1. Hoxworth
  2. Lab Services
  3. Immunohematology

Immunohematology

Hoxworth Blood Center’s Immunohematology Reference Laboratory (IRL) provides testing and consultation to assist hospitals in solving patients’ red blood cell (RBC) serological problems. The IRL provides rare (antigen matched) blood by maintaining local liquid and frozen rare blood inventories and by participating in the American Rare Donor Program (ARDP), a national search service. The IRL is an AABB and CLIA accredited Immunohematology Reference Laboratory (IRL). CLIA # 36D0346846.

Laboratory Hours: The lab is staffed 24 hours, 5 days a week from Sunday at 11:00 p.m. through Friday, at midnight. Friday midnight through Sunday at 11:00 p.m. on-call staff are available to provide laboratory testing services and confirmed typed RBC units for STAT requests and to provide historical antigen negative (non-confirm typed) RBC units.

Service Offered:

The IRL staff is always available as a resource for questions regarding difficult serological and hematological care.

Below is a list of available tests and services that can be requested. All IRL testing requires completion of test requisition. Click here for a IRL Consultation Request Form (IR-504-FORM).

  • Red Cell Antibody Investigations
    • Single to Complex Multiple Antibodies
    • Auto-antibodies
    • Drug-dependent Antibodies
    • Antibodies to High- and Low-Incidence Antigens
    • Reagent-dependent Reactivity
  • Molecular genotype investigations, RhD zygosity, testing for variant antigens
  • Hemolytic Disease of the Newborn Investigations
  • Transfusion Reaction Investigations
  • Aberrant or Discrepant Result Investigations
  • Polyagglutination Investigations
  • Donor/ Patient Red Cell Phenotype Requests
  • Platelet crossmatching for refractory patients
  • Prenatal evaluations including titers
  • Procurement of Antigen-Negative Donor Units
  • Procurement of IgA Deficient Plasma (from ARDP)
  • Testing for Atypical Chemokine Receptor 1 (ACKR1) previously known as DARC

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

Sample Requirements
Optimal sample size for red cell serological workups: 30 mL EDTA anticoagulated whole blood. See consultation request form for specific requirements.

Molecular Genotyping Guidelines
Click here for the Molecular Genotyping for Patient Blood Management - IRL Recommendations.

Turnaround Times (TAT)
Depending on the complexity of the work up and the request status, turn around times will vary. The following guidelines are used by the IRL:

 

REQUEST LEVEL TURN AROUND TIME FOR VERBAL REPORT
STAT
(Life Threatening)		 8 hours from time of sample receipt
ASAP
(Transfusion Needed but not Life Threatening)		 24 hours from time of sample receipt
Routine 1-5 days from time of sample receipt

 

Turnaround time listed above is from the time the sample is received in the testing laboratory. The time frames listed above are guidelines. TAT may vary by the complexity and extent of the serological problem.

All tests for consultation services, as well as antigen-negative blood requests must be entered into Blood Hub.  Check with your blood bank supervisor for more information.

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:
    a.   High output failure: heart failure, rapid pulse with insufficient O2 delivery.
    b.   Angina: coronary artery disease with persistent decrease in O2 delivery to myocardial muscle.
    c.   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

 

Emergency status should be considered for those patients who:
• Suffer any of the symptoms listed in #1. –Or—
• Have a “yes” answer to question 2.   –Or—
• Have a “yes” answer to questions 3 and 4.

Turn around time for reporting results (verbally or by fax) on a STAT request is, generally, within eight hours of sample receipt. Please remember to complete, as thoroughly as possible, the IRL Consultation Request Form (IR-504-FORM), and contact Hoxworth Blood Center IRL personnel before sending samples.

Reporting and Billing

Preliminary reports (prior to final review) and billing information will be phoned and faxed* at completion of workup.  
  
Final reports will be mailed and faxed* to the hospital after final review has been completed. 

A billing invoice will be forwarded to your facility by Hoxworth Blood Center Financial Services. The submitting facility is responsible for all charges and/or fees related to the resolution of the patient’s serologic problem and provision of RBC units.

*Faxing of reports and bills is done if requested by the facility. Reports and bills contain Protected Health Information (PHI) and can only be faxed to the confirmed number(s) provided by the facility’s authorize

Lab Contact Numbers:

Laboratory Phone: (513) 558-1547
On-Call Phone: (513) 558-1539 (request IRL Tech paged)
Fax Number: (513) 558-1533

Technical Supervisor:

Gregory Halverson, MS, MT(ASCP)SBB, DLM
Asst. Director, IRL
Ph: (513) 558-1549

Division and Medical Director:
David Oh, MD
Phone: (513) 558-1338