ID
44071
Description
ODM form derived from 19pp General Info EBMT Aplastic Anemia 06AA please refer to: http://www.ebmt.org/Contents/Data-Management/Registrystructure/MED-ABdatacollectionforms/Pages/MED-AB-data-collection-forms.aspx
Link
Keywords
Versions (5)
- 7/25/16 7/25/16 -
- 8/4/16 8/4/16 -
- 11/28/17 11/28/17 - Julian Varghese
- 3/15/21 3/15/21 - Dr. rer. medic Philipp Neuhaus
- 9/20/21 9/20/21 -
Copyright Holder
EBMT
Uploaded on
September 20, 2021
DOI
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License
Creative Commons BY-NC 3.0
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16760_General Info EBMT Aplastic Anemia
General Info EBMT Aplastic Anemia
- StudyEvent: ODM
Description
GENERAL INFORMATION
Description
Unique Identification Code (UIC)
Data type
text
Alias
- UMLS CUI [1]
- C2348585
Description
Hospital Unique Patient Number or Code
Data type
text
Alias
- UMLS CUI [1]
- C1827636
Description
Initials
Data type
text
Alias
- UMLS CUI [1]
- C2986440
Description
Date of birth
Data type
date
Alias
- UMLS CUI [1]
- C0421451
Description
Sex
Data type
text
Alias
- UMLS CUI [1]
- C0079399
Description
ABO Group
Data type
integer
Alias
- UMLS CUI [1]
- C0000778
Description
Rh factor
Data type
integer
Alias
- UMLS CUI [1]
- C0035403
Description
GENERAL INFORMATION
Description
Date of diagnosis
Data type
date
Alias
- UMLS CUI [1,1]
- C2316983
- UMLS CUI [1,2]
- C1274082
Description
Primary Disease Diagnosis
Data type
text
Alias
- UMLS CUI [1]
- C0277554
Description
BONE MARROW FAILURE SYNDROME (INCLUDING APLASTIC ANAEMIA)
Description
SUBCLASSIFICATION
Description
Acquired
Data type
boolean
Alias
- UMLS CUI [1]
- C0439661
Description
Aplastic anaemia
Data type
integer
Alias
- UMLS CUI [1]
- C0002874
Description
Pure red cell aplasia (non constitutional PRCA)
Data type
boolean
Alias
- UMLS CUI [1]
- C0034902
Description
Paroxysmal nocturnal haemoglobinuria (PNH)
Data type
boolean
Alias
- UMLS CUI [1]
- C0024790
Description
Haemolytic
Data type
boolean
Alias
- UMLS CUI [1]
- C0002878
Description
Aplastic
Data type
boolean
Alias
- UMLS CUI [1]
- C1368107
Description
Thrombotic
Data type
boolean
Alias
- UMLS CUI [1]
- C2674163
Description
Pure white cell aplasia
Data type
boolean
Alias
- UMLS CUI [1]
- C2242624
Description
Amegakaryocytic thrombocytopenia (non constitutional)
Data type
boolean
Alias
- UMLS CUI [1]
- C0398639
Description
Genetic
Data type
boolean
Alias
- UMLS CUI [1]
- C0813145
Description
Fanconi
Data type
boolean
Alias
- UMLS CUI [1]
- C0015625
Description
FANC complementation group
Data type
integer
Alias
- UMLS CUI [1]
- C1563385
Description
Diamond-Blackfan (congenital / constitutional PRCA)
Data type
boolean
Alias
- UMLS CUI [1]
- C1260899
Description
Shwachman-Diamond Syndrome
Data type
boolean
Alias
- UMLS CUI [1]
- C0272170
Description
Dyserythropoietic Anaemia
Data type
boolean
Alias
- UMLS CUI [1]
- C0002876
Description
Dyskeratosis congenita
Data type
boolean
Alias
- UMLS CUI [1]
- C0265965
Description
Amegakaryocytic thrombocytopenia
Data type
boolean
Alias
- UMLS CUI [1]
- C0398639
Description
ETIOLOGY
Data type
integer
Alias
- UMLS CUI [1]
- C1314792
Description
CYTOGENETICS
Description
Chromosome analysis
Data type
text
Alias
- UMLS CUI [1]
- C0200867
Description
CYTOGENETICS If done: Technique used
Data type
integer
Alias
- UMLS CUI [1,1]
- C0010802
- UMLS CUI [1,2]
- C0449851
Description
Number of metaphases with anomalies
Data type
integer
Alias
- UMLS CUI [1,1]
- C1621812
- UMLS CUI [1,2]
- C0449788
Description
number of metaphases examined
Data type
integer
Alias
- UMLS CUI [1,1]
- C0582103
- UMLS CUI [1,2]
- C1621812
Description
trisomy 8
Data type
integer
Alias
- UMLS CUI [1]
- C0432412
Description
trisomy 3
Data type
integer
Alias
- UMLS CUI [1]
- C1519652
Description
Other or associated abnormalities (specify)
Data type
integer
Alias
- UMLS CUI [1]
- C0008625
Description
Chromosomal breakage test
Data type
integer
Alias
- UMLS CUI [1]
- C0398791
Description
HAEMATOLOGICAL VALUES
Description
Haemoglobin
