A FHIR Human Leukocyte Antigen (HLA) Interface for Platelet Transfusion Support

William J Gordon; Jane Baronas; William J Lane

doi:10.4338/ACI-2017-01-CR-0010

Applied Clinical Informatics, Table of Contents

Appl Clin Inform 2017; 08(02): 603-611
DOI: 10.4338/ACI-2017-01-CR-0010

Case Report – Special Topic Interoperability and EHR

Schattauer GmbH

A FHIR Human Leukocyte Antigen (HLA) Interface for Platelet Transfusion Support

William J Gordon

¹Clinical Informatics and Innovation, Brigham and Women’s Hospital, Boston, MA

³Department of Medicine, Massachusetts General Hospital, Boston, MA

⁴Harvard Medical School, Boston, MA, USA

,

Jane Baronas

²Department of Pathology, Brigham and Women’s Hospital, Boston, MA

,

William J Lane

²Department of Pathology, Brigham and Women’s Hospital, Boston, MA

⁴Harvard Medical School, Boston, MA, USA

› Author Affiliations

Abstract

Summary

Platelet transfusions are a cornerstone of therapy for patients who develop thrombocytopenia while undergoing Hematopoietic Stem Cell Transplantation (HSCT). Many patients who develop Platelet Transfusion Refractoriness (PTR) require HLA-matched platelets. Identifying these patients early could lead to better utilization of platelets as well as increased platelet counts. We built a SMART on FHIR visualization tool to aid the oncology, blood bank, and blood donor center teams in identifying these patients by showing trends in thrombocytopenia along with a computer generated calculated Panel Reactive Antibody (cPRA) level. To do this, we required a FHIR interface to our HLA database. We describe our methods and outcome for constructing this FHIR interface, as well as the architecture and data flow of HLA data from its proprietary database to the SMART on FHIR environment and application database along with RESTful cPRA web service calculator. Future work will evaluate the clinical impact of this platelet visualization tool and overall success of our FHIR implementation.

Citation: Gordon WJ, Baronas J, Lane WJ. A FHIR human leukocyte antigen (HLA) interface for platelet transfusion Support. Appl Clin Inform 2017; 8: 603–611 https://doi.org/10.4338/ACI-2017-01-CR-0010

Keywords

Laboratory information systems - standards - FHIR - HLA antigens - platelet transfusion

