USER GUIDE
Contents
1. Welsh Histocompatibility amp Immunogenetics Service WHAIS USER GUIDE Welsh Transplantation and Immunogenetics Laboratory Welsh Blood Service Ely Valley Rd Pontyclun CF72 9WB Telephone 01443 622000 Fax 01443 622176 e mail wtail wales nhs uk WTAIL ORG UK Contents OMG EDS BOS irni E E eee 2 Consultant Clinical Scientists sscsiescaccseavsscesesncasctats teceassesasessentdenesiodeseavveseeaetieavabersventee 2 TYR OUAIA SOT es cine sehais e a e E E ace eae 2 Service PROVISO eta tease vat ex cacgnce caveueteesaceats cat watunataeasegeeatanaes eateateatasa danicuaesistenae 3 PS COU GIO OS seneese aaeeea ee e EEEE E SE areia aS 4 Service ProviSiOn es sssseseesesseseesestssestesesseserestsststesestesetestssentesestesetestssesteseseesestesens 5 Laboratory HOU S lt 5 sesc is essesscsss passat fedtacedgovesn tvensniis deacsatadea a a a 8 Contact Arrangements out of NOUS 4 cucsssssiessnessivasasicnvansstniwatettunananndcaasneladensseteatsts 8 Sample Requirements and REPOrting cc ceeeeseeeeeeseseseneeseseseseeeeeecseseneeeeeaeaees 9 CONS CIN aE TA ET 11 Confidentiality Speen ne ne eae Ree eRER A Ones eRe Oe ener ert e RIRNeR ENE Cee CnC ere ne eee 11 Important Factors That May Affect Histocompatibility amp Immunogenetics A amp D TESTS enan sansa te a a e a esse eas douteesn saben comessiniec ce ancutetee 11 Standard Tests and Samples Required ssssessssessesesssssresrssestesrssesesresrssesre2. 6ml hand written label Aom j Recipient Orn z HSCT P 6ml hand written label Family member 10 20ml 3 HLA B27 typi 5 10ml s 3 Disease ee b Association Miscellaneous e g Coeliac Investigations disease Abacavir 10 20ml sensitivity Refractory NAIT mum GITP ITP 40ml 10ml 2 Platelet antibody investigation Platelet investigation NAIT partner 20ml NAIT foetus baby Contact laboratory for sample requirements Sample of Drug ITP 40ml 20ml medication implicated Transfusion z 6ml reactions TRALI 4x 6ml 4x 6ml z Investigations Version 3 Page 12 of 18 Issued 10 04 15 Additional Samples and Testing Buccal swabs may be accepted by prior arrangement with the Molecular Genetics department contactable via email molecular genetics wales nhs uk or by calling 01443 622041 On agreement a pack of acceptable swabs and the procedure to follow for sampling will be sent to the requesting Clinician WHAIS also offer a range of other investigations for patients by request For further information please contact Dr T Rees Head of WTAIL Blood Sample Transportation Blood samples should normally be transported at ambient temperature and delivered to the Laboratory in as timely a manner as possible and at least within 24 hours of collection All specimens must be packaged in accordance with the current Post Office regulations and European Agreement concerning Carriage of Dangerous Goods by Road Regulati
3. in house and external courses Most laboratory staff are graduates and are trained to British Society for Histocompatibility amp Immunogenetics BSHI Diploma as a minimum Other qualifications include Ph D Dip RCPath FRCPath Royal College of Pathologists Part 1 MSc and FIBMS Members of WHAIS hold various external training positions e g Supervisor of higher degree students Version 3 Page 18 of 18 Issued 10 04 15
4. 0 04 15 Further information More detailed information on any of these services can be obtained on request Please contact Dr T Rees Head of WTAIL or one of the following WTAIL operational leads Miss Emma Burrows Head of Clinical Antibody Testing Mrs Sandra Lloyd Head of Patient Services Mrs Jennifer Pepperall Head of Molecular Genetics Laboratory Contacts for Services Provided WHAIS Services Primary Lead Ext Section pee ee Sandra Lloyd 622186 HLA Patient Services Transplantation pigemopelcne steel Jennifer Pepperall 622041 Molecular Genetics Transplantation HLA B27 typing in the Sandra Lloyd 622186 HLA Patient Services spondyloarthropathies Miscellaneous Disease Investigations excluding HLA B27 HLA pea 622031 Clinical Antibody Testing Investigations Platelet Investigations 622191 Clinical Antibody Testing General Service and Research Enquiries 622041 Molecular Genetics Jennifer Pepperall Tracey Rees 622175 Head of WTAIL Additional Services Hosted by the Laboratory Service Primary Lead Ext Website Link WBMDR Martin McGregor 622025 WBMDR UK NEQAS for H amp I Deborah Pritchard 622185 UK NEQAS for H amp I Version 3 Page 17 of 18 Issued 10 04 15 Training WHAIS has a designated Training Manager supported by a Training Co ordinator and BSHI Diploma Training Managers Training incorporates formal informal