Data type
float
Measurement units
- g/dL
Alias
- UMLS CUI [1]
- C0518015
Description
Platelets
Data type
float
Alias
- UMLS CUI [1]
- C0005821
Description
Neutrophils
Data type
integer
Alias
- UMLS CUI [1]
- C0948762
Description
Reticulocytes
Data type
float
Alias
- UMLS CUI [1]
- C0035286
Description
Ferritin
Data type
float
Alias
- UMLS CUI [1]
- C0015879
Description
Haemoglobin
Data type
integer
Alias
- UMLS CUI [1]
- C0518015
Description
Platelets
Data type
integer
Alias
- UMLS CUI [1]
- C0005821
Description
COMPLICATIONS
Description
PNH TESTS
Description
Date of PNH test
Data type
date
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C2826247
Description
PNH diagnostics by flow cytometry
Data type
integer
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C0016263
Description
Size of the PNH
Data type
integer
Measurement units
- %
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C0456389
Description
Flow cytometry assessment done on
Data type
integer
Alias
- UMLS CUI [1]
- C0016263
Description
(if type of test unknown, write “unknown” here)
Data type
integer
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0024790
- UMLS CUI [1,3]
- C3845569
Description
PNH diagnostics by other test
Data type
integer
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0024790
Description
Clinical manifestations of PNH
Data type
boolean
Alias
- UMLS CUI [1]
- C0024790
Description
FIRST IMMUNOSUPPRESSIVE TREATMENT EPISODE
Description
WAS THE PATIENT TREATED BEFORE THE HSCT PROCEDURE?
Data type
integer
Alias
- UMLS CUI [1]
- C1514463
Description
FIRST TREATMENT EPISODE FOR THIS REGISTRATION
Data type
date
Alias
- UMLS CUI [1,1]
- C3173309
- UMLS CUI [1,2]
- C0392920
Description
SEQUENTIAL NUMBER
Data type
integer
Alias
- UMLS CUI [1]
- C1115395
Description
IF 1ST TREATMENT EPISODE FOR THE PATIENT EVER
Description
NUMBER OF TRANSFUSIONS BEFORE HSCT
Data type
text
Alias
- UMLS CUI [1]
- C0014772
Description
RBC irradiated
Data type
integer
Alias
- UMLS CUI [1]
- C1548980
Description
Platelets
Data type
integer
Alias
- UMLS CUI [1]
- C0005821
Description
Platelets irradiated
Data type
integer
Alias
- UMLS CUI [1]
- C0443117
Description
IF PATIENT HAS BEEN TREATED BEFORE
Description
Haemoglobin
Data type
integer
Alias
- UMLS CUI [1]
- C0518015
Description
Platelets
Data type
float
Measurement units
- 1000/uL
Alias
- UMLS CUI [1]
- C0005821
Description
Platelets
Data type
integer
Alias
- UMLS CUI [1]
- C0005821
Description
Neutrophils
Data type
integer
Alias
- UMLS CUI [1]
- C0948762
Description
Reticulocytes
Data type
float
Alias
- UMLS CUI [1]
- C0035286
Description
Ferritin
Data type
float
Alias
- UMLS CUI [1]
- C0373607
Description
REASON FOR THIS TREATMENT
Data type
integer
Alias
- UMLS CUI [1]
- C1443309
Description
Medication
Data type
integer
Alias
- UMLS CUI [1]
- C0013227
Description
RESPONSE TO THIS IMMUNOSUPPRESSIVE TREATMENT EPISODE
Data type
integer
Alias
- UMLS CUI [1]
- C0521982
Description
Date response evaluated
Data type
date
Alias
- UMLS CUI [1,1]
- C1269701
- UMLS CUI [1,2]
- C1269701
Description
SECONDARY CLONAL COMPLICATIONS
Data type
boolean
Alias
- UMLS CUI [1]
- C2939419
Description
Date of diagnosis of MDS
Data type
date
Alias
- UMLS CUI [1,1]
- C3463824
- UMLS CUI [1,2]
- C2316983
Description
MDS WHO classification
Data type
integer
Alias
- UMLS CUI [1,1]
- C1301142
- UMLS CUI [1,2]
- C3463824
Description
Date of diagnosis of PNH
Data type
date
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C2826247
Description
Size of the PNH clone
Data type
float
Measurement units
- %
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C0456389
Description
Flow cytometry assessment done on
Data type
integer
Alias
- UMLS CUI [1]
- C0016263
Description
Clinical manifestations of PNH
Data type
boolean
Alias
- UMLS CUI [1]
- C0024790
Description
If HSCT registration also, please proceed to “Status before HSCT” on page 6 If only Immunosuppressive treatment continue to follow-up form
Data type
boolean
Alias
- UMLS CUI [1]
- C0279085
