Cost effectiveness in screening of class I HLA antibodies in Thai pregnant women.

Fifty-seven sera obtained from pregnant women who attended antenatal clinic were screened for class I HLA antibodies by standard microlymphocytotoxicity test. The age ranged from 20 to 40 years (mean +/- SD = 30.4 +/- 5). The lymphocytes obtained from 98 HLA-typed persons were used as the panel which would include all common HLA-A and HLA-B antigens and as many rare antigens as possible. Eight out of 57 sera (14%) had HLA antibodies which reacted as follows: 3 sera had nonspecific antibodies, 3 sera had multispecific antibodies (B60 + B48 + B7, B60 + B61 + B13 and B51 + B35 + B53), one serum had a monospecific antibody (A2) and one serum was unidentified. The identified antibodies showed strong reactivity (r > 0.8). These sera will be used as HLA typing sera and exchanged with other HLA laboratories. The screening test for class I HLA antibodies in pregnant women attending the antenatal clinic is useful and practical. Several HLA antisera can be obtained at low cost. The cost of self-screening antisera was US$90/ml while the cost of commercial HLA typing sera is approximately US$250/ml, a factor to be considered by a new HLA laboratory with limited budget.

The value of HLA-ABC common typing tray in relation to bone marrow transplantation.

Bone marrow transplantation (BMT) is one of the most effective procedures to cure the previously uncured hematologic diseases. However, it is costly and HLA typing to select the compatible donors contributed to its cost. A total of 53 prospective patients for BMT and their 114 siblings were analyzed to evaluate the use of locally prepared HLA-ABC common typing tray (ABCCT) during Mar 1988-Mar 1992. The 16, 9, 7, 5, 5 and 12 patients were diagnosed as aplastic anemia, CML, thalassemia, ALL, ANLL and other blood diseases, respectively. It was found that 18 patients were HLA-identical (HLA-ID) with one of their siblings except one patient had 2 HLA-ID sibs. All of those who appeared to be HLA-ID were further tested for the HLA-ABCDR typings. It was observed that 16 (88.89%) of 18 patients and 17 (89.47%) of 19 sibs were confirmed as HLA-ID. After careful clinical screening, only 13 HLA-ID pairs were able to proceed to the mixed lymphocyte culture and confirmed their status of HLA-ID by this test. Finally, only 6 (46.15%) of 13 patients received BMT with a high rate of success, ie all patients have survived with bone marrow engraftment. Thus, ABCCT is very useful for related BMT. It was highly efficient to exclude HLA-non-ID and haplo-ID yet the cost and workload were greatly reduced.