Address:
Country:
UK NEQAS for H&I REGISTRATION 2017
IMPORTANT: labs with outstanding payments will notbe registered for any of our Schemes in 2017.
If re-registration forms are not returned samples will continue to be distributed on the same basis as the previous year, unless a request to de-register is received in writing. Any material sent will be invoiced regardless of result submission.
Please refer to notes on registration in section 8 of the 2017Participants’ Manual
Please choose delivery method*:1st Class / Special delivery*** / Courier / Cost
Please the Scheme(s) you wish to register for: / post** / 9am / 1pm / delivery / (For UK NEQASuse)
Scheme 1A / HLA Phenotyping / YES** / YES / YES / YES
Scheme 1B / HLA-B27 Testing / YES** / YES / YES / YES
Scheme 2A / Cytotoxic Crossmatching / YES** / YES / YES / YES
Scheme 2B / Crossmatching by Flow Cytometry / YES** / YES / YES / YES
Scheme 3 / HLA Antibody Specificity Analysis / YES / YES / YES / YES
Scheme 4A1 / HLA Typing 1st field only / YES / YES / YES / YES
Scheme 4A1i / Interpretive HLA Genotype(inc. in price for 4A1)
Scheme 4A2 / HLA Typing to 2nd field / YES / YES / YES / YES
Scheme 4B / ABO DNA Grouping (inc. in price for 4A1/2) / YES / YES / YES / YES
Scheme 5A / HFE Typing / YES / YES / YES / YES
Scheme 5B / Interpretative: HFE and HH
Scheme 6 / HLA Antibody Detection / YES / YES / YES / YES
Scheme 7 / HLA-B57:01 Typing / YES / YES / YES / YES
Scheme 8 / Disease’ Typing - HLA-DR/DQ/DP only / YES / YES / YES / YES
Scheme 9 / KIR Genotyping / YES / YES / YES / YES
Scheme 10 / HPA Genotyping / YES / YES / YES / YES
Educational Scheme (ED) – Samples / YES** / YES / YES / YES
Educational Scheme (iED) – Interpretive Clinical Scenarios
Pilot Scheme / HPA Antibody Detection/Specification / YES / YES / YES / YES
Pilot Scheme / Allelic HLA Typing / YES / YES / YES / YES
Carriage is charged for the Educational Scheme Samples / Total Cost for 2017(for UK NEQAS use) / £
Total Carriage for 2017(for UK NEQAS use) / £
Royal Mail 1st class/Airmail delivery is included in scheme fees. Please note we are unable to track 1st class/Airmail deliveries.
* All samples are sent by Royal Mail 1st class to UK based labs and courier to labs based outside the UK unless appropriate alternative transportation is specifically requested.
**For labs outside the UK, postal delivery is unsuitable for Schemes where viable lymphocytes are required (i.e. 1A, 2A, 2B and also 1B and ED unless a DNA method is used).
***Special Delivery is not available to labs based outside the UK.
NB: One delivery charge is made for all samples shippedon the same date (see for details) and the total costwill be adjusted to reflect this.
(For office use only – initial/date)Entered onto database ______/______/ Checked ______/______/ Sent to finance ______/______
Invoice Details
Please check the below details and make any changes necessary, writing clearly in block capitals, or attach a label
Invoices should be marked for the attention of:
Address:
Country:
Telephone: / Fax:
E-mail:
Purchase Order Number:
A Purchase Order number must be provided to process your registration. Please contact UK NEQAS for H&I to request the total subscription cost, if required. Invoicesare issued by our host organisation, Velindre NHS Trust, and sent to the invoice email/address above. Please do not send payment until the invoice has been issued.
Are you subject to UK VAT?YES/NOYESNOIf “NO”, please provide your VAT Number:
*** Please note: Non-completion of a VAT number will result in UK VAT at the current rate applied to your subscription. Invoices will not be altered after issue due to incorrect completion of VAT information. Any alterations due to incorrect financial information will incur an administration fee for re-issue. Please check with your finance department if you are unsure of any of the above details***
Conditions for Participation: (see participant manual section 8 for further information)
- EQA samples must be tested and interpreted in an identical manner to a laboratory’s routine clinical samples
- Participants must inform UK NEQAS for H&I;
- If the expected samples do not arrive
- Reason(s) for failure to test EQA samples
- Participants must return signed registration documents, provide a purchase order number and ensure UK NEQAS for H&I is informed of any changes in contact information.
