Back Module: S-HAI-S1

Fundamentals of Histocompatibility & Immunogenetics

Module information

Module details

Title
Fundamentals of Histocompatibility & Immunogenetics
Type
Specialist
Module code
S-HAI-S1
Credits
20
Phase
2
Requirement
Compulsory

Aim of this module

This module will provide the trainee with the practical application of knowledge and skills relating to the scientific and practical basis of Histocompatibility and Immunogenetics (H&I). The trainee will gain experience of the fundamental techniques required for solid organ transplantation, haematopoietic stem cell transplantation, human leucocyte antigen (HLA) disease association and pharmacogenomic testing, including HLA typing, HLA antibody testing and crossmatching. Furthermore, they will gain experience of the interpretation of patient results in a variety of clinical settings.

Work-based content

Training activities

# Learning outcome Training activity Type Action
# 1 Learning outcome 1,6,7 Training activities

Receive a range of H&I samples and enter onto laboratory IMS

 Type ETA Action View
# 2 Learning outcome 3,6,7 Training activities

Isolate serum/plasma from blood samples and store according to local procedure and national guidance

 Type ETA Action View
# 3 Learning outcome 3,6,7 Training activities

Isolate, quantify and store lymphocytes according to all local protocols

 Type ETA Action View
# 4 Learning outcome 3,6,7 Training activities

Extract and quantify DNA from samples according to local protocol

 Type ETA Action View
# 5 Learning outcome 2,3,6 Training activities

Use local molecular based techniques in accordance with quality standards for HLA typing

 Type ETA Action View
# 6 Learning outcome 4,6 Training activities

Interpret data from all local HLA typing tests using current nomenclature

 Type ETA Action View
# 7 Learning outcome 4,6 Training activities

Analyse family HLA typing results to produce pedigree data

 Type ETA Action View
# 8 Learning outcome 4,6 Training activities

Review and select potential HLA matched donors for HSCT, for:

  • Related donors
  • Unrelated adult donors
 Type ETA Action View
# 9 Learning outcome 5,6 Training activities

Produce an interpretive genotyping report for a patient referred for disease association and/or pharmacogenetic reactions

 Type ETA Action View
# 10 Learning outcome 2,3,6 Training activities

Perform local laboratory methods for HLA antibody detection and definition

 Type ETA Action View
# 11 Learning outcome 4,6 Training activities

Interpret data from HLA antibody identification tests and identify clinically relevant antibodies

 Type ETA Action View
# 12 Learning outcome 2,6 Training activities

Select appropriate sera for crossmatching in accordance with local and national guidelines

 Type ETA Action View
# 13 Learning outcome 3,6 Training activities

Perform local laboratory methods for crossmatching donors and recipients for solid organ transplantation

 Type ETA Action View
# 14 Learning outcome 4,6 Training activities

Interpret crossmatch data and assign results according to local policies

 Type ETA Action View
# 15 Learning outcome 4,6 Training activities

Review and select potential living donors for solid organ transplantation

 Type DTA Action View
# 16 Learning outcome 4,6 Training activities

Prepare a crossmatch report for clinical colleagues for a standard risk solid organ transplant patient

 Type ETA Action View
# 17 Learning outcome 5 Training activities

Perform tests to detect or monitor donor specific antibodies for post-transplant patients

 Type ETA Action View
# 18 Learning outcome 6 Training activities

Participate in quality management activity

 Type DTA Action View
# 19 Learning outcome 7 Training activities

Maintain for routine use, a range of laboratory equipment and analysers in accordance with local policies and manufacturers’ instructions

 Type ETA Action View
# 20 Learning outcome 7 Training activities

Review a COSHH assessment

 Type DTA Action View

Assessments

Complete 4 Case-Based Discussions

Complete 4 DOPS or OCEs

Direct Observation of Practical Skills Titles

  • Perform HLA typing using local molecular methods.
  • Perform tests for a patient referred for disease association or pharmacogenomic reactions.
  • Perform tests for HLA antibody specification.
  • Perform tests for donor recipient crossmatching.
  • Perform tests to monitor post-transplant donor specific antibodies.
  • Select HLA matched donors for HSCT.
  • Interpret HLA sequence data.
  • Interpret Luminex antibody screening data for a sensitised patient.

Observed Clinical Event Titles

  • Communicate results of an HLA-disease association/pharmacogenomic test to a service user.
  • Telephone a service user to inform them of an issue with patient specimens.
  • Present a test issue or unusual laboratory finding at a laboratory meeting to discuss the potential impact on patient care.
  • Present laboratory results at a multidisciplinary team meeting.

Learning outcomes

# Learning outcome
1

Apply acceptance criteria, preparation and storage requirements to H&I laboratory specimens.
2

Apply the appropriate testing strategy for patients referred for solid organ transplantation, haematopoietic stem cell transplantation, HLA associated diseases and pharmacogenetic reactions.
3

Perform the relevant laboratory investigations for a range of patients referred to an H&I laboratory.
4

Interpret test results for the range of techniques performed.
5

Prepare clinical reports for laboratory investigations for a range of patients referred to an H&I laboratory.
6

Practice in accordance with quality and accreditation standards.
7

Employ safe working practices to maintain laboratory equipment, prepare, handle and store laboratory reagents and patient samples.

