Tissue Immunology Section
SANBS vision is to be “The cornerstone of Health Care in South Africa, through the gift of Life”. The Tissue Immunology Laboratories align with this vision by performing tissue compatibility testing for transplants and have been doing so since the 1970’s. We remain a key role player in South Africa and Africa, offering testing to facilitate solid organ, stem cell and bone marrow transplants. Additional stakeholder support includes Platelet Immunology and Immunohematology testing. Human platelet antigen and antibody testing is essential in identifying and treating Neonatal Alloimmune Thrombocytopenia (NAIT), Platelet refractoriness (PR) and transfusion reaction investigations.
A Pathologist who is available for consultation oversees the Tissue Immunology laboratories. Two Senior Biomedical Scientists manage the laboratory operations.
SANBS has two state-of-the-art Tissue Immunology Laboratories, one in Johannesburg based in Constantia Kloof and the other in Durban based in Pinetown. The laboratories are SANAS accredited and are preparing for EFI (European Federation of Immunology) accreditation.
Both laboratories are well equipped to provide an uninterrupted service to our clients on a 24/7/365 basis. The laboratories are supported by a Research & Development unit, which researches the market for developments and new assays in this field and actively validates these for the South African environment. This support has enabled the placement of the NGS platform approximately 4 years ago.
SANBS assists and has a collaborative relationship with the South African Bone Marrow Registry (SABMR) and the Sunflower Fund (SF).
The SABMR is the only internationally accredited donor registry in South Africa. It facilitates donor related services for ALL South African patients in need of a stem cell transplant. The SABMR’s highly qualified staff has many years of experience in the fields of donor search, testing and stem cell procurement, not to mention the abundance of information on donor selection, and its very own Patient Assistance Program. SABMR piggy backs on SANBS blood drives to recruit bone marrow donors.
Blood samples are collected from healthy volunteer donors who are then HLA tested by DNA typing or NGS technology. The test results are released to the SABMR and SF who capture and include the HLA results onto the donor register. Should you require further information on how to become a bone marrow donor, please contact the
SABMR on 021 447-8638 or https://sabmr.co.za/become-a-donor/
SUNFLOWER FUND on 0800 121082 or www.sunflowerfundregistry.com
Over the last 30 years, there has been a rapid evolution in HLA technology. The Tissue Immunology laboratories have embraced the advances in technology.
We can provide stakeholders with a wide range of tests to support the transplant community.
The list includes:
- ABO Grouping and ABO antibody titres for monitoring of ABO incompatible transplants
- Rapid HIV Screening – Gauteng only
- CDC (T and B cell) and Virtual Cross matching
- Molecular Class I and II HLA typing on donors and recipients utilising rSSO technology using standard 5 loci HLA typing on the Luminex platform at low to medium definition. During 2019, we will be introducing an upgraded kit (XR) which has improved definition (medium to high).
- Next Generation Sequencing testing is available for high resolution HLA typing for all 11 loci for the bone marrow registry and privately paying patients.
- HLA antibody identification (Single Antigen assay) is performed using a Luminex® bead-based multiplexing technology.
- Human platelet antibody identification is performed using Luminex xMAP technology. This assay is used to detect antibodies to HPA-1, HPA-1, HPA-2, HPA-3, HPA-4, HPA-5 and GPIV.
- Human platelet genotyping is performed using Luminex xMAP technology. This assay detects HPA 1 – 11 & 15.
The turn-around times:
- CDC X-match, HLA typing and antibody testing for non-elective cadaver organ transplantation is 6 to 12 hours.
- CDC crossmatches have a 48 hour TAT
- Non-urgent HLA tests are available within 15 working days.
- HLA typing NGS (High resolution) is performed once a month and therefore only suitable for elective cases
In consultation with the pathologist or laboratory manager, special arrangements may be possible.
Tissue Immunology laboratory, Johannesburg: (011) 761 9227/8 or
Tissue Immunology laboratory, Pinetown: (031) 719-6618/9 or
1. Antenatal testing
Antenatal tests are performed on all pregnant women in order to determine if obstetrically significant antibodies are present in their samples. The antenatal programme is therefore aimed at preventing or managing Haemolytic Disease of the Newborn (HDN).
Haemolytic disease of the newborn occurs when there is an incompatibility between the blood groups of a pregnant woman and the foetus that she is carrying. (The foetal red cell possesses a red cell antigen that the mother lacks). The mother’s immune system recognizes these antigens on the foetus’s red blood cells as foreign, and forms specific antibodies to them.
These antibodies may then cross the placenta and attach to the antigens on the foetal red cells (sensitizaion). These sensitized red cells are then removed from the foetal circulation and the foetus becomes increasingly anaemic. Intrauterine death may occur in severe cases.
The antibody most commonly implicated in HDN is AntiD. Rh negative individuals lack the D antigen on their red cells, and may develop AntiD, if exposed to Rh D positive blood, either through transfusion or pregnancy. It is for this reason that an Rh phenotype should be performed on all pregnant women.
Rapid Rh D typing Kits are available in antenatal clinics, and are used to determine the Rh D type of the mother. Samples from all mothers who type initially as Rh D negative are referred to the Red Cell Serology Laboratories in Durban and Johannesburg. There the Rh D type is confirmed and antibody identification tests are performed to determine if Anti –D antibodies are present. A report is then issued to the clinic or doctor, accompanied by a letter which advocates the administration of AntiD immunoglobulin in order to prevent HDN from occurring. Should antibodies be present in the maternal samples, further specimens are requested at regular intervals in order to monitor antibody activity, and arrangements are made to handle potentially affected infants.
