EMDIS message: PAT_UPD

Description Patient registration and update

The PAT_UPD message is used for two things: registering a new patient at a remote EMDIS hub and for updating the data of already registered patients. The search status cannot be changed with the PAT_UPD message, this has to be done with the PAT_STAT message.

EMDIS Fields

Field description (WMDA dictionary field) EMDIS field code Required Field Type
Sending EMDIS registry (REG_SND) REG_SND Optional N4
Receiving EMDIS registry (REG_RCV) REG_RCV Optional N4
Patient identification (Patient Identification) P_ID Required A17
Physical location of the patient (Patient location identifier) PAT_POOL Optional A2
Patient first name (First name) P_FNAME Required A30
Patient last name (Last name) P_LNAME Required A30
Patient date of birth (Date of birth) P_BIRTH_DATE Required D8
Patient diagnosis (Patient Diagnosis) P_DIAG Required A3
Additional explanatory text describing the diagnosis of the patient for P_DIAG codes OL, OM and OND (Diagnosis details) P_DIAG_TEXT Optional A50
Date of patient diagnosis (Patient Diagnosis date) P_DIAG_DATE Optional D8
Patient disease phase (Disease stage) P_DIS_PHA Optional A2
Patient sex (Sex) P_SEX Required A1
Patient blood group and rhesus (Blood Group (ABO)) P_ABO Optional A3
Patient ethnic group (Ethnicity) P_ETHN Optional A4
Patient weight (Weight) P_WEIGHT Optional N3
Patient CMV status (CMV antibodies test result) P_CMV Optional A1
Grafting physician identification (Transplant physician) P_GRAF_ID Optional A10
Major version of the HLA Nomenclature in use[1] (HLA Nomenclature Version) HLA_NOM_VER Required A7
Patient HLA-A, 1st antigen (HLA-A (serological)) P_A1 Optional A5
Patient HLA-A, 2nd antigen (HLA-A (serological)) P_A2 Optional A5
Patient HLA-B, 1st antigen (HLA-B (serological)) P_B1 Optional A5
Patient HLA-B, 2nd antigen (HLA-B (serological)) P_B2 Optional A5
Patient HLA-C, 1st antigen (HLA-C (serological)) P_C1 Optional A5
Patient HLA-C, 2nd antigen (HLA-C (serological)) P_C2 Optional A5
Patient DNA-A, 1st allele (HLA-A (molecular)) P_DNA_A1 Optional A20
Patient DNA-A, 2nd allele (HLA-A (molecular)) P_DNA_A2 Optional A20
Patient DNA-B, 1st allele (HLA-B (molecular)) P_DNA_B1 Optional A20
Patient DNA-B, 2nd allele (HLA-B (molecular)) P_DNA_B2 Optional A20
Patient DNA-C, 1st allele (HLA-C (molecular)) P_DNA_C1 Optional A20
Patient DNA-C, 2nd allele (HLA-C (molecular)) P_DNA_C2 Optional A20
Patient HLA-DR, 1st antigen (HLA-DRB1 (serological)) P_DR1 Optional A5
Patient HLA-DR, 2nd antigen (HLA-DRB1 (serological)) P_DR2 Optional A5
Patient HLA-DQ, 1st antigen (HLA-DQB1 (serological)) P_DQ1 Optional A5
Patient HLA-DQ, 2nd antigen (HLA-DQB1 (serological)) P_DQ2 Optional A5
Patient DNA-DRB1, 1st allele (HLA-DRB1 (molecular)) P_DRB11 Optional A20
Patient DNA-DRB1, 2nd allele (HLA-DRB1 (molecular)) P_DRB12 Optional A20
Patient DNA-DRB3, 1st allele (HLA-DRB3 (molecular)) P_DRB31 Optional A20
Patient DNA-DRB3, 2nd allele (HLA-DRB3 (molecular)) P_DRB32 Optional A20
Patient DNA-DRB4, 1st allele (HLA-DRB4 (molecular)) P_DRB41 Optional A20
Patient DNA-DRB4, 2nd allele (HLA-DRB4 (molecular)) P_DRB42 Optional A20
Patient DNA-DRB5, 1st allele (HLA-DRB5 (molecular)) P_DRB51 Optional A20
Patient DNA-DRB5, 2nd allele (HLA-DRB5 (molecular)) P_DRB52 Optional A20
Patient DNA-DQA1, 1st allele (HLA-DQA1 (molecular)) P_DQA11 Optional A20
Patient DNA-DQA1, 2nd allele (HLA-DQA1 (molecular)) P_DQA12 Optional A20
Patient DNA-DQB1, 1st allele (HLA-DQB1 (molecular)) P_DQB11 Optional A20
Patient DNA-DQB1, 2nd allele (HLA-DQB1 (molecular)) P_DQB12 Optional A20
Patient DNA-DPA1, 1st allele (HLA-DPA1 (molecular)) P_DPA11 Optional A20
Patient DNA-DPA1, 2nd allele (HLA-DPA1 (molecular)) P_DPA12 Optional A20
Patient DNA-DPB1, 1st allele (HLA-DPB1 (molecular)) P_DPB11 Optional A20
Patient DNA-DPB1, 2nd allele (HLA-DPB1 (molecular)) P_DPB12 Optional A20
Matching preference for HLA-A, and -B typed adult donors (Patient matching preferences (AB)) P_MATCH_AB Optional A30
Matching preference for HLA-A, -B and -DR typed adult donors (Patient matching preferences (ABDR)) P_MATCH_DR Optional A30
Matching preference for cord blood units (Patient matching preferences (CBU)) P_MATCH_CB Optional A30
Maximum number of HLA-A, and -B typed donors (Maximum requested donors (AB)) P_MAX_DON_AB Optional N4
Maximum number of HLA-A, -B and -DR typed donors (Maximum requested donors (ABDR)) P_MAX_DON_DR Optional N4
Maximum number of cord blood units (Maximum request CBUs) P_MAX_DON_CB Optional N4

