National Immunohematology Reference Laboratory (NIRL)
National Blood Transfusion Service – Sri LankaSpecialised immunohematology investigations, expert consultation and support for complex transfusion requirements.1. About Us
The National Immunohematology Reference Laboratory (IHRL) of the National Blood Transfusion Service (NBTS), Sri Lanka, is a national-level reference laboratory providing specialised immunohematology testing, technical consultation and support for complex transfusion requirements.The laboratory operates 24 hours a day, seven days a week, including weekends and public holidays, supporting blood banks, hospitals and transfusion medicine services in managing cases that cannot be adequately resolved through routine immunohematology testing.Through specialised serological investigations, reference testing, expert consultation and assistance in identifying compatible blood, the laboratory contributes to safe and effective transfusion practice across Sri Lanka.
2. Our National Reference Role
The National Immunohematology Reference Laboratory provides specialised support to the national blood transfusion network through the following functions:
- Reference-level investigation of complex red cell serological problems.
- Resolution of difficult blood grouping, antibody identification and compatibility cases.
- Expert technical consultation for hospital blood banks and transfusion medicine services.
- Identification of suitable antigen-negative and rare compatible blood for patients with complex transfusion requirements.
- Support for standardisation, quality assurance and the development of immunohematology practice within NBTS.
- Education, specialist training, research and professional development in immunohematology.
3. Specialised Reference Services
The laboratory provides specialised investigations and support for complex immunohematological cases.
Complex Red Cell Antibody Identification
Investigation and confirmation of clinically significant red cell antibodies when routine laboratory testing is inconclusive, including cases involving multiple antibodies.
Antibodies to High- or Low-Prevalence Antigens
Specialised investigation of unusual antibody reactivity and suspected antibodies directed against high- or low-prevalence red cell antigens.
Extended Red Cell Phenotyping
Extended red cell antigen typing to support antibody investigations, patient management and the selection of compatible blood.
ABO and Rh Blood Group Discrepancy Investigations
Reference-level investigation of unresolved ABO, RhD and other blood group typing discrepancies.
Autoantibody Investigations
Investigation of warm- and cold-reactive autoantibodies and associated serological problems.
Direct Antiglobulin Test (DAT) Investigations
Further investigation of clinically relevant positive or discrepant DAT results, where indicated.
Adsorption and Elution Studies
Specialised techniques to separate or characterise antibodies in complex serological investigations, where applicable.
Complex Compatibility Testing
Support for patients for whom compatible red cell units are difficult to identify using routine compatibility procedures.
Transfusion Reaction Investigations
Reference-level immunohematological support for suspected immune haemolytic transfusion reactions referred to the laboratory.
Haemolytic Disease of the Fetus and Newborn (HDFN)
Specialised investigation of maternal red cell antibodies relevant to HDFN, according to the laboratory’s approved service scope.
Rare Blood Group Investigations
Characterisation of rare or unusual red cell phenotypes and support for locating appropriate compatible blood.
4. Rare Blood and Complex Transfusion Support
Patients with rare blood group phenotypes, antibodies to high-prevalence antigens, multiple clinically significant red cell antibodies or other complex compatibility problems may require specialised investigations and assistance to identify suitable blood.The laboratory works in coordination with Consultant Transfusion Physicians and the NBTS blood bank network, using phenotyped donor databases and rare donor registries to facilitate the identification of suitable donors and appropriately matched blood components.The process generally involves:
- Assessing the patient’s requirements: Specialised testing identifies relevant blood group characteristics and antibodies that may affect transfusion.
- Identifying suitable donors: Phenotyped donor databases and rare donor registries are used to identify potentially suitable donors.
- Confirming compatibility: Appropriate investigations are performed to confirm that the selected blood meets the patient’s requirements and is compatible.
- Coordinating blood provision: The laboratory works with the NBTS blood bank network and transfusion medicine specialists to facilitate access to suitable blood.
Identifying rare or specially matched blood may require additional time because suitable donors or blood components may not be immediately available at the treating hospital. Donor contact, collection, testing and transport arrangements may be necessary, including coordination between different parts of Sri Lanka.
5. Complex Antibody Investigations
Complex antibody investigation is a key reference function of the laboratory.Referral may be appropriate when:
- Routine testing cannot resolve serological incompatibility.
- Multiple red cell antibodies are suspected.
- Antibody reactivity suggests an antibody against a high-prevalence antigen.