5. The following information is required on each sample tube Details Requirement Outcome if missing Please note Patient details on from request form sample amp request form must match exactly Patient name Surname amp Mandatory Discard Forename Date of birth Mandatory Discard Hospital number NHS number Mandatory Discard Date sample taken Mandatory Discard Version 3 Page 9 of 18 Issued 10 04 15 The following information is required on the request forms Details Requirement Outcome if missing Please note Patient details on from request form sample amp request form must match exactly Patient name Surname amp Mandatory Discard Forename Date of birth Mandatory Discard Hospital number NHS number Mandatory Discard Clinical details tests required Mandatory Discard if we can not ascertain required details Diagnosis Desirable Process Date and where applicable time Desirable Discard if no e g solid organ rejection cases information on sample tube Requesting person and place to Desirable Process and identify report requesting clinician GP e g by contact requesting hospital GP In cases of clinical urgency or where it is not possible to obtain repeat samples i e deceased donor samples the laboratory may agree to process a sample referred without all requested identifiers in accordance with locally documented procedures copy available
6. and allogeneic stem cell transplants from related and unrelated donors HLA typing of patients and potential donors is performed by PCR based methods and serology If required the patient is tested for HLA antibodies by Luminex based methods A graft identification advisory service is provided and WHAIS liaise with WBMDR staff to facilitate unrelated donor searches confirmatory typing sample provision and stem cell products WBMDR is licensed by the Human Tissue Authority to import haemopoietic stem cells Version 3 Page 3 of 18 Issued 10 04 15 Platelet Immunology Service The laboratory provides investigations for a variety of immune thrombocytopenias which include e Platelet refractoriness Neonatal alloimmune thrombocytopenia Drug induced thrombocytopenia excluding Heparin Idiopathic thrombocytopenia ITP Gestational ITP e Post transfusion purpura HLA and HPA antibody screening is performed by Luminex based methods and the Monoclonal Antibody Immobilization of Platelet Antigen MAIPA test respectively HLA and HPA typing is performed by PCR based methods The Laboratory works in close collaboration with the Welsh Blood Service selecting suitable HLA HPA matched platelets when clinically required Disease and drug hypersensitivity HLA typing is provided to support disease diagnosis for a number of diseases e g HLA B27 and ankylosing spondylitis DQA DQB for coeliac disease and HLA 5701 for abacavir sensitivity Transfusio
7. er on call for WTAIL Consultant advice may be obtained from the Head of WTAIL or the Consultant to the WTAIL Duty Consultant for WBS Contact WBS main switchboard 01443 62200 and ask for the WBS Duty Consultant Version 3 Page 8 of 18 Issued 10 04 15 Sample Requirements and Reporting Request Forms Please use the standard WTAIL request forms as detailed below and complete ALL sections as appropriate click on the links below to access the appropriate form HLA Typing Request Form Renal This form is to be used for all renal and pancreas patient donor testing requests HLA Typing Request Form Haematopoietic Stem Cell Transplants HSCT This form is to be used for all bone marrow patient donor testing requests For potential HSCT patients the diagnosis should be detailed on the request form The relationship of family members as potential donors to the patient should be documented on the request form HLA amp Disease Association Request Form This form is to be used for all disease association requests including requests for HLA B27 and B 57 01 testing Platelet Immunology and additional requests Requests for platelet TRALI and additional services can be made using standard haematology forms The forms must clearly state the required investigation and referral laboratory in addition to the information required below Known high risk samples must be labelled as such on both the sample tubes and request form
8. es2 wales nhs uk or by writing to Dr T Rees Welsh Transplantation and Immunogenetics Laboratory Welsh Blood Service Ely Valley Road Talbot Green Pontyclun CF72 SWB Although we are committed to providing our customers with an excellent service there may be times when we fail to fully meet your requirements As a learning organisation we firmly believe that every complaint is to be valued as an opportunity to discuss with our customers how the service can be improved Terms and Conditions The WBS standard terms and conditions of service shall apply where a Service Level Agreement has not been signed between WHAIS and the customer A full set are available on request the key elements of which are detailed below Invoicing Velindre NHS Trust shall invoice the customer for work undertaken on completion of the individual task where appropriate Payment due within 30 days of receipt of invoice Any Debts not paid within 30 days shall be considered to be outstanding and may incur interest charges at a daily rate of 0 05 of the outstanding balance until the amount has been settled Method of payment The general method of payment shall be in accordance with current policy as stated on the reverse of the Invoice No receipt will be given unless specifically requested Any customer requesting a service supplied by WHAIS shall be deemed to agree to these terms and conditions Version 3 Page 15 of 18 Issued 10 04 15 Quality Assura
