Hospitals & Science

Histocompatibility & Immunogenetics (H&I) – Request forms

Current Histocompatibility and Immunogenetics (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.

The forms are stored in a PDF format and require Adobe Acrobat Reader

Please complete both pages on all forms.

3A – Diagnostic laboratory (Transfusion related and general H&I) FRM 745/2.
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 FRM 1008/2
For the investigation of solid organ transplantation.

3C – Haematopoietic stem cell transplantation FRM 1010/2
For the investigation of haematopoietic stem cell transplantation.

3D – Platelet Immunology FRM999/2
For the investigation of fetal/neonatal alloimmune thrombocytopenia (NAIT), heparin induced thrombocytopenia (HIT), other drug related thrombocytopenias, autoimmune thrombocytopenia, thrombasthenias.
Changes to form 3D

3E – Granulocyte Immunology FRM1001/2
For the investigation of neonatal alloimmune neutropenia (NAIN), adult autoimmune neutropenia, infant autoimmune neutropenia, drug related neutropenia.
Changes to form 3E