- A patient has a history of clinically significant red cell antibodies.
- Compatible donor units are difficult to identify.
Depending on the case, reference investigations may include antibody identification panels, selected red cells, extended phenotyping, enzyme techniques, adsorption, elution, titration and other specialised serological methods available at the laboratory.
6. Support for Haemolytic Disease of the Fetus and Newborn
The laboratory provides specialised investigation and technical advice concerning maternal red cell alloantibodies associated with haemolytic disease of the fetus and newborn (HDFN).Investigations may include antibody identification, confirmation, titration and other immunohematological assessments relevant to transfusion support and clinical management, within the laboratory’s approved service scope.
7. Sample Referral Guidelines
Samples should be referred to the laboratory when specialised immunohematology investigation is required beyond the capacity of routine testing.Referring institutions should provide adequate clinical, transfusion and laboratory information to support accurate interpretation of results.
Information Required with a Referral
Please ensure that the following information is provided, where applicable:
- Patient identification details and demographic information.
- Clinical diagnosis and reason for referral.
- Previous and current blood grouping results.
- Antibody screening and identification results already obtained.
- Crossmatch and compatibility findings.
- Relevant pregnancy history.
- Previous transfusions and dates of recent transfusions.
- Known historical antibodies or previous immunohematology reports.
- Details of any suspected transfusion reaction.
- Contact details of the referring medical officer or laboratory.
Request Form and Sample Labelling
The IHRL Request Form must be completed with all required patient identification, clinical, transfusion history and laboratory information.All samples must be properly labelled with patient identification details that correspond with the information on the request form.Incomplete request forms, inadequately labelled samples or discrepancies between the sample label and request form may result in sample rejection and delays in investigation.IHRL Request Forms are available at hospital blood banks. Referring clinicians and institutions should obtain the appropriate form from their respective hospital blood bank and ensure that it is completed before submitting samples.
8. Immunohematology Tests and Sample Guide
The following table provides the sample requirements and general referral purposes described in the proposed laboratory guide.
| Test / Investigation | Sample requirement | Purpose |
|---|
| ABO/RhD group confirmation | Clotted blood 5–7 mL and EDTA blood 2 mL | Confirmation or resolution of blood group results requiring reference-level investigation. |
| Direct antiglobulin test (DAT) profile | EDTA blood 2 mL | Reference investigation of DAT findings. |
| Antibody identification | Clotted blood 7–10 mL and EDTA blood 2 mL | Identification of atypical or clinically significant red cell antibodies, including complex cases. |
| Difficult compatibility testing | Clotted blood 7–10 mL and EDTA blood 2 mL | Cases where compatible blood cannot be identified through routine hospital blood bank testing. |
| Antenatal serology | Clotted blood 7–10 mL and EDTA blood 2 mL | Specialised immunohematological investigation during pregnancy, including clinically significant red cell antibodies. |
| Extended phenotyping (minor blood group typing) | EDTA blood 2 mL | Extended red cell antigen typing to support antibody investigation and selection of compatible blood. |
| Anti-A and Anti-B IgG titre | Clotted blood 5–7 mL | Measurement of IgG anti-A/anti-B titre where clinically indicated. |
| Cold haemagglutinin test | Separated serum 5 mL at 37°C and EDTA blood 2 mL | Investigation of suspected cold-reactive antibodies or cold haemagglutinins. |
| Isohaemagglutinin test | Clotted blood 5–7 mL | Specialised testing of naturally occurring ABO-related antibodies where indicated. |
Important: Referring institutions should confirm the current sample collection, handling, transport and acceptance requirements with the laboratory before dispatching samples. The test menu and sample requirements should be confirmed by the laboratory before publication.
9. Urgent and Complex Cases
For urgent cases in which compatible blood is required for an immediate or time-critical transfusion, the referring blood bank or clinician should first consult the Cluster or hospital Consultant Transfusion Physician.Following consultation, the National Immunohematology Reference Laboratory should be contacted, where appropriate, before dispatching samples.The laboratory can provide specialised support and advice on sample requirements, further immunohematological investigations and appropriate arrangements for managing complex transfusion requirements.