9. n Related Acute Lung Injury Investigations for this include HLA antibody screening of the implicated donors and the patient using Luminex technology and HLA typing where appropriate Investigations for HNA antibodies are referred to the NHSBT Miscellaneous The laboratory is happy to discuss requirement for ad hoc HLA typing or antibody definition e g for appropriate research projects Please contact Dr T Rees for further information Version 3 Page 4 of 18 Issued 10 04 15 Service Provision Laboratory Tests The current range that can be undertaken are given below 1 Serological Phenotyping Tests HLA A B C DR DQ phenotyping Serological typing of HLA Class I A B amp C and II DR DQ specificities using the complement dependent cytotoxicity CDC assay for the purpose of assisting in the definition of expression variants Serological Crossmatching and Antibody Screening Tests Complement dependent cytotoxic crossmatch Complement dependent cytotoxicity crossmatch CDCXM to detect donor or auto reactive specific cytotoxic antibodies in recipient sera using donor lymphocytes This technique uses purified B cells T cells or peripheral blood lymphocytes to detect complement fixing antibody This can also be performed using dithiothrietiol treated sera to determine the IgG or IgM class of the antibody Donor specific HLA antibodies detected using this technique are normally considered a contraindication to solid orga
10. n recipients potential HLA mismatched and HSCT recipients platelet refractoriness and for monitoring HLA antibodies in HLA antibody incompatible transplants Indirect PIFT FC Platelet Immunofluorescence Test by Flow Cytometry This technique uses a fluorescent anti human antibody AHG to detect antibody bound to the platelet surface Therefore all antibodies bound will be detected i e HLA ABO and HPA antibodies It is often difficult to differentiate an HPA antibody using this technique because HLA antibodies can mask the reaction pattern of HPA antibodies Direct PIFT FC Patient platelets are incubated directly with fluorescent AHG The fluorescent level observed is compared to that of ten normal platelet samples The results indicate if there are raised levels of bound immunoglobulin on the patient s platelets MAIPA Monoclonal Antibody Immobilisation of Platelet Antigen This sensitive technique detects antibodies directed to different platelet glycoproteins This allows the identification of mixtures of platelet specific antibodies in the presence of HLA antibodies The patient s serum is incubated with a panel of HPA typed platelets and defined antibodies reported DNA based HLA and HPA typing HLA Class I amp II DNA typing low resolution by PCR using sequence specific primers PCR SSP Determination of HLA A B C DR DQ and DP alleles or groups of alleles by DNA analysis with a range of PCR primers gi
11. n transplantation Flow cytometry crossmatch FCXM This is a more sensitive crossmatch than CDC and uses donor or recipient lymphocytes and recipient sera using a flurochrome labelled secondary antibody in order to detect IgG donor specific antibodies against T and or B cells Donor specific antibodies detected using these techniques are considered an intermediate risk to transplant to transplant high risk transplants Serum screening for HLA Class I and II antibodies Complement dependent cytotoxicity CDC assay to determine the presence of specific HLA A B and Cw antibodies using an HLA typed reference panel representing known specificities and incorporating uncommon antigen associations HLA DR and DQ antibodies are specified using a random panel of HLA typed purified B cells Donor specific antibodies detected using this technique are normally considered a contraindication to solid organ transplantation Serum screening for HLA Class I amp Class II antibodies by Luminex based methods This is specific for IgG HLA class I and or II antibodies including both complement and non complement fixing sub classes utilising Luminex Version 3 Page 5 of 18 Issued 10 04 15 technologies This technique is more sensitive that CDC is highly specific and can resolve complex antibody profiles in highly sensitised patients using beads coated with a single HLA antigen This technique is used to detect and specify antibodies in solid orga
