Histocompatibility

Module details

Title

Histocompatibility

Type

Specialist

Module code

SLS134

Credits

10

Requirement

Compulsory

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.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1, 2, 3	Competency Receive samples for patients undergoing transplant workup or investigation of platelet refractoriness and enter onto Laboratory Information Management System (LIMS).	Action View
# 2	Learning outcome 1, 2, 3	Competency Isolate serum/plasma from blood samples according to local protocol.	Action View
# 3	Learning outcome 2	Competency Isolate and quantify lymphocytes from anti-coagulated blood according to local protocol.	Action View
# 4	Learning outcome 2	Competency Isolate and quantify lymphocytes from deceased potential donor spleen and lymph node according to local protocol.	Action View
# 5	Learning outcome 2	Competency Perform the cryopreservation of lymphocytes from different sources	Action View
# 6	Learning outcome 1, 2, 3,5	Competency Perform laboratory methods for HLA antibody detection for example: Complement dependent cytotoxicity ELISA Flow cytometry X-MAP Technologies(Luminex)	Action View
# 7	Learning outcome 1, 2, 3,5	Competency Perform laboratory methods for HLA antibody definition, including:  Complement dependent cytotoxicity ELISA Flow cytometry xMAP Technologies(Luminex)	Action View
# 8	Learning outcome 2,5	Competency Select appropriate sera for the cross-matching of donor and recipients in accordance with local and national guidelines.	Action View
# 9	Learning outcome 2,5	Competency 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	Action View
# 10	Learning outcome 3,5	Competency Perform laboratory testing for a patient referred for investigation of platelet refractoriness, including: HLA typing Antibody testing	Action View
# 11	Learning outcome 4	Competency 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.	Action View
# 12	Learning outcome 4	Competency 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.	Action View

Assessments

You must complete:

• 2 case-based discussion(s)
• 2 of the following DOPS/ OCEs:

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	DOPS
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.	OCE

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.

Learning outcomes

1. Discuss the clinical implications of immunodeficiency and the primary and secondary causes of immunodeficiency.
2. Explain the role of the humoral and cellular components of the immune system in immunodeficiency.
3. Describe the design, operation and performance of laboratory tests and assays used to investigate and define immunodeficiency.
4. Explain the principles of immunotherapy.
5. Describe and monitor the impact of immunotherapeutic treatments.
6. Discuss and justify appropriate immunotherapeutic strategies/treatment regimens for patients with a range of primary and secondary immunodeficiencies.
7. Describe the partnership between the clinical immunology laboratory and other clinical specialisms in the investigation of immunodeficiency and immunotherapy and patient care.

Indicative content

• Assessing immune function (T lymphocytes; B lymphocytes; phagocytes; complement)
• Deficiencies of innate immunity (phagocytic cell defects; leukocyte adhesion defects; complement system defects)
• B lymphocyte deficiencies (X-linked agammaglobulinaemias; selective IgA deficiency; IgG subclass deficiency; common variable immunodeficiency; transient hypogammaglobulinaemia of infancy; selective specific antibody deficiencies)
• T lymphocyte deficiencies (Di George syndrome; Ommen’s syndrome; bare lymphocyte syndrome; X-linked hyper IgM syndrome; severe T cell deficiencies [X-linked recessive form; adenosine deaminase (ADA) deficiency; purine nucleoside phosphorylase (PNP) deficiency])
• Combined T and B cell defects
  • Severe combined immunodeficiency (SCID) (autosomal recessive SCID; T cell receptor immunodeficiency; MHC Class II deficiency; IL-2 production defect)
  • Wiskott-Aldrich syndrome
• Secondary immunodeficiencies (iatrogenic; neoplasia; infection)
• Cytokine defects
• Human immunodeficiency virus (HIV) and AIDS
  • Pathogenesis of HIV infection
  • Epidemiology, prevalence and modes of transmission
  • Laboratory abnormalities in HIV infection
  • Management of HIV infection (drug therapies; vaccines)
• Immunotherapy
  • Antibodies as immunosuppressive agents (plasmapheresis and plasma exchange; monoclonal antibody therapy; generation of antibodies; ‘magic bullet’ therapy)
  • Immunosuppressive drugs (corticosteroids; cyclosporin and tacrolimus; other anti-inflammatory agents)
  • Other immunosuppressive agents (X-irradiation; ultraviolet light)
  • Cytokines and anti-cytokines (interleukin-1; interleukin-2; interferons; tumour necrosis factors [TNF]; Th1/Th2 balance)
  • Immune modulation by intravenous immunoglobulins
  • Immune potentiation (hormones; cytokine therapy; gene therapy)
  • Other uses of monoclonal antibodies
  • Stress and the immune system (psycho-neuro-endocrino-immune pathway)
  • Immunisation against infection (adjuvants; routine immunisations; travel immunisations; passive immunisation; new vaccines)
  • Cancer immunotherapy
  • Novel approaches to autoimmune disease (T cell vaccines; oral tolerance)
  • Other approaches (lymphocyte vaccination; blocking T cell-adenomatous polyposis coli [APC] interactions; gene repair; patient specific amplification of cytotoxic cells; stem cell therapies)

Activities

• Actively participate in ward rounds and/or clinics at which patients are being worked up for transplantation. Discuss and critically reflect on your experiences and the involvement of the services provided by the laboratory in the management of patients.
• Attend multidisciplinary review meetings at which laboratory results are presented as part of the clinical record in patients awaiting or being monitored following solid organ transplantation. Critically reflect on your learning from this activity and set out a personal development action plan and provide evidence of completing each action.
• Critically reflect on your own experience of supervision and mentoring and identify how you will use this in your learning training, supervising and mentoring of others.
• Review the case notes of a patient requiring transfusion of Human Leucocyte Antigen (HLA) matched platelets and discuss the indications, contraindications, potential side effects and the transfusion support the patient may need with the clinical team. Critically reflect on your learning and how it will affect your future practice