Regional
The Evolution of Malaysia National Blood Centre's Platelet Immunology Laboratory
Nor Hafizah Ahmad
National Blood Centre, Kuala Lumpur, Malaysia
Noor Sheereen Adzaludin
National Blood Centre, Kuala Lumpur, Malaysia
Nurul Munira Yahya
National Blood Centre, Kuala Lumpur, Malaysia
The Malaysia National Blood Centre (NBC) has long been at the forefront of blood transfusion services, and since 1992, it has pioneered platelet immunology laboratory service in the country. Over the decades, the service has evolved into the national and sole referral hub for platelet immunology, offering a range of specialized services and tests crucial for patient care in transfusion medicine.
Inception and Early Developments
The journey began in 1992 when the NBC team, led by Dr. Afifah Haji Hassan, who was then the head of the Immunohematology division and later served as the former Director of NBC, initiated its platelet immunology laboratory with the recruitment and training of two personnel in platelet testing using the Solid Phase Red Cell Adherence (SPRCA) method. These initial tests employed the commercial Capture-P assay, a system designed for detecting platelet antibodies. The foundation laid by this early work set the stage for further advancements and specialized techniques.me institutions without PBM initiatives or activities.
Expanding Expertise: Training and Method Validation
In 1998, a pivotal step was taken when one of the NBC’s medical laboratory technologists (MLT) underwent on-the-job training in Australia, focusing on the SPRCA method, a critical technique in platelet immunology. The introduction of the SPRCA method into the laboratory's repertoire marked a significant advancement. Subsequently, in 2005, an expert from Australia introduced the Monoclonal Antibody Immobilization of Platelet Antigens (MAIPA) method at the NBC, further enhancing the laboratory's capabilities for more advance platelet antibody detection. Between 2005 and 2006, the NBC validated the MAIPA methodology within its laboratory settings, optimizing it as the primary testing method. This period marked the transition from basic platelet antibody testing to a more sophisticated and reliable diagnostic process, reinforcing the laboratory’s capability in handling complex platelet immunology cases.
Strengthening Capabilities and International Collaboration
In 2007, the NBC further enhanced its capabilities by training one of its Scientific Officers in Human Platelet Antigen (HPA) genotyping. This training, conducted abroad, encompassed comprehensive services in platelet immunohematology, including platelet crossmatching and patient reporting. This expansion into HPA genotyping allowed the laboratory to offer more targeted and specific testing services, crucial for managing conditions like Neonatal Alloimmune Thrombocytopenia (NAIT).
The NBC continued to prioritize international collaborations and training. In 2013, two of our MLTs received training at the Guangzhou Blood Centre, China. In 2019, four MLTs underwent hands-on training in the MAIPA method at the Japanese Red Cross (JRC), ensuring the seamless integration of the latest techniques and best practices into the laboratory’s operations. Most recently, in 2023, a Transfusion Medicine Specialist from the NBC received job training at the JRC, covering various advanced methods of platelet testing, including the use of the Luminex system.
Continuous Engagement and Professional Development
The NBC’s commitment to professional development and international collaboration is exemplified by its involvement in the Platelet Immunology Working Party (PIWP) of the International Society of Blood Transfusion (ISBT). This engagement ensures continuous skill-building, professional networking, and the adoption of global best practices in platelet immunology.
In 2022, NBC successfully co-coordinated the 21st International Platelet Immunology Workshop under the PIWP, showcasing its leadership and expertise in the field. Furthermore, since then, having a laboratory representative in the PIWP-ISBT has enabled us to enhance our international presence and expand professional networking in this field. Participation in the PIWP-ISBT workshops as well as the UK National External Quality Assessment Service (NEQAS) for platelet antibodies and HPA genotyping further underscores the NBC’s dedication to maintaining high standards and external validation of its testing processes.
Clinical Services and Growth
The NBC’s platelet immunology laboratory currently utilizes manual SPRCA for platelet crossmatching and the MAIPA method for platelet antibody investigation in most of its tests. Platelet antibody investigation services were initially introduced to patients in 2000, with in-house platelet crossmatching services for selected cases beginning in 2007. The test was officially offered in 2016, marking a significant milestone for the laboratory. It offers a comprehensive range of clinical services, including NAIT testing (parental crossmatching, maternal direct testing, and HPA genotyping), Idiopathic Thrombocytopenic Purpura (ITP) workups, Platelet Transfusion Refractoriness (PTR) cases, and donor’s HPA genotyping for in house reagents. The demand for these services has grown significantly over the years. In 2023, the laboratory reported a 71% increase in testing volume compared to the previous year, with a total of 157 cases tested. This rise in workload reflects both the growing recognition of the laboratory’s expertise and the increasing clinical need for specialized platelet immunology services.
Challenges and Strategic Initiatives
Despite this growth, the platelet laboratory faces several significant challenges, including limited operational budgets and facilities. Additionally, the restricted pool of HLA-typed donors presents a constraint. To address this, the laboratory is collaborating with the Histocompatibility and Immunogenetics (H&I) laboratory to increase the number of typed donors. Moreover, training medical laboratory technologists (MLTs) is difficult due to our limited experience in this field. Therefore, we are looking to network with other regional laboratories to enhance learning opportunities and support our personnel's professional development.
Future Directions
Looking ahead, the NBC plans to further enhance its capabilities by incorporating commercial SPRCA and Luminex testing systems into its current settings. These advancements will improve testing efficiency, accuracy, and capacity, ensuring that the laboratory continues to meet the evolving needs of patients and healthcare providers. The Malaysia National Blood Centre’s journey in platelet immunology is a testament to its commitment to excellence, continuous improvement, and international collaboration. From humble beginnings with basic SPRCA testing to becoming a national leader and international collaborator in platelet immunology, the NBC has consistently strived to provide the best possible care for patients requiring specialized platelet diagnostics. As it embraces new technologies and methodologies, the Centre is poised to maintain its leadership and continue its critical role in transfusion medicine and patient care.
Acknowledgment: Afifah Haji Hassan Former Director (2022-2023) Malaysia National Blood Centre Nang Pah Nik Ibrahim Senior Medical Laboratory Technologist (Immunohematology Section) Malaysia National Blood Centre
