CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Dr. Kopko
“The problem is this: When somebody gets registered on a registry as a potential stem cell donor, they do that with a buccal swab,” Dr. Kopko says. “Well, when you do that, you want the HLA type, but you kind of want to know what the donor’s ABO type is. If you’ve got a buccal swab, you can’t do ABO by serologic methods, which is how we do it in the blood bank and the transfusion service. In fact, ABO by molecular methods is not licensed for patient usage, but yet we still have to find a way for the National Marrow Donor Program and other donor registries to take that buccal swab and get a presumptive ABO type, so that when somebody is searching for a donor for their patient, one of the things that weighs into the consideration is that if there’s a donor who’s ABO-matched, that would be preferable to a donor who’s not ABO-matched. But if we say, ‘You have to do serologic testing,’ they don’t have a sample that can be used.
“So we wrote this long note in the checklist explaining that you can use molecular methods for presumptive ABO and RhD typing only for donor registry purposes, and that for transfusion and the actual transplant you have to use FDA-cleared or -approved serologic methods. For a presumptive type, you can use ABO molecular methods, and there’s an explanation there in the checklist that it’s only for preliminary information, and you can’t use it for transplant.”
Finally, an effort was made, as elsewhere, to harmonize the language in the histocompatibility checklist with that of others, such as the laboratory general checklist, “so that if you’re talking about something we do in multiple types of labs, the wording is the same,” Dr. Kopko says. “For example, we harmonized a lot with the molecular checklist because so much of the work done in an HLA lab is done with molecular testing. We didn’t want to have one set of requirements/language in one checklist and use completely different wording in another checklist.” n
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Anne Ford is a writer in Evanston, Ill.