The Thalassemia Post-Infusion (2158) Form is one of the Comprehensive Report Forms. This form captures thalassemia-specific post-infusion data such as the recipient’s thalassemia diagnosis, donor related information, transfusion, hepatic, cardiac, renal, iron overload assessment prior to the start of the preparative regimen, hematologic labs, organ impairment, and pre-infusion therapy.
This form must be completed for all transplant and gene therapy recipients, randomized to the Comprehensive Report Form (CRF) track whose primary disease is reported as Hemoglobinopathies – Transfusion dependent thalassemia: Transfusion beta dependent thalassemia or Other transfusion dependent thalassemia on the Disease Classification (2402) Form.
Links to Sections of Form:
Q1 – 15: Post-Infusion Disease Testing
Q16 – 17: Transfusion Therapy
Q18 – 29: Treatment
Q30 – 31: Splenic Assessments
Q32 – 55: Hepatic Assessments
Q56 – 68: Cardiac Assessments
Q67 – 73: Renal Assessments
Q74 – 76: Avascular Necrosis
Q77: Other Symptoms
Q78 – 92: Additional Iron Overload Assessments
Q93 – 101: Additional Hematologic Labs
Q102 – 113: Specify Existing Other Organ Impairments
Q114 – 121: Disease Modifying Therapies
Q122: Marrow Evaluation
Manual Updates:
Sections of the Forms Instruction Manual are frequently updated. The most recent updates to the manual can be found below. For additional information, select the manual section and review the updated text.
If you need to reference the historical Manual Change History for this form, please reference the retired manual section on the Retired Forms Manuals webpage.
| Date | Manual Section | Add/Remove/Modify | Description |
|---|---|---|---|
| 7/26/2024 | 2158: Thalassemia Post-Infusion | Add | Version 2 of the 2158: Thalassemia Post-Infusion section of the Forms Instructions Manual released. Version 2 corresponds to revision 2 of the Form 2158. |
Need more help with this?
Don’t hesitate to contact us here.