Q90 – 104: Vascular Impairment / Disorder

The purpose of this section is to capture any impairments or disorders present during the current reporting period, regardless of treatment or intervention, unless otherwise specified. Review each impairment or disorder description to determine whether treatment or intervention is required for reporting the condition.

Question 90: Did the recipient experience a deep vein thrombosis (DVT)? (excluding pulmonary embolism)

A deep vein thrombosis (DVT) is the development of a blood clot in a deep vein.

Indicate if the recipient experienced a deep vein thrombosis, excluding a pulmonary embolism, in the current reporting period. The intent of this question is to capture each instance of deep vein thrombosis occurring in the reporting period.

If the recipient did not have a deep vein thrombosis in the current reporting period or is unknown, select No.

*Reporting Multiple Deep Vein Thromboses
Complete Date of DVT onset through Was the DVT catheter related questions to report multiple deep vein thromboses by adding an additional instance in the FormsNet3^SM application.

Question 91: Date of DVT onset

Specify the date of the deep vein thrombosis.

For more information regarding reporting partial or unknown dates, see General Instructions, General Guidelines for Completing Forms.

Question 92: Was the DVT catheter related?

Specify if the deep vein thrombosis was catheter related. This information is typically documented within the results of the ultrasound.

Question 93: Did the recipient experience a pulmonary embolism (PE)?

A pulmonary embolism (PE) is the development of a blood clot I the arteries of the lung.

Indicate if the recipient experienced a pulmonary embolism in the current reporting period. The intent of this question is to capture each instance of a pulmonary embolism occurring in the reporting period.

If the recipient did not have a pulmonary embolism in the current reporting period or is unknown, select No.

*Reporting Multiple Pulmonary Embolisms
Complete Date of PE onset through Was the PE catheter related questions to report multiple pulmonary embolisms by adding an additional instance in the FormsNet3^SM application.

Question 94: Date of PE onset

Specify the date of the pulmonary embolism.

For more information regarding reporting partial or unknown dates, see General Instructions, General Guidelines for Completing Forms.

Question 95: Was the PE catheter related?

Specify if the pulmonary embolism was catheter related. This information is typically documented within the results of the ultrasound.

*Reporting Multiple Hyperlipidemias
Complete Was hyperlipidemia present through Date therapy for hyperlipidemia stopped questions to report multiple hyperlipidemias by adding an additional instance in the FormsNet3^SM application.

Questions 96 – 97: Was hyperlipidemia present? (high total cholesterol, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol, and / or high triglyceride levels)

Hyperlipidemia is high levels of lipids (fat particles) in the blood and is typically diagnosed by a lipid panel.

Indicate if hyperlipidemia was present in the current reporting period.

Report Developed in the following scenarios:

• This is the first time the recipient was diagnosed with hyperlipidemia in the reporting period.
• Hyperlipidemia resolved in a prior reporting period and then recurred in the current reporting period.

Report Persisted in the following scenarios:

• Hyperlipidemia was diagnosed pre-infusion and persisted into the Day 100 reporting period.
• Hyperlipidemia was diagnosed (or persisted) in the prior reporting period and persisted into the current reporting period.

If hyperlipidemia was not present in the current reporting period or unknown if present, select Not present.

Questions 97 – 101: Specify which lipids were assessed (check all that apply)

Indicate which lipids were assessed and specify the results and units of measurement using the guidelines below. Select all that apply.

• If hyperlipidemia Developed (first diagnosis or recurrence), report the labs from the initial diagnosis / recurrence.
• If hyperlipidemia Persisted, report the most recent lab values in the current reporting period.

Question 102: Was therapy received to treat hyperlipidemia

Specify if therapy to treat hyperlipidemia was received in the current reporting period.

If therapy was not received or is unknown, select No.

Questions 103 – 104: Was the recipient still receiving therapy for hyperlipidemia at the date of contact for this reporting period?

Specify if the recipient was still receiving hyperlipidemia treatment at the contact date for the current reporting period.

If the recipient was no longer receiving treatment at the contact date, select No and specify the therapy completion date.

For more information regarding reporting partial or unknown dates, see General Instructions, General Guidelines for Completing Forms.

Section Updates:

Question Number	Date of Change	Add/Remove/Modify	Description	Reasoning (If applicable)
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CIBMTR® (Center for International Blood and Marrow Transplant Research) is a research collaboration between the Medical College of Wisconsin and NMDP.