12. nce WHAIS complies with the WBS Quality Manual Management Procedures and Standard Operating Procedures SOPs A comprehensive Quality Assurance programme monitors and audits all aspects of the service Standards of testing are maintained by the rigorous use of internal quality assurance protocols and through participation in appropriate UK National External Quality Assessment Services UK NEQAS In addition WHAIS participates in International Exchange Schemes Quality Assessment and External Audit A copy of last year s participation certificate and results summary is available on request for each of the following e UK NEQAS for Histocompatibility and Immunogenetics e University of California Los Angeles International Cell Exchange e University of California Los Angeles International HLA DNA Exchange e British Blood Transfusion Society BBTS Platelet and Granulocyte Serology Working Group Organised by National Institute for Biological Standards and Control NIBSC e UK NEQAS for Blood Transfusion Practice Accreditation and Regulation WHAIS laboratories are accredited by Clinical Pathology Accreditation UK Ltd CPA WHAIS is also accredited by the European Federation for Immunogenetics EFI Accreditation categories and techniques covered are available on request WHAIS as part of the WBS is also regulated by the Medicines and Healthcare Products Regulatory Agency MHRA Version 3 Page 16 of 18 Issued 1
13. nd the Caldicott Principles Important Factors That May Affect Histocompatibility amp Immunogenetics H amp I Tests The following factors may affect any of the H amp I tests that are performed by the Laboratory Factors that may affect testing How to minimise effects Sample storage and transportation Store and transport samples at temperature ambient temperature Sample storage time Ensure samples arrive within 24 hours of collection Anticoagulant Ensure correct blood tubes are used see the Standard Tests and Samples Required Table Immunosuppressant s e g Rituximab Note medication treatments on IVIg sample request form Low white cell count Note low count on sample request form Please contact the Laboratory for help and advice on any of the above Version 3 Page 11 of 18 Issued 10 04 15 Standard Tests and Samples Required Testing Required Samples Required EDTA Clotted Other Renal Pancreas Recipient HLA New pallens Tom 20ml typi amp re type samples 6ml hand written label yping me 40ml Recipient 6ml hand written label Aom Renal Donor bonore live 40ml 7 i Testing 6ml hand written label Donor Deceased 60ml Lymph Spleen Renal Antibody Routine Transplant list Monitoring Post Transplant E 20ml 7 Samples Rejection HLA incompatible ABO Titres Recipient Donor 6ml 40ml Borne grate j
14. nsplant of various donor types including Local deceased donors e Deceased donors allocated via NHSBT Organ Donation and Transplant ODT e Potential living renal donors e ABO incompatible transplants e HLA incompatible transplants e Altruistic donor transplants e Paired pool exchange donors Laboratory testing encompasses HLA typing crossmatching and HLA antibody detection identification HLA typing is performed by PCR based methods at the resolution required for patient registration and donor allocation by NHSBT ODT Additional typing is performed to assist in antibody definition HLA antibody screening is routinely performed on potential transplant patients every 3 months and following any sensitisation events by CDC and Luminex based methods Testing schedules for patients receiving antibody incompatible transplants are discussed and agreed with the transplant team on an individual basis Donor specific antibody testing is performed for transplant patients where antibody mediated rejection is suspected and to monitor effectiveness of treatment Allogeneic and autologous crossmatching is performed by Complement Dependent Cytotoxicity CDC and Flow Cytometry The Laboratory manages patient registration and updates with ODT Clinical advice in relation to risk and donor selection is provided Histocompatibilty Testing for Haematopoietic Stem Cell Transplants WHAIS supports services to the local transplant centre for autologous