- Failure to pay subscription fees on presentation of an invoice will result in suspension from participation.
- Participants will be charged for all Schemes they receive samples for, regardless of whether they submitted results.
- Cancellation of participation must be in writing.
- All reports and the data they contain are copyright and may not be published in any form without the permission of the Director
- Collusion between laboratories is not allowed. If a laboratory is suspected of collusion, UK NEQAS for H&I will appraise the laboratory’s participation in its schemes
- UK laboratories agree to abide by the JWG Conditions of EQA Scheme Participation (see Participant Manual)
To be signed by the Head of the Laboratory:
By signing the registration forms you agree to abide by the conditions for participation above and all other expectations as stated in the Participant Manual.
Signature: Name:Date:
Lab Name:
(if you have not registered with UK NEQAS for H&I previously, please leave this blank and we will provide an appropriate, unique lab name)
Please provide the following information:
Top of Form
Lab name:
Sample Addressee:
Please send the completed form to UK NEQAS for H&I, Welsh Blood Service, Ely Valley Road, Talbot Green, Pontyclun, CF72 9WB, UK; Fax +44 (0) 1443 622001 or email:
UK NEQAS for H&I is provided from the Welsh Blood Service which is a Division of the Velindre NHS Trust.
NEQ 24
Issue 5
Page 1 of 19 Effective Date 31/10/16
Address for samples:
Country:
General laboratory contact details:
Tel no
Fax
Important information may be communicated to participants via email. Include group email addresses or several alternative email addresses if possible to ensure this information is received in the laboratory.
Please send the completed form to UK NEQAS for H&I, Welsh Blood Service, Ely Valley Road, Talbot Green, Pontyclun, CF72 9WB, UK; Fax +44 (0) 1443 622001 or email:
UK NEQAS for H&I is provided from the Welsh Blood Service which is a Division of the Velindre NHS Trust.
NEQ 24
Issue 5
Page 1 of 19 Effective Date 31/10/16
Bottom of Form
Head of Laboratory
Please indicate below if you wish any of the samples and reports to be redirected for specific schemes: (if left blank, all samples/reports will be sent to the sample/report addressee above)
Scheme / Sample Addressee / Email Address / Telephone/Fax Number1A1B2A2B34A14A24B5A5B678EDiED
1A1B2A2B34A14A24B5A5B678EDiED
1A1B2A2B34A14A24B5A5B678EDiED
1A1B2A2B34A14A24B5A5B678EDiED
1A1B2A2B34A14A24B5A5B678EDiED
1A1B2A2B34A14A24B5A5B678EDiED
1A1B2A2B34A14A24B5A5B678EDiED
1A1B2A2B34A14A24B5A5B678EDiED
1A1B2A2B34A14A24B5A5B678EDiED
Scheme reports will be e-mailed to laboratories in PDF format and no longer be sent by post. Please complete at least one e-mail address for reports to be sent to. If possible, include group email addresses or several email addresses to ensure reports are received.
Report recipients: Note – if not completed default is to send reports to the head of lab
Name: / E-mail address:Note: Additional Scheme 5B – Interpretative: HFE genotype and hereditary haemochromatosis report details are collected separately on page 10.
PREFERRED MATERIAL FOR TESTING
Certain techniques employed by participants require the testing of viable lymphocytes.
We can supply isolated lymphocytes suspended in Park/Terasaki medium to selected non-UK destinationswith extended shipping times.
Please indicate if you wish to receive blood samples or isolated lymphocyte suspensions for each of the schemes listed.
Please note: with the exception of the Educational Scheme, there is an additional charge(available on request) per schemefor participants that require isolated lymphocytes.
