MHC Typing Sample Delivery Form

By Doris Hart,2014-04-26 19:32
8 views 0
MHC Typing Sample Delivery Form

    MHC Typing Sample Delivery Form

    AIDS Vaccine Research Laboratory

    University of Wisconsin Dept of Pathology & Laboratory Medicine

    Contact Information Send Results to

    Institution Name

    Investigator Organization

    Address Address

    Address Address

    Address Address

    Address Address

    Phone Phone

    Fax Fax

    E-mail E-mail

    Shipping Contact


    Date Shipped

    FedEx tracking number

    UW Account number ______________________

    PO number ______________________________

Number of specimens to be tested ____________

     6____ Blood (EDTA anti-coagulated) _____Cells (2 x 10, live frozen)

Do these samples have any known pathogens?_______________________

     List: ____________________________________________________

    391112846.doc Page 1 of 3

Service requested:

    _____ Genotyping: tray of 9 class I SIV alleles

    (Mamu-A*01, A*02, A*08, A*11, B*01, B* 03, B*04, B*08, B*17)

    _____ Genotyping: single allele (circle alleles requested)

    Class I:

    Mamu-A*01 (A1*00101) Mamu-B*06 group Mamu-B*46 group

    Mamu-A*02 (A1*00201) Mamu-B*07 group Mamu-B*48 (B*4801)

    Mamu-A*07 group Mamu-B*08 (B*0801) Mamu-B*49 (B*4901)

    Mamu-A*08 (A1*00801) Mamu-B*17 (B*1701) Mamu-B*52 (B*5201)

    Mamu-A*11 (A1*01101) Mamu-B*22 (B*2201) Mamu-B*55 (B*5501)

    Mamu-B*01 (B*010101) Mamu-B*29012 (B*290102) Mamu-B*5802

    Mamu-B*03 (B*0301) Mamu-B*30 (B*3001) Mamu-B*64 (B*6401)

    Mamu-B*04 (B*0401)

    Class II:

    Mamu-DPB1*06 Mamu- DRB1*0306 group Mamu-DRB*w2101-04/w402

    Mamu-DRB*w201 Mamu- DRB1*0401/06/11 Mamu- DRB1*1003 group


    _____ Sequencing (list alleles) ____________________________________

    List of sample names or ID: (add additional pages if necessary) 1)________________ 13)________________ 25)________________ 2)________________ 14)________________ 26)________________ 3)________________ 15)________________ 27)________________ 4)________________ 16)________________ 28)________________ 5)________________ 17)________________ 29)________________ 6)________________ 18)________________ 30)________________ 7)________________ 19)________________ 31)________________ 8)________________ 20)________________ 32)________________ 9)________________ 21)________________ 33)________________ 10)_______________ 22)________________ 34)________________ 11)_______________ 23)________________ 35)________________ 12)_______________ 24)________________ 36)________________

    391112846.doc Page 2 of 3


    1. Accounts and purchase orders must be set up IN ADVANCE with the University of

    Wisconsin Dept of Pathology and Laboratory Medicine and must be included on the

    Delivery form.

    2. Fill in the Delivery form completely. This will ensure prompt processing of your

    samples and correct reporting of results. Please type sample IDs to ensure proper

    identification of samples.

    3. Include the sample delivery form with your shipment. Please additionally send it by fax

    or e-mail ( when you ship out your samples so that we can prepare

    to receive your samples and track them if they do not arrive when expected. 4. For testing we require (preferably) 2 mL of EDTA anti-coagulated blood. This should be

    sent at 4?C in an insulated shipper with cold packs. If you are sending cells, they must

    666have been live frozen, 2 x 10 nucleated cells (2 x 10/1 ml for BLCL, 2 x 10/200 ul for

    PBMC). Cells must be shipped on dry ice; upon receipt we will freeze them at -80 until

    we extract DNA.

    If necessary we will accept purified DNA, at a minimum of 100uL @ 25ug/mL, shipped

    at room temperature. Note: Our PCR method has been optimized for DNA extracted with

    the Roche MagNA Pure system. We achieve optimal typing results from blood or cells

    extracted on this system and discourage clients from shipping DNA samples extracted by

    other methods.

    5. Ship samples to:

    Gretta Borchardt

    MHC Typing Core

    UW AIDS Vaccine Research Lab

    555 Science Drive

    Madison, WI 53711

    Lab phone: (608) 890-0920

    Fax: (608) 265-8084


    6. An electronic copy of the results will be sent to the primary investigator listed on the

    account via e-mail, unless a paper copy is requested.

    391112846.doc Page 3 of 3

Report this document

For any questions or suggestions please email