15. nsplantation and Immunogenetics Laboratory e mail tracey rees2 wales nhs uk Tel 01443 622175 Home 02920 890718 Mobile 07979 770274 Dr Christopher Darke FRCPath e mail chrisdarke browhead fsnet co uk Home 01409 220199 Mobile 07801 557890 Introduction The Welsh Histocompatibility and Immunogenetics Service WHAIS together with the Welsh Bone Marrow Donor Registry WBMDR form the Welsh Transplantation and Immunogenetics Laboratory WTAIL and hosts the UK National External Quality Assessment Services for Histocompatibility and Immunogenetics UK NEQAS for H amp I WHAIS provides Histocompatibility and Immunogenetics H amp I support to a variety of health care providers ranging from specialist transplant units to General Practitioners This service is critical to both solid organ and blood stem cell transplant programmes The services provided include HLA typing patient donor crossmatching HLA antibody testing solid organ and stem cell donor recipient matching platelet typing and platelet antibody testing Our staff work closely with clinicians in the management of solid organ transplant blood stem cell transplant and thrombocytopenic patients Version 3 Page 2 of 18 Issued 10 04 15 Service Provision Histocompatibility Testing for Solid Organ Transplantation e WHAIS provides laboratory testing and clinical advice for patients requiring a pancreas or kidney who are transplanted in Wales The service supports tra
16. on request In some cases prior to processing the sample the laboratory will need verbal written clarification that the referring clinician will accept responsibility for processing the requests Generated reports will clearly state which identifiers were missing and whether these were from the sample the request form or both It is the responsibility of the clinician receiving the report to check the identifiers given to confirm this is the correct patient donor Urgent testing of samples must be by prior arrangement by contacting the laboratory Version 3 Page 10 of 18 Issued 10 04 15 Consent Please note that it is the responsibility of the requester to obtain informed consent for the requested tests Surplus material s may also be stored for further diagnostic testing to benefit the individual and anonymously for quality control education and training and approved research and development Confidentiality The laboratories have access to the data and information needed to provide a service that meets the needs and requirements of internal and external customers The laboratory information system whether computerised or paper based provides for the collection processing recording storage and retrieval of data and has documented procedures in place to ensure the confidentiality of patient information and the security of the data during each step of the process WBS laboratories comply with the data Protection Act 1998 a
17. ons amp packing instructions 650 ADR 2007 to prevent breakage or spillage in transit They must be clearly labelled according to the ADR 2007 regulations and display the hazard diamond as illustrated below In addition the statement BIOLOGICAL SUBSTANCE CATEGORY B must be noted on the packaging Packaging materials must be suitable for transporting UN3373 Biological substance Category B or UN 2814 as appropriate and addressed to Welsh Transplantation and Immunogenetics Laboratory Welsh Blood Service Ely Valley Rd Pontyclun CF72 9WB For other arrangements please contact the Laboratory for help and advice Version 3 Page 13 of 18 Issued 10 04 15 Procedures for Specimen Handling Our procedures for handling blood samples and other specimens are available on request Reporting Times The following target response times relate to working days where applicable after the sample request is received at the laboratory if requested a copy of the report can be faxed or emailed as soon as it is available For urgent requests please contact the laboratory to arrange testing and reporting arrangements Target Report WTAIL Turnaround Times 90 within Live Donor Work up Mismatch Grade Head of Patient Services working days Renal Live Donor Work up typing and Head of Patient Services 10 crossmatching working days Transplantation Live Donor Final Testing Head of Patient Services ee working days Deceased donor te
18. sess 12 Additional Samples and Testing av ivaisisossicsssnanessavsvcavsssaevatvadboncnvaseneetianpesaevasneaiterens 13 Blood Sample Transportation yeescaccssasccaesancananavesessnaandeanagevencasseesesenaviaesaserteseaseneaels 13 Procedures for Specimen OMAN Gs osdessssesiwssssersusinasssneasavadhessaeiansnsunvsasasaeusenonidves 14 Reporting TIMES 5 15 ccceecisnseatentasednss geecasesseetexcarheeatoajausaaunaeeaisaiaeadiaaine ead maes 14 Compliments and CONCEMMNS eeeseseeseseeeceeeseececeeesesesceeeeeececaesceceataeseeceeteeeeaeaeees 15 T rms and Conditions sisisi irienn reee ie eiea aeae 15 Quality ASSUranCe ssesessesesseseesessessesestssestestssestesestssestestsestesestssestesessestenestesestesens 16 Accreditation and Regulation sssssesessessesessssssresesseseesestssestesesseseesestssesresesseseene 16 Further information ss sssssssssseessesteseestessestestestessestestestesestessetesetessetessestessttens 17 Laboratory Contacts for Services Provided cceeseeseseesesesescsetetetenseseeeeteees 17 Additional Services Hosted by the LaDOratory ee eeeeeeeeteeeeeeeeseseeeeeeeeeaees 17 TRISH VNR orca eats E E A E ene ere ene 18 Version 3 Page 1 of 18 Issued 10 04 15 Contact Details Welsh Transplant and Immunogenetics Laboratory Welsh Blood Service Ely Valley Road Pontyclun Wales CF72 9WB Tel 01443 622186 Fax 01443 622176 Consultant Clinical Scientists Dr Tracey Rees FRCPath Head of Welsh Tra