Full Text

References

References
1 Gratwohl A, Baldomero H, Aljurf M, Pasquini MC, Bouzas LF, Yoshimi A, Szer J, Lipton J, Schwendener A, Gratwohl M, Frauendorfer K, Niederwieser D, Horowitz M, Kodera Y. Hematopoietic stem cell transplantation A Global Perspective. JAMA J Am Med Assoc 2010; 303 (16) 1617-1624.
2 Pasquini MC, Zhu X. Current uses and outcomes of hematopoietic stem cell transplantation. 2015 Available from: http://www.cibmtr.org
3 Barbee I Whitaker. The 2011 National Blood Collection and Utilization Survey Report. American Association of Blood Banks; 2011. [cited 2017 Jan 6]. Available from: http://www.aabb.org/research/hemovigilance/bloodsurvey/Documents/11-nbcus-report.pdf
4 Kaufman RM, Djulbegovic B, Gernsheimer T, Kleinman S, Tinmouth AT, Capocelli KE, Cipolle MD, Cohn CS, Fung MK, Grossman BJ, Mintz PD, O’Malley BA, Sesok-Pizzini DA, Shander A, Stack GE, We-bert KE, Weinstein R, Welch BG, Whitman GJ, Wong EC, Tobian AAR. AABB. Platelet transfusion: a clinical practice guideline from the AABB. Ann Intern Med 2015; 162 (03) 205-213.
5 Riley W, Smalley B, Pulkrabek S, Clay ME, McCullough J. Using lean techniques to define the platelet (PLT) transfusion process and cost-effectiveness to evaluate PLT dose transfusion strategies. Transfusion (Paris). 2012; 52 (09) 1957-1967.
6 Fuller AK, Uglik KM, Braine HG, King KE. A comprehensive program to minimize platelet outdating. Transfusion (Paris). 2011; 51 (07) 1469-1476.
7 Kiefel V. Reactions Induced by Platelet Transfusions. Transfus Med Hemotherapy. 2008; Oct 35 (05) 354-8.
8 Mayor NP, Robinson J, McWhinnie AJM, Ranade S, Eng K, Midwinter W, Bultitude WP, Chin C-S, Bowman B, Marks P, Braund H, Madrigal JA, Latham K, Marsh SGE. HLA Typing for the Next Generation. PLOS ONE 2015; 10 (05) e0127153.
9 Choo SY. The HLA System: Genetics, Immunology, Clinical Testing, and Clinical Implications. Yonsei Med J 2007; 48 (01) 11.
10 Group TT to RA to PS. Leukocyte Reduction and Ultraviolet B Irradiation of Platelets to Prevent Alloimmunization and Refractoriness to Platelet Transfusions. N Engl J Med 1997; 337 (26) 1861-1870.
11 Cecka JM. Calculated PRA (CPRA): The New Measure of Sensitization for Transplant Candidates. Am J Transplant 2010; 10 (01) 26-29.
12 Hod E, Schwartz J. Platelet transfusion refractoriness. Br J Haematol 2008; 142 (03) 348-360.
13 Mandel JC, Kreda DA, Mandl KD, Kohane IS, Ramoni RB. SMART on FHIR: a standards-based, interoperable apps platform for electronic health records. J Am Med Inform Assoc 2016; 23 (05) 899-908.
14 Organ Procurement and Transplantation Network. CPRA Calculator. [cited 2017 Feb 20]. Available from: https://optn.transplant.hrsa.gov/resources/allocation-calculators/cpra-calculator
15 Maiers M. A community standard XML message format for sequencing-based typing data. Tissue Antigens 2007; 69: 69-71.
16 National Marrow Donor Program: Be The Match. Histoimmunogenetics Markup Language. [cited 2017 Jan 9]. Available from: https://bioinformatics.bethematchclinical.org/hla-resources/hml
17 Clinical Genomics Work Group, Health Level 7 International. Genomics Implementation Guidance. [cited 2017 Jan 9]. Available from: http://build.fhir.org/genomics.html
18 Goodwin S, McPherson JD, McCombie WR. Coming of age: ten years of next-generation sequencing technologies. Nat Rev Genet 2016; 17 (06) 333-351.
19 Milius RP, Heuer M, Valiga D, Doroschak KJ, Kennedy CJ, Bolon Y, Schneider J, Pollack J, Kim HR, Cereb N, Hollenbach JA, Mack SJ, Maiers M. Histoimmunogenetics Markup Language 1.0: Reporting Next Generation Sequencing-based HLA and KIR Genotyping. Hum Immunol 2015; 76 (12) 963-974.
20 Health Level Seven International (HL7). Introducing HL7 FHIR. [cited 2017 Jan 9]. Available from: http://www.hl7.org/fhir/summary.html
21 Orders and Observations Work Group, Health Level 7 International. Resource DiagnosticReport –Content. [cited 2017 Jan 9]. Available from: http://www.hl7.org/fhir/diagnosticreport.html
22 Milius RP, Mack SJ, Hollenbach JA, Pollack J, Heuer ML, Gragert L, Spellman S, Guethlein LA, Trachtenberg EA, Cooley S, Bochtler W, Mueller CR, Robinson J, Marsh SGE, Maiers M. Genotype List String: a grammar for describing HLA and KIR genotyping results in a text string. Tissue Antigens 2013; 82 (02) 106-112.
23 Orders and Observations Work Group, Health Level 7 International. Resource Observation –Content. [cited 2017 Jan 9]. Available from: http://www.hl7.org/fhir/observation.html
24 FHIR Infrastructure Work Group, Health Language 7 International. Resource References: Contained Resources. [cited 2017 Jan 9]. Available from: http://www.hl7.org/FHIR/references.html