Lab name:
Blood samplesLymphocyte suspensions
Scheme 1A – HLA Phenotyping
Scheme 1B – HLA-B27 Testing
Scheme 2A – Cytotoxic Crossmatching
Scheme 2B – Crossmatching by Flow Cytometry
Educational Scheme
NAME:
SIGNED: DATE:
UK NEQAS for H&I SCHEME 1A – HLA PHENOTYPING
TYPING FOR HLA-A, B, C, DR, DQ
Depending on their typing strategies participants may register for HLA- A, B, C, DR, DQ assessment
Participants must only register to be assessed on those loci tested using serological methods.
The Steering Committee acknowledges that many laboratories use supplementary techniques to aid in the definition and refinement of HLA specificities.
Participants will retain their assessment level for all samples tested throughout the year.
PLEASE INDICATE THE LOCI TO BE ASSESSED
Lab name:
HLA – ABCDRDQ
Please tick the loci for assessment:
NAME:
SIGNED: DATE:
UK NEQAS for H&I SCHEME 2A – CYTOTOXIC CROSSMATCHING
TESTING WITH PBL AND/OR T-CELLS AND/OR B-CELLS WITH AND WITHOUT DITHIOTHREITOL TREATMENT
Participants may register for peripheral blood lymphocyte PBL/T-cell assessment and/or B-cell assessment with or without dithiothreitol (DTT) treatment.
Participants will retain their assessment level for all samples tested throughout the year.
PLEASE INDICATE YOUR REGISTRATION
Lab name:
PBLassessment without DTT
T-cell assessment without DTT
B-cell assessment without DTT
PBLassessment with DTT
T-cell assessment with DTT
B-cell assessment with DTT
NAME:
SIGNED: DATE:
UK NEQAS for H&I SCHEME 2B – CROSSMATCHING BY FLOW CYTOMETRY
TESTING WITH PBL/T-CELLS AND/OR B-CELLS
Participants may register for T-cell and/or B-cell assessment.
Participants will retain their assessment level for all samples tested throughout the year.
PLEASE INDICATE YOUR REGISTRATION
Lab name:
T-cell assessment
B-cell assessment
NAME:
SIGNED: DATE:
UK NEQAS for H&I SCHEME 3 - HLA ANTIBODY SPECIFICITY ANALYSIS
TESTING FOR HLA CLASS I & II ANTIBODIES
Depending on their testing repertoires participants may register for either HLA Class I only or HLA Class I and II antibody identification.
Participants will retain their assessment level for all samples tested throughout the year.
PLEASE INDICATE YOUR REGISTRATION
Lab name:
HLA Class I antibody identification only
HLA Class I and II antibody identification
NAME:
SIGNED: DATE:
UK NEQAS for H&I SCHEME 4A1 – DNA HLA TYPING AT 1ST FIELD RESOLUTION
There is a separate form for Scheme 4A2 - DNA Typing to 2nd Field Resolution - registration.
Participants may register for first field assessment of HLA-A, B, C, DRB1, DQA1 and DQB1 and for 1st field or ‘presence of’ assessment for DRB3, DRB4 and, DRB5. Participants may also register for first field assessment of DPA1 results and these will be assessed if sufficient results are received.
Participants will retain their assessment level for all samples tested throughout the year. Failure to report all registered loci will result in unacceptable performance.
PLEASE INDICATE YOUR REGISTRATION
Lab name:
HLA- / A / B / C / DRB1 / DRB 3/4/5 / DQA1 / DQB1 / DPA11st field assessment
(2-digit/low resolution)
DRB3/4/5 presence only
UK NEQAS for H&I SCHEME 4A1i – INTERPRETIVE HLA GENOTYPING
Scheme 4A1i is only available to participants registered for Scheme 4A1.
Participants may register for interpreted specificity assessment for any of the following: HLA-A, B, Cw, DRB1, DQB1 or ‘presence of’ assessment for Bw4/6 and DR51/52/53.
HLA- / A / B / Bw4/6 / Cw / DRB1 / DRB 3/4/5 / DQB1Assessment
NAME:
SIGNED: DATE:
UK NEQAS for H&I SCHEME 4A2 – DNA HLA TYPING TO 2ND FIELD RESOLUTION
There is a separate form for Scheme 4A1 - DNA Typing at 1st Field Resolution - registration.
