PATIENT
Unique Identification Code (UIC)
text
Hospital Unique Patient Number or Code
text
Initials
text
Date of birth
date
Sex
text
ABO Group
integer
Rh factor
integer
DISEASE
Date of Diagnosis
date
Check the disease for which this transplant was performed
integer
Primary Disease Diagnosis
text
SPECIFICATIONS OF THE DISEASE
Previous HSCT registration
integer
CLASSIFICATION and SPECIFICATIONS OF THE DISEASE
integer
SCID (Severe Combined Immune Deficiency)
integer
SCID (Severe Combined Immune Deficiency)
integer
CID (Combined Immune Deficiency)
integer
CID (Combined Immune Deficiency)
integer
Other primary immune deficiencies
integer
Inherited disorders of metabolism
integer
Other inherited disorders
integer
Stored material
integer
Stored material
integer
Tick only one
text
CYTOGENETICS
integer
Complete only for SCID patients
integer
(in clear text)
integer
(in clear text), For Alpha c, use Allele 1 only
text
STATUS OF DISEASE AT HSCT
Date of HSCT
date
HAEMATOLOGICAL VALUES
integer
T-CELL FUNCTION
integer
T-CELL FUNCTION
integer
T-CELL FUNCTION
integer
IMMUNOGLOBULINS (B-CELL FUNCTION)
integer
Antibody response
integer
CLINICAL STATUS GENERAL MANIFESTATIONS
integer
CLINICAL STATUS GENERAL MANIFESTATIONS
integer
CLINICAL STATUS GENERAL MANIFESTATIONS
integer
CLINICAL STATUS GENERAL MANIFESTATIONS
integer
CLINICAL STATUS GENERAL MANIFESTATIONS
integer
Infections
integer
Septicemia
integer
Septicemia
integer
Pulmonary
integer
Meningeal
integer
Skin infection
integer
Skin infection
text
Liver
integer
Liver
integer
Bone or joints
integer
Bone or joints
integer
Gut infection
integer
Gut infection
text
Undetermined
integer
Undetermined
text
Other infections
integer
Other infections
integer
GVHD STATUS PRIOR TO HSCT
integer
Manifestation
integer
Lymphadenopathy acute GVH disease
text
Cause of the GvHD
integer
Maternal engraftment
float
Test used
integer
Treatment
integer
NUMBER OF TRANSFUSIONS BEFORE HSCT
integer
Platelets
integer
ADDITIONAL TREATMENT POST-HSCT
BEST DISEASE RESPONSE AT 100 DAYS POST-HSCT
DISEASE STATUS AT 100 DAYS AFTER HSCT
integer
Date of assessment
date
RECONSTITUTION CHIMAERISM (ENGRAFTMENT)
integer
T-cell Full
date
RECONSTITUTION CHIMAERISM (ENGRAFTMENT)
integer
RECONSTITUTION CHIMAERISM (ENGRAFTMENT)
integer
RECONSTITUTION CHIMAERISM (ENGRAFTMENT)
integer
RECONSTITUTION CHIMAERISM (ENGRAFTMENT)
integer
RECONSTITUTION CHIMAERISM (ENGRAFTMENT)
integer
RECONSTITUTION CHIMAERISM (ENGRAFTMENT)
integer
HAEMATOLOGICAL RECONSTITUTION
float
HAEMATOLOGICAL RECONSTITUTION
float
HAEMATOLOGICAL RECONSTITUTION
float
HAEMATOLOGICAL RECONSTITUTION
float
HAEMATOLOGICAL RECONSTITUTION
float
IMMUNOLOGICAL RECONSTITUTION T-cells
integer
IMMUNOLOGICAL RECONSTITUTION T-cells
integer
B-cells
integer
Antibody production after vaccination
integer
ON-GOING TREATMENT FOR RECONSTITUTION AT 100 DAYS
integer
ON-GOING TREATMENT FOR RECONSTITUTION AT 100 DAYS
text
Patient still receiving IV Immunoglobulins
integer
Growth factors (cytokines) administered to the patient?
integer
FORMS TO BE FILLED IN