and the clinical consequences. 2. Granulocyte Antigens and Antibodies 2.1 The genetic basis for granulocyte antigens including their gene frequencies. 2.2 The techniques used for granulocyte antigen typing.

3 2.3 The techniques used for the detection of granulocyte antibodies. 2.4 The clinical consequences of granulocyte antibody formation. Objective: To understand the techniques used for granulocyte antigen and antibody detection and the clinical consequences. 3 Well Characterised Independent Blood Group Antigens The names and ISBT code numbers of the independent high incidence antigens currently associated with the 901 series. 3.2 The names and ISBT code numbers of the independent low incidence antigens currently associated with the 700 series. Objective: To be familiar with antigens of high and low incidence which are not currently associated with a blood group system. ABO Subgroups and H- deficient Blood Groups 4.1 The serological properties and methodologies used to identify ABO subgroups and H-deficient phenotypes. Objective: To recognise ABO subgroups and H-deficient phenotypes 5 The Complexities of the Rh System 5.1 The molecular biology of the Rh system including Variants of RhD, Weak D, Rh null and Rh mod. 5.2 Low incidence Rh antigens associated with red cells that carry partial D. 5.3 Clinical aspects of the Rh system including the role of molecular genotyping. Objective: To have an understanding of the Rh complex. To be familiar with low incidence antigens associated with partial D. 6 High Titre Low Avidity Antibodies 6.1 The genetic basis for so called HTLA antigens ( Ch/Rg, Knops system, Yk a /Csa, JMH ) including their gene frequencies. 6.2 The principles and technical requirements of current methodologies and procedures used for the identification of HTLA antibodies. 6.3 Clinical significance of HTLA antibodies.

4 Objective: To be thoroughly familiar with the characteristics of HTLA antibodies and the techniques used for identification. 7 Race-related and Other Red Cell Antigens and Alloantibodies 7.1 Then genetic, molecular and biochemical basis for the high and low frequency antigens of the MNSs system and the serological properties of corresponding antibodies. 7.2 Antibodies to high incidence and low incidence antigens in different ethnic backgrounds. Genetic background of red cell null phenotypes in Lu, Ge, Fy, Jk, MNSs, Kell, Cr, Do systems. 7.3 Biological and clinical consequences of red cell null phenotypes, including Kx. 7.4 Implications for transfusion (including sickle cell disease). 7.5 The properties of the antigens and antibodies of the Yt, Do, Di, Co and Cr systems and the clinical significance of the antibodies. 7.6 Polyagglutination and associated antigens. Objective: To be familiar with the high and low incidence antigens associated with established blood group systems and their antibodies, including those found in different ethnic backgrounds and associated with null phenotypes. Awareness of the transfusion, clinical and biological implications. Familiarity with T/Tn system cryptantigens and mechanisms effecting their exposure. 8 Identification of Novel Red Cell Antigens 8.1 The serological (including enzymes and chemical modifications) and molecular techniques available for use in identifying a novel red cell antigen. 8.2 Understanding of the ISBT terminology for Red Cell surface Antigens Objective: To be thoroughly familiar with the process of identifying novel red cell antigens. E Rationale for Content A comprehensive understanding of the scientific principles required for a reference immunohaematology laboratory. F Examination Examination will focus on an overall understanding of the scientific basis of reference immunohaematology laboratory.

5 Under the Fellowship Regulations, a 3-hour written examination will be held at the completion of this Module. The examination will contain a mixture of short answer questions and essay style questions..clinical and laboratory case based scenarios may be included in the question mix. Examination for this Module will focus on an overall understanding of the principles and procedures across the major topic themes : Platelet Antigens and Antibodies Granulocyte Antigens and Antibodies ABO Subgroups and H- deficient Blood Group Systems Complexities of the Rh System High titre low Avidity Antibodies Race related and other red cell antigens and alloantibodies Identification of novel red cell antigens The examination will consist of: 10 short answer questions (5 minutes each total 50 minutes) 5 assay style questions (20 minutes each total 100 minutes) Questions will be divided across the topic themes. The unallocated 30 minutes of the exam period should be devoted to carefully reading the questions and reflecting on your response. G. Texts and Supporting Material The following texts and articles are recommended. In addition current volumes of the recommended journals should be consulted for relevant articles. 1 Issitt PD, Anstee DJ. Applied Blood Group Serology. Montgomery Scientific Publications 4 th Edition Klein HG, Anstee DJ. Molllisons Blood Transfusion in Clinical Medicine. 11 th Edition Technical Manual American Association of Blood banks current Edition 4 Metcalfe P. Platelet antigens and antibody detection. Vox. Sang. 2004; 87: (Suppl 1) S Stroncek D, Granulocyte antigen and antibody detection. Vox. Sang. 2004; 87: (Suppl 1), S Recommended Journals:

6 Transfusion Vox Sanguinis including ISBT Science Series Transfusion Medicine Transfusion Medicine Reviews Immunohaematology H. Appointment of a Mentor Each candidate is required to nominate a mentor for the Module at the time of application for entry and into the Fellowship Program. If a candidate is unable to nominate a mentor then the candidate should contact the Module Convenor for assistance. The appointment of a mentor is made by the Examinations Council. I. Module Communications Module Convenor: Dr T Cobain trevor.cobain@health.nsw.gov.au Discipline Committee: Ms Dianne Grey Dr D Roxby Ms D Stern J. Candidate Feedback Immediately following notification of the examination result each candidate will be asked to complete a feedback questionnaire on the Module. However, feedback at anytime during the study of the Module is encouraged through the mentor or directly to the Module Convenor.

Georgia Spanos, MT LifeSouth Community Blood Centers Gainesville, Fl. SEABB March 2017

Georgia Spanos, MT LifeSouth Community Blood Centers Gainesville, Fl. SEABB March 2017 Case Study 1 Patient Demographics -44 year old -African-American Female -Diagnosis: Gastroenteritis -Facility reported