19. sting Head of Patient Services aes A Head of Molecular 5 10 working Potential family donor work up Head of Molecular days from matched donors Genetics receipt of last sample 5 working Potential family donor work up no Head of Molecular days from matched donors Genetics receipt of last sample 10 working Head of Molecular days from Genetics receipt of last sample Platelet Antibody Investigations Head of Clinical Antibody 1 Platelet Urgent verbal report Testing working day Immunology Platelet antibody investigations non Head of Clinical Antibody 5 urgent and written reports for urgent Testing modny days Head of Molecular written unless otherwise stated Operational lead Haemopoietic Stem Cell Transplantation Unrelated donor work up Additional Services HLA B27 typing Head of Patient Services u days Head of Clinical Antibody HLA antibody investigations urgent Testing 1 working day Version 3 Page 14 of 18 Issued 10 04 15 Please note when successive testing or testing of multiple individuals is required e g typing of potential haemopoietic stem cell transplant donors the turnaround times may not apply Compliments and Concerns If you have any complaints or suggestions for improvements please contact either Dr T Rees or one of the WTAIL operational leads Contact can be made via telephone on 01443 622175 and 01443 622178 respectively by facsimile on 01443 622309 via e mail using Tracey Re
20. tatus by flow cytometry Coates amp Darke European Journal of Immunogenetics 1998 25 29 Miscellaneous disease association In consultation with our customers we can undertake any specific HLA typing request or family studies We also undertake disease susceptibility association projects Determination of HLA A B C DRB1 3 4 5 DQA1 DQB1 DPB1 HLA types in combinations and resolution appropriate to requirements e ABO titres This is performed using donor cells and recipient plasma for assessing and monitoring ABO antibody removal for ABO incompatible transplants A diamed gel card method is used to determine titres by saline and AHG In addition to these tests expert H amp I advice is available from our staff Version 3 Page 7 of 18 Issued 10 04 15 Laboratory Hours Routine Monday to Friday 09 00 17 00 excluding Bank Holidays Out of Hours Requests The H amp I service for deceased kidney and pancreas donor HLA typing crossmatching and matching is available 24 hours a day 365 days a year The out of hours service is staffed by Clinical Scientists all of whom are employed within the WTAIL For each on call period two laboratory staff are available This team consists of experienced Clinical Scientists who perform HLA typing and patient donor crossmatching Contact Arrangements out of hours On call WTAIL Scientist Contact WBS main switchboard 01443 622000 and ask for either the HLA Typer or Crossmatch
21. ving definition comparable to serological typing for the purpose of HLA typing in solid organ transplantation as an aid to disease diagnosis and for selection of HLA compatible platelet transfusions HLA Class I amp II DNA typing high resolution 2 field Determination of HLA A B C DR DQ and DP alleles by DNA analysis with a range of PCR primers or sequence based methods giving high resolution definition This is used for matching in haemopoietic stem cell transplantation Human Platelet Antigen HPA Typing Determination of HPA antigens by typing for HPA alleles by DNA analysis using PCR SSP Version 3 Page 6 of 18 Issued 10 04 15 HLA B 57 01 typing by molecular techniques Determination of HLA B57 01 positive or negative and differentiation of the common HLA B57 subtypes subtypes determined by sequence based typing This is used to determine patients at risk of hypersensitivity type reactions to Abacavir 4 Additional tests o HLA B27 typing by flow cytometry Determination of HLA B27 positive or negative and differentiation of the common HLA B27 subtypes B 27 02 B 27 05 and B 27 08 subtypes B 27 02 and B 27 08 confirmed by PCR SSP Associations of HLA antigens with rheumatic diseases have been well established over the last two decades Notably HLA B27 typing has been particularly useful in the diagnosis of the atypical spondyloarthropathies Determination of patient HLA B27 s
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