H&I Test Request Forms

H&I test request forms can be downloaded below. For printed copies please phone your local H&I laboratory. Please withdraw ALL previous versions of request forms. For general enquiries about H&I services email HINatnl@nhsbt.nhs.uk.

The forms collect the relevant clinical details to enable us to perform the appropriate tests, to reflect the services currently provided by the laboratories and to comply with accreditation regulations. They have been designed in response to user feedback.

  • Guidance information for completion of the H&I Diagnostic Laboratory Test Request forms (INF1182)
  • H&I Requirements for Sample Labelling and Request Form Completion (MPD1108/1.1)

Please complete both pages on all forms. The forms are PDF format and require Adobe Acrobat Reader

  • 3A – Diagnostic Laboratory (Transfusion related and general H&I) FRM745
    For the investigation of platelet refractoriness, HLA/HPA/HNA antibody screening, HLA/HPA/HNA typing, transfusion-related acute lung injury (TRALI), transfusion associated graft versus host disease (TA-GvHD), post transfusion purpura (PTP), non-haemolytic febrile transfusion reaction (NHFTR), HLA typing & disease association

  • 3B – Organ Transplant Recipients and Donors FRM1008
    For the investigation of solid organ transplantation

  • 3C – Haematopoietic Stem Cell Transplantation FRM1010
    For the investigation of haematopoietic stem cell transplantation

  • 3D – Platelet Immunology FRM999
    For the investigation of fetal/neonatal alloimmune thrombocytopenia (NAIT), heparin induced thrombocytopenia (HIT), other drug related thrombocytopenias, autoimmune thrombocytopenia, and thrombasthenias

  • 3E – Granulocyte Immunology FRM1001
    For the investigation of neonatal alloimmune neutropenia (NAIN), adult autoimmune neutropenia, infant autoimmune neutropenia, and drug related neutropenia

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