Question 91: Specify organ impairments or disorders developed since the last reporting period
Indicate if the recipient developed any of the co-existing disease or organ impairments listed below during the current reporting period. Select all that apply.
- Amenorrhea: Absence of menstruation
- Cardiomyopathy: A disease of the heart muscle that makes it more difficult for the heart to pump blood to the rest of the body
- Cholelithiasis: Presence of one or more gallstones in the gallbladder
- Growth hormone deficiency / short stature: A condition in which the body does not produce enough growth hormone / a reduced overall rate of growth.
- Hypersplenism: Overactive spleen. Diagnosis is typically based on a physician’s exam (checking for splenomegaly), a CBC to assess the concentration of red and white blood cells, and / or an ultrasound, measuring the size of the spleen.
- Hypothyroidism requiring replacement therapy: Decreased activity of the thyroid gland. Diagnosis of hypothyroidism includes high levels of thyroid-stimulating hormone (TSH). Symptoms of hypothyroidism include fatigue, depression, weakness, weight gain, musculoskeletal pain, decreased taste, hoarseness, and / or puffy face.
- Osteopathies (porosis, penia): Includes osteoporosis or osteopenia. Osteopathies should be reported if osteopenia or osteoporosis is documented within the medical record by the physician or based on the Z or T-score. Osteopenia is defined as a Z or T-score between -1.0 and -2.0 by a DEXA or quantitative CT scan. Osteoporosis is defined as a Z or T-score less than -2.0 by a DEXA or quantitative CT scan.
- Pulmonary hypertension: Refers to elevated pulmonary arterial pressure and is diagnosed either by an echocardiogram or right heart catheterization.
- Retinal changes: Changes include but are not limited to macular degeneration, floaters, diabetic eye disease, retinal detachment, and retinitis pigmentosa.
- Thrombosis: Blood clot within the vein or artery.
The co-existing disease or organ impairment should be reported in any of the following scenarios:
- The co-existing disease or organ impairment was first diagnosed in the current reporting period.
- The co-existing disease or organ impairment was diagnosed prior to infusion or in a prior reporting period and persisted into the current reporting period.
- The co-existing disease or organ impairment was diagnosed prior to infusion or in a prior reporting period, resolved, and then recurred in the current reporting period.
Report None and continue with question 103 in any of the following scenarios:
- No co-existing disease or organ impairments developed during the current reporting period.
- A co-existing disease or organ impairment developed prior to start of the preparative regimen / infusion or in a prior reporting period but resolved before the current reporting period.
Question 92: Was this organ impairment previously reported?
Specify if the co-existing disease or organ impairment diagnosis date was previously reported. If Yes, continue with question 94.
If the co-existing disease or organ impairment was diagnosed prior to infusion or in a prior reporting period, resolved, and then recurred in the current reporting period, report No.
Question 93: Date of diagnosis
Report the diagnosis date of the co-existing disease or organ impairment.
If the co-existing disease or organ impairment was diagnosed prior to infusion or in a prior reporting period, resolved, and then recurred in the current reporting period, report the diagnosis date as the date of the most recent episode.
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.
Question 94: Method used to assess osteopathies (report the most recent Z-score available; Z-score are used in patients younger than or equal to 20 and T-scores in patients older than 20) (check all that apply)
Specify the method use to assess osteopathies during the current reporting period. Select all that apply.
If the osteopathy was not assessed during the current reporting period or is not known if assessed, select Unknown and continue with question 103.
Questions 95 – 96: DEXA scan vertebral
Indicate if the vertebral Z-score by DEXA is known. If Known, report the Z or T-score. Select Negative value if the Z or T-score is a negative (i.e., Z-score is -1.0).
If multiple DEXA scans were performed during the current reporting period, report the most recent vertebral Z or T-score.
Questions 97 – 98: DEXA scan hip
Indicate if the hip Z-score by DEXA is known. If Known, report the Z or T-score. Select Negative value if the Z or T-score is a negative (i.e., Z-score is -1.0).
If multiple DEXA scans were performed during the current reporting period, report the most recent hip Z or T-score.
Questions 99 – 100: Quantitative CT vertebral
Indicate if the vertebral Z-score by quantitative CT is known. If Known, report the Z or T-score. Select Negative value if the Z or T-score is a negative (i.e., Z-score is -1.0).
If multiple quantitative CT scans were performed during the current reporting period, report the most recent vertebral Z or T-score.
Questions 101 – 102: Quantitative CT hip
Indicate if the hip Z-score by quantitative CT is known. If Known, report the Z or T-score. Select Negative value if the Z or T-score is a negative (i.e., Z-score is -1.0).
If multiple quantitative CT scans were performed during the current reporting period, report the most recent hip Z or T-score.
Section Updates:
| Question Number | Date of Change | Add/Remove/Modify | Description | Reasoning (If applicable) |
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