Patient
Unique Identification Code
integer
Patient Number
integer
Initials
integer
Date of birth
date
Patient Gender
integer
ABO Group
integer
Rh factor
integer
DISEASE
Date of diagnosis
date
Check the disease for which this transplant was performed (if other diagnosis, specify)
integer
Disease Diagnosis
integer
Typ of Thalassemia
integer
Primary Disease Diagnosis
text
if use Compound Heterozygous States
integer
Molecular marker test
integer
PRE-HSCT MAIN CLINICAL FEATURES
integer
Splenomegaly
integer
if use present: Spleen size
integer
Hepatomegaly
integer
if use Present: Liver size
integer
Diabetes
integer
if use yes
integer
CLINICAL FEATURES AND COMPLICATIONS
Gonadal dysfunction
integer
Substitutional hormonal therapy
integer
Growth impairment
integer
Red blood cell immunization
integer
Sickle nephropathy
integer
Central nervous system haemorrhage
integer
Recurrent acute chest syndrome
integer
Impaired neuropsychologic function and abnormal Magnetic Resonance Imaging scan
integer
Bilateral proliferative retinopathy and visual impairment
integer
Osteonecrosis
integer
CLINICAL ABNORMALITIES INDICATING THE SEVERITY OF THE PRIMARY DISEASE
integer
MAJOR DISEASES NOT RELATED TO THE TREATMENT OF HEMOGLOBINOPATHY
integer
CHELATION TREATMENT PRE-HSCT
integer
Start CHELATION TREATMENT PRE-HSCT
date
STATUS OF DISEASE AT HSCT
Date of HSCT
date
Splenectomy
text
Splenectomy
date
RBC Transfusions
integer
if RBC Transfusions: Age at transfusion (months)
integer
Total number of RBC units transfused
integer
Enzymes
LDH
float
LDH
float
LDH Times Upper Limit
float
LDH not evaluated
integer
AST (SGOT)
integer
ALT (SGPT)
integer
Gamma GT
integer
Albumin
integer
Bilirubin
integer
Ferritin
integer
Transferrin
integer
Unbounded Transferrin
integer
LIVER FUNCTION
Evidence of hepatitis or other liver disease
integer
Types of Hepatitis
integer
Liver biopsy
integer
RESULTS OF LIVER BIOPSY
Hepatitis
integer
Siderosis
integer
Fibrosis
integer
if Fibrosis Present
integer
CARDIAC FUNCTION
cardiac insufficiency
integer
if History of cardiac insufficiency: Type of therapy
integer
LVEF
integer
ORGAN INVOLVEMENT
integer
CLASS
integer
ADDITIONAL TREATMENT POST-HSCT
FORMS TO BE FILLED IN