Questions 93 – 94: Was hemoglobin electrophoresis performed?
Indicate if hemoglobin electrophoresis studies were performed prior to the start of the preparative regimen / infusion. If hemoglobin electrophoresis studies were performed, report Yes and provide the date of the most recent hemoglobin electrophoresis study performed prior to the start of the preparative regimen / infusion.
If hemoglobin electrophoresis studies were not performed or if no information is available to determine if hemoglobin electrophoresis studies were performed prior to the start of the preparative regimen or infusion, report No or Unknown, respectively and go to question 108.
If RBC transfusion(s) were given within four weeks of the hemoglobin electrophoresis, report Not applicable.
Questions 95 – 107: 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 question 94). If the hemoglobin allele type was identified, 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 in question 105, specify the other hemoglobin allele type, and provide the percentage.
Report No if the specified hemoglobin allele type was not assessed.
Questions 108 – 110: Were red blood cell counts tested?
Red blood cell counts are part of a complete blood count panel. Indicate if red blood cell counts were assessed prior to the start of the preparative regimen / infusion. If red blood cell (RBC) counts were assessed, report Yes, provide the RBC cell count in cells / µL and specify the date the sample was collected for examination. If the RBC count was assessed multiple times prior to the start of the preparative regimen / infusion, report the value and date of the most recent assessment.
If RBC counts were not assessed or if no information is available to determine if RBC counts were assessed, select No or Unknown, respectively and go to question 111.
If the sample collection date is partially known (i.e., the recipient’s RBC 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 111 – 113: Were reticulocyte counts tested?
Indicate if reticulocyte counts were assessed prior to the start of the preparative regimen / infusion. If reticulocyte counts were assessed, report Yes. Provide the reticulocyte cell count in cells / µL and specify date the sample was collected for examination. If the reticulocyte count was assessed multiple times prior to the start of the preparative regimen / infusion, report the value and date of the most recent assessment.
If reticulocyte counts were not measured or if no information is available to determine if reticulocyte counts were assessed, select No or Unknown, respectively.
If the sample collection date is partially known (i.e., the recipient’s RBC 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 114 – 116: Were soluble transferrin receptors (sTfR) tested?
Soluble transferrin receptors (sTfR) are proteins found in the blood and used as a measure of functional iron status. These levels are typically elevated in individuals with an iron deficiency (i.e., iron deficiency anemia). This assessment is a blood test and may be performed at the transplant center or by an outside facility.
Indicate if sTfR was tested prior to the start of the preparative regimen / infusion. If sTfR counts were assessed, report Yes, provide the sTfR value in mg / L, and specify the date the sample was collected for examination. If the sTfR was assessed multiple times prior to the start of the preparative regimen / infusion, report the value and date of the most recent assessment.
If the sTfR was not measured or if no information is available to determine if sTfR was assessed, select No or Unknown, respectively and go to question 117.
If the sample collection date is partially known (i.e., the recipient’s RBC 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 117 – 119: 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 an EPO level was obtained prior to the start of the preparative regimen / infusion. If EPO levels were assessed, report Yes, specify the EPO level in IU / L, and report the date the sample was collected for examination. If the EPO was assessed multiple times prior to the start of the preparative regimen / infusion, report the value and date of the most recent assessment.
If EPO levels were not measured or if no information is available to determine if EPO levels were assessed, select No or Unknown, respectively go to question 120.
If the sample collection date is partially known (i.e., the recipient’s RBC counts were measured in mid-July 2019), use the process described for reporting partial or unknown dates in General Instructions, Guidelines for Completing Forms.
Section Updates:
| Question Number | Date of Change | Add/Remove/Modify | Description | Reasoning (If applicable) |
|---|---|---|---|---|
| . | . | . | . | . |
Need more help with this?
Don’t hesitate to contact us here.