Questions 134 – 135: Was hemoglobin electrophoresis performed? (do not include results if an RBC transfusion occurred within 4 weeks of the electrophoresis study)
Indicate if hemoglobin electrophoresis studies were performed since the date of last report. If hemoglobin electrophoresis studies were performed, report Yes and provide the date of the most recent hemoglobin electrophoresis study performed in the current reporting period.
If the exact date is not known report an estimated date and check the Date estimated box. Refer to General Instructions, Guidelines for Completing Forms for information about reporting estimated dates.
If hemoglobin studies were not performed or if no information is available to determine if hemoglobin electrophoresis studies were conducted in the current reporting period, select No or Unknown.
If a hemoglobin electrophoresis study was performed but RBC transfusion(s) were given within four weeks prior to the study, select Not applicable.
Questions 136 – 148: : Specify the hemoglobin allele types based on the reported sample
Specify the hemoglobin allele types identified in the reported hemoglobin electrophoresis study (reported above in Was hemoglobin electrophoresis performed?). If the hemoglobin allele type was assessed, report Yes and specify the percentage. If additional sickle related hemoglobin allele types are identified and not listed as options on the form, report Yes for Other sickle related hemoglobin allele type, specify the other hemoglobin type, and provide the percentage.
Report No if the specified hemoglobin allele type was not assessed.
Questions 149 – 151: Were absolute reticulocyte counts tested?
Indicate if absolute reticulocyte counts were assessed in the current reporting period. If reticulocyte counts were measured, report Yes, provide the absolute reticulocyte cell count, and specify the date the sample was collected for examination. If absolute reticulocyte counts were measured multiple times in the current reporting period, report the most recent results.
If absolute reticulocyte counts were not measured or if no information is available to determine if absolute reticulocyte counts were assessed, select No or Unknown, respectively.
If the sample collection date is partially known (i.e., the recipient’s reticulocyte counts were measured in mid-July 2019), use the process described for reporting partial or unknown dates in General Instructions, Guidelines for Completing Forms.
Questions 152 – 154: Were soluble transferrin receptors (sTfR) tested?
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 was tested since the date of last report. If sTfR counts were assessed in the current reporting period, report Yes, provide the sTfR value in mg / L, and specify the date the sample was collected for. If sTfR was measured multiple times in the current reporting period, report the most recent results.
If sTfR counts were not measured since the date of last report or if no information is available to determine if sTfR counts were measured, select No or Unknown, respectively.
If the sample collection date is partially known (i.e., the recipient’s sTfR counts were measured in mid-July 2019), use the process described for reporting partial or unknown dates in General Instructions, Guidelines for Completing Forms.
Questions 155 – 157: Was an erythropoietin (EPO) level obtained?
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 was tested since the date of last report. If EPO levels were assessed in the current reporting period, report Yes, specify the EPO level in IU / L, and report the date the sample was collected for examination. If EPO was measured multiple dates in the reporting period, report the results of the most recent assessment.
If EPO levels were not measured or if no information is available to determine if EPO levels were assessed since the date of last report, select No or Unknown, respectively.
If the sample collection date is partially known (i.e., the recipients sTfR counts were measured in mid-2019), use the process described for reporting partial or unknown dates in General Instructions, Guidelines for Completing Forms.
Questions 158 – 159: Was a D-dimer level tested?
D-dimer is a byproduct of the blood clotting and breakdown process, serving as a marker of ongoing coagulation and fibrinolysis. The D-Dimer test is a quantitative immunoturbidimetric test – elevated levels may indicate the presence of pulmonary embolism, deep vein thrombosis, arterial thrombosis or DIC.
Indicate if a D-Dimer test was conducted since the date of the last report. If D-dimer test was assessed, report Yes, specify the D-dimer level in ng/mL, ug/mL, or mg/mL. Report the date the test was conducted. If the D-dimer test was taken multiple times prior to the start of the preparative regimen / infusion, report the value and date of the most recent assessment.
If D-dimer tests were not measured or if no information is available to determine if D-dimer tests were conducted, select No or Unknown, respectively.
Section Updates:
| Question Number | Date of Change | Add/Remove/Modify | Description | Reasoning (If applicable) |
|---|---|---|---|---|
| . | . | . | . | . |
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