National Renal Complement Therapeutics Centre

Combined aHUS Lab Diagnostics

ADULT FORM

This form is ONLY for patients referred to the national aHUS service

Patient information:

NHS number / Ethnic group
Surname / Forename
Sex / Date of Birth(dd/mm/yy)
Hospital
Address
Postcode

Referring Clinician:

Name
Address
Postcode
E-mail address(@nhs.net)
Telephone number

Sample Collection:

Date / Time

Please tick for

New Referral

C3, C4, CH100, AH100, FH, FI, FB. FBb, sC5b-9, CD46, FH autoantibodies, Genetic analysis (All coding exons of CFH, CFI, CD46, C3, CFB. MMACHC, DGKE (including copy number of CFH, CFI, CD46, CFHR1 and CFHR3) and C5 Eculizumab non responder SNPs (p.R885H; p.R885C)

ADAMTS13

Follow up (pre dose CH100, AH100, sC5b-9)

Laboratory team:

When samples are ready for collection please email using account name: Royal Victoria Infirmary- aHUS Account number: CS027325and state that a Bio 15 with dry ice is required for the collection. Please send your full address, telephone number and contact name to help ease the process. City Sprint will make arrangements to come and collect the samples.Please copy: into the email.

Address box to: Nation aHUS service, Pathology reception, Haematology Laboratory, Blood Sciences, Freeman Hospital, NE7 7DN

For any other enquiries call aHUS on call Consultant on 0191 23 36161

Samples required

1x5ml citrated blood (ADAMTS13)

1x5ml EDTA plasma (sC5b-9)

1x5ml EDTA (CD46)

1x5ml EDTA (Genetic analysis)

2x7ml Serum (C3, C4, FH, FI, FB, CH100, AH100, Factor H autoantibodies)

Following blood draw, it is essential to deliver samples to the local lab within 15 minutes for processing prior to shipment.

ADAMTS13 Sample preparation- 5ml citrated blood

Centrifuge citrate sample at 2,000g for 15 min and (avoiding buffy coat) pipette plasma into fresh tube for repeat centrifugation at 2,000g for 15 min. Pipette plasma into ~4x0.5ml aliquots. Screw top 0.5ml tube compatible with -80OC storage

Label all aliquots CITRATED PLASMA with forename, surname and date of birth

Freeze sample in -800C and ship subsequently on dry ice.

(EDTA is a strong inhibitor of ADAMTS13 activity and EDTA samples cannot be used for this assay)

EDTA plasma sample preparation (soluble C5b-9)

Put on ice IMMEDIATELY

Centrifuge citrate sample at 2,000g for 15 min and (avoiding buffy coat) pipette plasma into ~5x0.5ml aliquots. Screw top 0.5ml tube compatible with -80OC storage

Label all aliquots EDTA PLASMA with forename, surname and date of birth

Freeze sample in -800C and ship subsequently on dry ice.

Serum Sample preparation (C3, C4, FH, FI, FB, CH100, AH100, Factor H autoantibodies)

Allow the blood to clot by leaving undisturbed at room temperature for 30 minutes

Centrifuge at 2,000 x g for 15 minutes in a refrigerated centrifuge.

Pipette serum into ~8x 0.5ml aliquots. Screw top 0.5ml tube compatible with -80OC storage

Label all aliquots SERUM with forename, surname and date of birth

Freeze sample in -800C and ship subsequently on dry ice.

CD46 Flow Cytometry analysis

1 EDTA tube

Store at ambient temperature

DO NOT FREEZE

Label with forename, surname and date of birth, NHS#

Genetic Analysis

One 5 ml EDTA sample is required for DNA analysis.

DO NOT FREEZE

Label with forename, surname and date of birth,NHS#

Version9.11.17