Participants may register for HLA-A, B, C, DRB1, DRB3, DRB4, DRB5, DQA1, DQB1, DPA1 and DPB1 for 2nd field assessment.
Participants will retain their assessment level for all samples tested throughout the year. Failure to report all registered loci will result in unacceptable performance.
PLEASE INDICATE YOUR REGISTRATION
Lab name:
HLA- / A / B / C / DRB1 / DRB 3/4/5 / DQA1 / DQB1 / DPA1 / DPB12nd field assessment
(4-digit/high resolution)
NAME:
SIGNED: DATE:
UK NEQAS for H&I SCHEME 5A – HFE TYPING
TESTING FOR H63D, C282Y and S65C
Depending on their testing repertoires participants may register for S65C, H63D and C282Y assessment.
Participants will retain their assessment level for all samples tested throughout the year.
PLEASE INDICATE YOUR
Lab name:
H63D assessment
C282Y assessment
S65C assessment
Reminder – UK NEQAS for H&I also offer Scheme 5B- Interpretative: HFE genotype and hereditary haemochromatosis, which may be of value to participants of Scheme 5A. Please see the participant manual section 22 for more information.
NAME:
SIGNED: DATE:
UK NEQAS for H&I SCHEME 5B – INTERPRETATIVE: HFE GENOTYPE AND HEREDITARY HAEMOCHROMATOSIS
Laboratories may register for assessment of reporting on provided clinical scenarios and HFE genotypes.
Lab Name:
Registered individual:
E-mail address for scenarios/reports:
Note that all scenarios/reports will be distributed by e-mail.
Laboratory supplying clinical HFE testing service:
*Registrant’s performance monitor:
(*Registrant’s performance monitor – the medical Consultant or hospital administrator who is responsible for monitoring the performance of the registrant. The performance monitor will receive a copy of the reporting assessment and a copy of all correspondence regarding laboratory performance.)
NAME:
SIGNED: DATE:
UK NEQAS for H&I SCHEME 6 - HLA ANTIBODY DETECTION
TESTING FOR HLA CLASS I & II ANTIBODIES
Depending on their testing repertoires participants may register for either HLA Class I only or HLA Class I and II antibody detection.
Participants will retain their assessment level for all samples tested throughout the year.
PLEASE INDICATE YOUR REGISTRATION
Lab name:
HLA Class I antibody detection only
HLA Class I and II antibody detection
NAME:
SIGNED: DATE:
UK NEQAS for H&I SCHEME 9 – KIR GENOTYPING
Participants can register for assessment for the presence/absence of: KIR2DL1, KIR2DL2, KIR2DL3, KIR2DL4, KIR2DL5, KIR3DL1, KIR3DL2, KIR3DL3, KIR3DS1, KIR2DS1, KIR2DS2, KIR2DS3, KIR2DS4, KIR2DS5, KIR2DP1, KIR3DP1.
Participants will retain their assessment level for all samples tested throughout the year. Failure to report all registered loci will result in unacceptable performance.
PLEASE INDICATE YOUR REGISTRATION
Lab name:
KIR- / 2DL1 / 2DL2 / 2DL3 / 2DL4 / 2DL5 / 3DL1 / 3DL2 / 3DL3Assessment
KIR- / 3DS1 / 2DS1 / 2DS2 / 2DS3 / 2DS4 / 2DS5 / 2DP1 / 3DP1
Assessment
NAME:
SIGNED: DATE:
UK NEQAS for H&I SCHEME 10 – HPA GENOTYPING
Participants can register for assessment for any combination of the following: HPA-1, HPA-2, HPA-3, HPA-4, HPA-5, HPA-6, HPA-15.
Participants will retain their assessment level for all samples tested throughout the year. Failure to report all registered loci will result in unacceptable performance.