Red Cell Serology Laboratory 031 719 6685
2. Antibody Identification
In the event of an incompatibility detected in a Crossmatching Laboratory as a result of the presence of antibodies in a patient’s sample, compatible blood may not be immediately available for the patient. In such instances, the patient’s samples are referred to the Red Cell Serology Laboratories in Durban or Johannesburg, for antibody identification tests. Antibodies may also be detected in blood donations, and samples from these donations are also referred to the Red Cell Serology Laboratories.
Area 1 (Johannesburg) Red Cell Serology Laboratory 011 761 9208
Area 2 (Durban) Red Cell Serology Laboratory 031 719 6685
3. Provision of blood for patients with rare blood types
The National Immunohaematology Reference Laboratory houses the South African Rare Donor File, which facilitates the provision of blood for patients with rare blood types, both nationally and internationally.
The South African Rare Donor File is linked to International Rare Donor Panel in the United Kingdom, which facilitates the international exchange of rare donations.
Fresh rare donations may be available in stock, or rare donors can be bled upon request. The central storage facility in Durban facilitates the storage of frozen rare donations. There is also an ongoing effort to identify rare donors; routine donations are screened with rare antisera, sera from patients with rare antibodies are used to screen and crossmatch blood, and family study investigations are performed on patients and donors found to have a rare blood type, in order to determine if any of their relatives have the same rare blood type. These patients and their relatives are enrolled as donors, where possible.
Immunohaematology, Reference Laboratory 031 719 6544
4. Transfusion reaction investigations
Area 1 (Johannesburg) Red Cell Serology Laboratory 011 761 9208
Area 2 (Durban) Red Cell Serology Laboratory 031 719 6685
5. Blood typing reagents
The Reagents Laboratory in Durban provides various blood grouping antisera and reagent red cells to the various SANBS laboratories and to external customers for the testing of patient and donor samples. Included are the reagents required for automated blood grouping of all blood donations received by SANBS. The reagent red cells include panel and screening cells which are required for the identification of red cell antibodies in patient and donor samples. Rapid Rh Typing Kits are prepared for use in the Emergency Blood Banks located throughout the country.
Reagents Laboratory 031 719 6689
6. Anti-D programme
The programme is aimed at obtaining high titre AntiD plasma from selected donors for the production of AntiD Immunoglobulin. This AntiD immunoglobulin is administered to Rh negative mothers who
give birth to Rh positive babies, and prevents them from forming AntiD antibodies. (Refer to Antenatal Testing). The goal is to make South Africa selfsufficient in the production of this product and eliminate the need to import AntiD immunoglobulin.
Donors are carefully selected, and divided into plasma and red cell donors. Plasma donors are immunised with red cells from matched red cell donors over a period of time, and stimulated to produce AntiD. The plasma containing the antiD antibodies is then harvested by plasmapheresis once suitable antibody levels are reached, and the plasma is supplied to the National Bioproducts Institute.
Immunohaematology, Reference Laboratory
7. Evaluation of new reagents and techniques
An Evaluation and Projects Laboratory is available to perform evaluations of new reagents and techniques. These tests are generally not charged for.
The Reference Laboratory participates in international workshops to test new monoclonal and polyclonal blood grouping reagents.
Evaluation and Projects Laboratory 031 719 6952
Molecular research and development
1. Molecular research and development
The Molecular Research and Development Section provides support to the Specialised Laboratory Services Department, by researching and developing current technologies that contribute to the molecular processes performed within the laboratories.
Keeping abreast with the new advances in technology allows us to achieve the level of excellence and service provided by blood transfusion services worldwide.
(i) Cytogenetics Laboratory
Introduction of the Aneuploidy PCR allows for the prenatal and postnatal detection of Trisomy.13 (Patau syndrome), Trisomy.18 (Edward syndrome), Trisomy.21 (Downs Syndrome), and the X and Y sex chromosome abnormalities such as Turner syndrome. Results are provided within 48 72hours.
Current research is underway for Bone Marrow PCR, that is a qualitative multiplex, nested RTPCR test designed to detect 28 different translocations or chromosomal rearrangements found to be specific for various types of leukemia’s example, Acute Myelogenous Leukemia (AML), Chronic Myelomonocytic Leukemia (CML) are being researched.
(ii) Immunohaematology, Reference Laboratory
Initiating the BAGene Project where BAGene DNA SSP kits are used for the genetic determination of the ABO, Rh, Partial D, MNS, Kell, Kidd and Duffy blood group systems on a molecular genetic basis, to facilitate the clear typing of donors, recipients and pregnant women at the DNA level with a high resolution.
(iii) Tissue Immunology and Paternity Laboratory
Investigating the feasibility of Sequence Based Typing (SBT) which offers high resolution typing of HLA Class I Loci A, B, and C and Class II Loci DPB1 and DQB1 which is important in preorgan transplant testing, more especially bone marrow transplantation,
New technologies are been evaluated and validated to improve the quality of results when screening and detecting Class I and Class II HLA antibodies which will aid in reducing the risk of organ rejection and Graft vs. Host Disease.