Clinical experiences

Clinical experiences help you to develop insight into your practice and a greater understanding of your specialty's impact on patient care. Clinical experiences should be included in your training plan and you may be asked to help organise your experiences. Reflections and observations from your experiences may help you to advance your practice and can be used to develop evidence to demonstrate your awareness and appreciation of your specialty.

Activities

  1. Attend ward rounds and/or clinics at which patients are being worked up for, or monitored following haematopoietic stem cell transplantation.
  2. Attend ward rounds and/or clinics at which patients are being worked up for, or monitored following solid organ transplantation.
  3. Discuss with a Specialist Nurse in organ donation their role in patient care.
  4. Attend a dialysis clinic and where possible, discuss the impact of dialysis on lifestyle with a patient.
  5. Attend multidisciplinary team meetings to appreciate the involvement of other specialties in the patient pathway.
  6. Visit a combined Blood Sciences Laboratory to appreciate the contribution of other disciplines to transplant patient care.

Academic content (MSc in Clinical Science)

Important information

The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.

Learning outcomes

On successful completion of this module the trainee will be able to:

  1. Demonstrate extended understanding of the coordination of the components of the immune system in the context of generating and maintaining immunological tolerance in transplantation.
  2. Critically appraise the advantages and limitations of the techniques and assays available in histocompatibility and immunogenetics.
  3. Discuss the pre-transplant work-up of patients undergoing renal transplantation.
  4. Discuss the post-transplant management of patients undergoing renal transplantation including the mechanisms of graft rejection and immunosuppressive therapies.
  5. Discuss the pre-transplant work-up of patients and donors undergoing matched related and unrelated haemopoietic progenitor cell transplantation.
  6. Explain the role of HLA and non-HLA genes in the pathogenesis of associated diseases and the clinical use of HLA genotyping.
  7. Explain the role of HLA and non-HLA genes in associated pharmacogenetic reactions and the clinical use of HLA genotyping.
  8. Critically discuss the legislative requirements associated with transplantation.

Indicative content

Fundamental immunological components:

  • Innate defence mechanisms and inflammation.
  • Pathogen recognition.
  • Complement.
  • Innate lymphoid cells.
  • B- and T-lymphocyte development, differentiation and activation.
  • Immunoglobulins.
  • Secondary lymphoid organs.
  • Regulation and resolution of immune responses.

Histocompatibility antigens:

  • HLA structure and function.
  • Major histocompatibility gene complex arrangement.
  • Antigen presentation.
  • Serological nomenclature.
  • Linkage disequilibrium, CREGS, public and private epitopes, allele nomenclature and databases.
  • Polymorphism.
  • Pedigrees, inheritance and recombination.
  • Linkage disequilibrium.
  • Epitopes.
  • Antibody production against HLA.
  • Population immunogenetics.

Techniques and assays:

  • HLA typing (resolution/speed).
  • Antibody identification.
  • Cross matching.
  • Selection in appropriate clinical contexts.

Renal transplantation:

  • Kidney function and terminal renal failure.
  • HLA matching.
  • HLA antibody identification and the role of pre-sensitisation.
  • Selection and cross matching of recipient and donor.
  • Living kidney donation scheme.
  • Deceased donor organ allocation scheme.
    • Management of the post-transplantation period and graft survival.
    • Recognition of alloantigens.
    • Allograft rejection – immunopathological mechanisms and classification schemes.
    • Immunosuppression – mechanism of drug action, therapeutic monitoring and adverse effects.

Haemopoietic stem cell transplantation:

  • HSCs and the bone marrow niche.
  • Malignant/non-malignant indications.
  • Paediatric and adult recipients.
  • Resolution of HLA typing.
  • Donor sources and stem cell registries.
  • Patient and donor matching.
  • Non-HLA factors in donor selection (CMV, age, sex, ABO).

HLA-associated diseases:

  • Principles of immunological tolerance in self-antigen presentation.
  • Disorders with high predictability (For example, coeliac disease, ankylosing spondylitis, birdshot retinochoroidopathy, narcolepsy).
  • Disorders with HLA associations (For example, SLE, RA, Behcet’s uveitis, autoimmune diabetes).

HLA-associated pharmacogenomics, for example:

  • Abacavir and HIV.
  • Carbamazepine.

Legislation:

  • Quality assurance processes.
  • UKAS and ISO15189:2012.
  • Human Tissue Authority (HTA).
  • Joint accreditation committee-ISCT (JACIE).
  • European Federation for Immunogenetics (EFI).

Module assigned to

Specialties

Specialty code Specialty title Action
Specialty code SLS1-4-22 Specialty title Histocompatibility & Immunogenetics [2022] Action View
Specialty code SLS1-4-23 Specialty title Histocompatibility & Immunogenetics [2023] Action View
Specialty code SLS1-4-24 Specialty title Histocompatibility & Immunogenetics [2024] Action View
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