Q69 – 74: Additional Iron Overload Assessments

*Additional Iron Overload Assessments
Report the additional iron overload assessments prior to the start of the preparative regimen / infusion using results measured within 60 days prior to the start of the preparative regimen. If the assessment was performed multiple times, report the closest value to the start of the preparative regimen.

Questions 69 – 72: Serum ferritin

Ferritin is a protein that stores, transports, and release iron. Iron is toxic to cells, so it is stored within the ferritin protein for use. Ferritin that is too low might be indicative of iron deficiency related anemia. Ferritin that is too high might be indicative of iron overload.

Indicate if the serum ferritin is known within 60 days prior to the start of the preparative regimen / infusion. If Known, specify the value in ng / mL (µg/L), sample collection date, and the upper limit of normal. If the exact date is not known report an estimated date and check the Date estimated box. Refer to General Instructions, General Guidelines for Completing Forms for information about reporting estimated dates.

If the serum ferritin was assessed multiple times, report the most recent assessment prior to the start of the preparative regimen.

Questions 73 – 74: Soluble transferrin receptors (sTfR)

Soluble transferring receptors (sTfR) are proteins found in the blood and are used as a measure of functional iron status. These levels are typically elevated in individuals with an iron deficiency (i.e., iron deficiency anemia).

Indicate if sTfR is known within 60 days prior to the start of the preparative regimen / infusion. If Known, report the sTfR value in mg / L. If the sTfR was assessed multiple times, report the most recent results prior to the start of the preparative regimen / infusion.

Questions 75 – 76: Erythropoietin (EPO)

Erythropoietin (EPO) is a hormone predominantly produced in the kidneys which plays a critical role in the production of red blood cells.

Indicate if EPO is known within 60 days prior to the start of the preparative regimen / infusion. If Known, specify the EPO level in IU / L. If EPO was measured multiple times, report the most recent results prior to the start of the preparative regimen / infusion.

Questions 77 – 78: Serum hepcidin

Hepcidin is a peptide hormone produced in the liver which regulates iron delivered to blood plasma.

Indicate if serum hepcidin is known within 60 days prior to the start of the preparative regimen / infusion. If Known, specify the serum hepcidin level in ng / mL (µg / L). If serum hepcidin was measured multiple times, report the most recent results prior to the start of the preparative regimen / infusion.

Section Updates:

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