PLEASE INDICATE YOUR REGISTRATION
Lab name:
HPA- / 1 / 2 / 3 / 4 / 5 / 6 / 15Assessment
NAME:
SIGNED: DATE:
UK NEQAS for H&I PILOT SCHEME – ALLELIC HLA TYPING
Participants may register for HLA-A, B, C, DRB1, DRB3, DRB4, DRB5, DQA1, DQB1, DPA1 and DPB1 allelic level typing.
PLEASE INDICATE YOUR REGISTRATION
Lab name:
HLA- / A / B / C / DRB1 / DRB 3/4/5 / DQA1 / DQB1 / DPA1 / DPB1Allelic level typing
NAME:
SIGNED: DATE:
UK NEQAS for H&I EDUCATIONAL SCHEME
SAMPLES AND CLINICAL INTERPRETATIVE SCENARIOS
Participants of UK NEQAS for H&I Schemes may register to receive samples for testing that offer a beneficial educational element. Participants may also register to receive one or all of the Interpretative Clinical Scenarios.
Participants can also register to receive samples to perform combined crossmatching, HLA typing and antibody definition. The individual test results are reported along with a basic clinical interpretation in the context of a kidney transplant case.
PLEASE INDICATE YOUR REGISTRATION
Lab name:
ED: Educational HLA Typing Samples for testing:
For Scheme 1A or Scheme 4A1/2 participants
EDXM: Samples for combined HLA typing/crossmatching/
HLA antibody definition and interpretation:
For Scheme 2A, 2B, or Scheme 3 participants
iED:
Interpretative Clinical Scenario 1:
Solid Organ Transplantation
Interpretative Clinical Scenario 2:
Haematopoietic Stem Cell Transplantation
Interpretative Clinical Scenario 3:
Platelet/ transfusion immunology
Note that all scenarios/result summaries will be distributed by e-mail.
NAME:
SIGNED: DATE:
UK NEQAS for H&I –LABORATORY SERVICES 2017
To enable us to plan our resources for the future we would be grateful for the following information regarding the clinical services you provide. Your information will be treated as strictly confidential. The results of this questionnaire will be summarised and reported (without laboratory names or code numbers) back to participants for their interest.
Lab name:
Please tick all that apply / Planning to:Start
2017-18 / Discontinue
2017-18
Laboratory type: / Clinical service provider (NHS or government funded)
Clinical service provider (Privately funded)
Educational
Commercial
Other (specify)
Clinical HLA typing service for: / Solid organ transplantation
Blood stem cell donor registry
Blood stem cell transplantation
Platelet transfusion
Reference cell panels for antibody investigation
HLA and disease association, e.g. B*27
Paternity testing
Pharmacogenetic markers, e.g. B*57
Other (specify)
Clinical crossmatching service for: / Solid organ transplantation
Blood stem cell transplantation
Platelet transfusions
Other (specify)
Clinical service for HLA antibody detection/analysis for: / Solid organ transplantation
Blood stem cell transplantation
Platelet transfusions
Adverse reactions to blood transfusion, e.g. TRALI
Other (specify)
Clinical service for other genetic markers: / HFE
Other (specify)
UK NEQAS for H&I –LABORATORY SERVICES 2017
Lab name:
European Federation for Immunogenetics (EFI) Accreditation
To aid UK NEQAS for H&I to consider EFI rules for EPT it would be helpful if you would indicate your current EFI Accreditation status:
EFI Accredited since: / Month:JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / Year:2013201220112010200920082007200620052004200320022001200019991998199719961995Awaiting first EFI Accreditation inspection due: / Month:JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / Year:2013201220112010200920082007200620052004200320022001200019991998199719961995
Preparing for first EFI Accreditation inspection – likely in: / Year:2013201220112010200920082007200620052004200320022001200019991998199719961995
If no current intention to be EFI Accredited, please tick:
Please add/continue any comments/suggestions:
Please send the completed form to UK NEQAS for H&I, Welsh Blood Service, Ely Valley Road, Talbot Green, Pontyclun, CF72 9WB, UK; Fax +44 (0) 1443 622001 or email:
UK NEQAS for H&I is provided from the Welsh Blood Service which is a Division of the Velindre NHS Trust.
NEQ 24
Issue 5
Page 1 of 19 Effective Date 31/10/16