Q17 – 20: Megakaryopoiesis / Platelet Recovery

!The megakaryopoiesis / platelet recovery section can only be completed on the 100 day, 6 month, 1 year, and 2 year follow-up forms. These questions will be skipped for all subsequent reporting periods.

*Combined Follow-Up
In scenarios where a cellular therapy was given after an HCT and this form is now being completed based on the subsequent cellular therapy date, these questions do not apply and are disabled.

The following questions refer to initial platelet recovery following the HCT for which this form is being completed. All dates should reflect no platelet transfusions administered for the previous seven days. Report the date of the first of three-consecutive laboratory (≥ 20 × 10⁹/L and ≥ 50 × 10⁹/L) obtained on different days, as shown in Example 10 below. Note that platelet recovery may take place well after the recipient has returned to the referring physician for care. It is essential that information and laboratory values be obtained from the referring physician.
Transfusions temporarily increase platelet counts. When the data are used for analysis, it is important to be able to distinguish between a recipient whose own body was creating the platelets and a recipient who required transfusions to support the counts.

The following example illustrates the procedure to follow for reporting platelet recovery.

Example 1: Reporting Platelet Recovery

Example 2: Reporting Platelet Recovery (≥ 20 × 10⁹/L and ≥ 50 × 10⁹/L)

Date	Day	Platelet Count
June 13	0	10,000	Date of last platelet transfusion
June 14	1	30,000
June 15	2	25,000
June 16	3	10,000
June 17	4	15,000
June 18	5	19,000
June 19	6	23,000
June 20	7	25,000	1st of 3 consecutive laboratory values ≥ 20 × 109/L (report this date in question 15)
June 21	8	40,000
June 22	9	50,000	1st of 3 consecutive laboratory values ≥ 50 × 109/L (report this date in question 18)
June 23	10	56,000
June 24	11	65,000
June 25	12	72,000

This section relates to initial platelet recovery. All dates should reflect no transfusions in the previous 7 days. To report dates in this section, use the first of 3 consecutive laboratory values obtained on different days.

Question 17: Was an initial platelet count ≥ 20 × 10⁹/L achieved?

Indicate whether or not there was evidence of initial platelet recovery following this HCT.

Check only one response:

• If Yes if platelet count ≥ 20 × 10⁹ / L was achieved and sustained for 3 consecutive laboratory values, obtained on different days without platelet transfusions administered in the previous 7 days
• If No if platelet count was not ≥ 20 × 10⁹ / L or if platelet transfusions were administered in the previous 7 days.
• Check Not applicable, if the recipient’s platelets never dropped below 20 × 10⁹/L at any time post-HCT and a platelet transfusion was never required. If the recipient’s platelet count drops below 20 × 10⁹/L and/or the recipient received a platelet transfusion even once, do not use this option. This option is only applicable in the 100-day reporting period.
• Check Previously reported, if this is the 6 month or annual follow-up, and initial platelet recovery has already been reported on a previous form.

*Not applicable and Previously reported options: When Not applicable is reported for 100-day reporting period, for all future reporting periods, select Previously reported.

Question 18: Date platelets ≥ 20 × 10⁹/L

Enter the first date of three consecutive laboratory values obtained on different days where the platelet count was ≥ 20 × 10⁹/L. Ensure that no platelet transfusions were administered for seven days immediately preceding this date. Include day seven, as shown in Example 1 above, when determining the recovery date.

*Reporting estimated dates: If a recipient is not seen within a month after their last platelet transfusion, an estimated date may be reported. In this case, the date seven days after the last platelet transfusion may be reported (see Example A below). However, if the recipient is seen within a month of the last platelet transfusion, an estimated date should not be reported.

If three laboratory values were not obtained on consecutive days, but a sequential rise of ≥ 20 × 10⁹/L is demonstrated, follow the examples below when determining an estimated date.

Reporting Scenarios:

A. The recipient is being seen in the outpatient clinic and receives a platelet transfusion on January 1. The platelet count is 22 × 10⁹/L on January 2, 24 × 10⁹/L on January 3, and 28 × 10⁹/L on January 4. The recipient does not come into the clinic for evaluation until one month later. The recipient has not received any more platelet transfusions and the platelet count is well above 20 × 10⁹/L. Report January 8 (day seven post-platelet transfusion) for the date of platelet recovery.

B. The recipient is being seen in the outpatient clinic and receives a platelet transfusion on January 1. The platelet count is ≥ 20 × 10⁹/L on January 2, January 3, and January 4. The recipient is then discharged back to their primary care physician. The transplant center receives a follow-up note from the primary care physician that states “recipient recovered their platelets in January of 2011.” Report an estimated date of recovery using the guidelines available in General Instructions, General Guidelines for Completing Forms.

Question 19: Was an initial platelet count ≥ 50 × 10⁹/L achieved?

Indicate whether a platelet count of ≥ 50 × 10⁹/L was achieved following this HCT.

Check only one response:

• If Yes if platelet count ≥ 50 × 10⁹ / L was achieved and sustained for 3 consecutive laboratory values, obtained on different days without platelet transfusions administered in the previous 7 days
• If *No if platelet count was not ≥ 50 × 10⁹ / L or if platelet transfusions were administered in the previous 7 days.
• Check Not applicable if the recipient’s platelets never dropped below 50 × 10⁹/L at any time post-HCT and a platelet transfusion was never required. If the recipient’s platelet count drops below 50 × 10⁹/L and / or the recipient received a platelet transfusion even once, do not use this option. This option is only applicable in the 100-day reporting period.
• Check Previously reported, if a platelet count of ≥ 50 × 10⁹/L was achieved and reported previously.
  

Question 20: Date platelets ≥ 50 × 10⁹/L

Enter the first date of three consecutive laboratory values obtained on different days where the platelet count was ≥ 50 × 10⁹/L. Ensure that no platelet transfusions were administered for seven days immediately preceding this date. Include day seven, as shown in Example 2 above, when determining the recovery date.

If three laboratory values were not obtained on consecutive days, but a sequential rise of ≥ 50 × 10⁹/L is demonstrated, follow the examples included in the instructions for question 15 above.

Section Updates:

Question Number	Date of Change	Add/Remove/Modify	Description	Reasoning (If applicable)
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