The first PAT_UPD is used as registration for the patient. After the registration, the status of the patient is PRE for ”preliminary search”. With this status a match list, a phenotype list and a match summary are sent once. No further actions are taken in this status. After the status is set to active by a PAT_STAT message, search runs are repeated on a regular basis (see EMDIS Repeat Search Program).

The only way to change the patient status is a PAT_STAT message.

The default for PAT_UPD.P_MAX_DON_* is zero. Three zeroes mean no (repeat) search is performed for that patient i.e. no (new or updated) donors are sent. However, it may depend on the local matching implementation, whether updates of previously reported donors are sent or not (see EMDIS Repeat Search Program).

Although all HLA fields of the PAT_UPD message are defined as optional at a minimum antigen and/or allele values must be provided for the loci A, B and DRB1.

Patient records containing a birthdate up to 300 days in the future in the field P_BIRTH_DATE should be accepted and processed normally. A WARNING may be issued.

The P_DIAG_TEXT is required if the P_DIAG is OL, OM or OND. However, it’s up to the receiving hub to decide how to react if P_DIAG in [OL, OM, OND] and P_DIAG_TEXT is missing. Options are: accept silently, accept with WARNING, reject with MSG_DEN.

If patient data relevant for matching is updated so that a new match run at the remote hub would yield more or other donors for that patient search, this match run has to be performed as if the patient was registered for the first time. The new search should be run as soon as possible (immediately would be ideal) and the remote hub has to send back DONOR_LIST, PHEN_LIST and MATCH_SUM. The patient data relevant for matching are typically HLA loci considered by the matching algorithm of the remote hub, the matching preferences (P_MATCH_AB, P_MATCH_DR and P_MATCH_CB) and the maximum number of donors requested (P_MAX_DON_AB, P_MAX_DON_DR AND P_MAX_DON_CB). For the P_MAX_DON_* fields, a re-run of the search might not be necessary if the previous search run has already identified the requested number of donors.

The remote hub should only provide the number and type of donors that are asked for in the PAT_UPD.P_MAX_DON_* fields. If e.g. up to 40 potentially matching ABDR donors are requested and there are only 30 potentially matching ABDR donors (according to the matching preferences of the patient) in the file, the missing 10 donors must neither be filled with mismatched ABDR nor with AB typed donors. Only the 30 potentially matching ABDR donors have to be sent to the requesting hub.