For urgent referrals, please contact the laboratory before sending the sample.10. Quality Assurance and Accreditation
The National Immunohematology Reference Laboratory operates within the established Quality Management System of the National Blood Transfusion Service.According to the laboratory’s proposed website content, it was among the first government-sector laboratories in Sri Lanka to achieve ISO 15189 laboratory accreditation in 2011 and has maintained its accreditation since then.The laboratory maintains internal quality control and quality assurance procedures for immunohematological investigations. It also participates in National External Quality Assessment (EQA) programmes and the UK NEQAS scheme for Blood Group Serology, with participation reported since 2011.These activities support the laboratory’s commitment to laboratory quality, technical competence, patient safety and continuous improvement.
11. Education, Training and Professional Support
As a national reference facility, the laboratory contributes to strengthening immunohematology capacity through:
- Specialist training and laboratory attachments.
- Continuing professional development.
- Case-based teaching and discussion.
- Technical guidance for medical officers and transfusion medicine trainees.
- Training and professional support for medical laboratory technologists and other relevant professionals.
These activities contribute to strengthening expertise and improving immunohematology practice across the national blood transfusion network.
12. Research and Development
The laboratory supports research and development in areas including:
- Blood group antigen and antibody profiles.
- Red cell alloimmunisation.
- Rare red cell phenotypes.
- Complex serological cases.
- Haemolytic disease of the fetus and newborn.
- Transfusion reactions.
- Laboratory quality improvement.
- Emerging immunohematology technologies.
13. Contact Information
National Immunohematology Reference Laboratory
National Blood Transfusion Service, Sri Lanka
Address:
No. 555/5D, Elvitigala Mawatha,
Narahenpita, Colombo 05,
Sri Lanka.
Telephone: +94 11 23 69 931
Telephone extensions:- Routine enquiries: Emergency enquiries:
Email: reflabnbc@gmail.comOperating hours: 24 hours a day, 7 days a week, including public holidays.For urgent and complex transfusion cases, please follow the referral pathway described above.
14. Downloads and Useful Resources
The following resources should be made available for download when the approved documents are ready:
- IHRL Sample Referral / Serology Investigation Request Form —
- Sample Collection and Transport Instructions —
- Please obtain the relevant request form through your hospital blood bank and follow the laboratory’s current sample submission instructions.
15. Frequently Asked Questions
Who can refer samples to the laboratory?
Samples may be referred from NBTS blood banks, private hospitals, clinical laboratories and other authorised institutions, subject to the laboratory’s referral arrangements.
When should a sample be referred?
A sample should be referred when routine testing cannot resolve a complex blood grouping, antibody identification or compatibility problem, or when specialised reference investigation is required.
Should the laboratory be contacted before sending an urgent sample?
Yes. For urgent or particularly complex cases, the referring blood bank should first consult the relevant Cluster or hospital Consultant Transfusion Physician and contact the laboratory as appropriate before dispatching samples.
What information should accompany a referral?
The referral should include patient identification details, clinical information, transfusion and pregnancy history where relevant, previous immunohematology findings and results of investigations already performed.
How does the laboratory help identify antigen-negative or rare blood?
The laboratory investigates the patient’s blood group characteristics and relevant antibodies, searches phenotyped donor databases and rare donor registries, and coordinates with the NBTS blood bank network to facilitate identification of suitable donors and compatible blood components.
Why can it take time to find suitable antigen-negative or rare blood?
Rare or specially matched blood may not be immediately available at the treating hospital. Identifying suitable donors, arranging donation, performing the necessary testing and transporting blood between locations can require additional time.
Why is it important to carry my antibody card when admitted to hospital?
An antibody card provides important information about previously identified red cell antibodies. Some antibodies may become difficult to detect over time but can remain relevant to future transfusions.Always carry your antibody card and show it to your doctor and the hospital blood bank when admitted, particularly if a blood transfusion may be required. This information can help the blood bank select suitable blood and reduce delays.
What should I do if I lose my antibody card or need a copy of a previous laboratory report?
Request a replacement antibody card or a copy of the previous IHRL report through your hospital blood bank.A written request should include your identification details and relevant hospital admission information so that the laboratory can locate and verify the previous records. Following verification, a replacement card or certified true copy of the relevant report may be issued, as appropriate.
16. Our Commitment
The National Immunohematology Reference Laboratory supports safe transfusion practice through specialised laboratory investigations, professional consultation, quality assurance and collaboration with the national blood transfusion network.By helping resolve complex immunohematological problems and facilitating the identification of suitable compatible blood, the laboratory contributes to improved transfusion support for patients across Sri Lanka.