Description
ADDITIONAL IMMUNOSUPPRESSIVE TREATMENT EPISODE
Description
Date treatment started
Data type
date
Description
SEQUENTIAL NUMBER OF THIS TREATMENT EPISODE
Data type
text
Description
REASON FOR THIS TREATMENT
Data type
text
Description
REASON FOR THIS TREATMENT
Data type
text
Description
Haemoglobin
Data type
integer
Alias
- UMLS CUI [1]
- C0518015
Description
Platelets
Data type
float
Measurement units
- 1000/uL
Alias
- UMLS CUI [1]
- C0005821
Description
Platelets
Data type
integer
Alias
- UMLS CUI [1]
- C0005821
Description
Neutrophils
Data type
integer
Alias
- UMLS CUI [1]
- C0948762
Description
Reticulocytes
Data type
float
Alias
- UMLS CUI [1]
- C0035286
Description
Ferritin
Data type
float
Alias
- UMLS CUI [1]
- C0373607
Description
REASON FOR THIS TREATMENT
Data type
integer
Alias
- UMLS CUI [1]
- C1443309
Description
Medication
Data type
integer
Alias
- UMLS CUI [1]
- C0013227
Description
RESPONSE TO THIS IMMUNOSUPPRESSIVE TREATMENT EPISODE
Data type
integer
Alias
- UMLS CUI [1]
- C0521982
Description
Date response evaluated
Data type
date
Alias
- UMLS CUI [1,1]
- C1269701
- UMLS CUI [1,2]
- C1269701
Description
SECONDARY CLONAL COMPLICATIONS
Data type
boolean
Alias
- UMLS CUI [1]
- C2939419
Description
Date of diagnosis of MDS
Data type
date
Alias
- UMLS CUI [1,1]
- C3463824
- UMLS CUI [1,2]
- C2316983
Description
MDS WHO classification
Data type
integer
Alias
- UMLS CUI [1,1]
- C1301142
- UMLS CUI [1,2]
- C3463824
Description
Date of diagnosis of PNH
Data type
date
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C2826247
Description
Size of the PNH clone
Data type
float
Measurement units
- %
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C0456389
Description
Flow cytometry assessment done on
Data type
integer
Alias
- UMLS CUI [1]
- C0016263
Description
Clinical manifestations of PNH
Data type
boolean
Alias
- UMLS CUI [1]
- C0024790
Description
If HSCT registration also, please proceed to “Status before HSCT” on page 6 If only Immunosuppressive treatment continue to follow-up form
Data type
boolean
Alias
- UMLS CUI [1]
- C0279085
Description
STATUS AT HSCT
Description
Date of HSCT
Data type
date
Alias
- UMLS CUI [1]
- C2584899
Description
Chromosome analysis
Data type
integer
Alias
- UMLS CUI [1]
- C0200867
Description
Chromosome analysis
Data type
integer
Alias
- UMLS CUI [1,1]
- C0200867
- UMLS CUI [1,2]
- C0200888
Description
Number of metaphases with anomalies
Data type
integer
Alias
- UMLS CUI [1,1]
- C1621812
- UMLS CUI [1,2]
- C0449788
Description
number of metaphases examined
Data type
integer
Alias
- UMLS CUI [1,1]
- C1621812
- UMLS CUI [1,2]
- C0449788
Description
Chromosome analysis
Data type
text
Description
Other or associated abnormalities (specify)
Data type
text
Description
Haemoglobin
Data type
float
Measurement units
- g/dL
Alias
- UMLS CUI [1]
- C0518015
Description
Platelets
Data type
float
Alias
- UMLS CUI [1]
- C0005821
Description
Neutrophils
Data type
integer
Alias
- UMLS CUI [1]
- C0948762
Description
Reticulocytes
Data type
float
Alias
- UMLS CUI [1]
- C0035286
Description
Ferritin
Data type
float
Alias
- UMLS CUI [1]
- C0015879
Description
Haemoglobin
Data type
integer
Alias
- UMLS CUI [1]
- C0518015
Description
Platelets
Data type
integer
Alias
- UMLS CUI [1]
- C0005821
Description
Haemorrhages
Data type
integer
Alias
- UMLS CUI [1]
- C0019080
Description
Resistance to random platelets
Data type
integer
Alias
- UMLS CUI [1]
- C1277097
Description
Systemic infection
Data type
integer
Alias
- UMLS CUI [1]
- C0243026
Description
Date of PNH test
Data type
date
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C2826247
Description
PNH diagnostics by flow cytometry
Data type
integer
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C0016263
Description
Size of the PNH
Data type
integer
Measurement units
- %
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C0456389
Description
Flow cytometry assessment done on
Data type
integer
Alias
- UMLS CUI [1]
- C0016263
Description
(if type of test unknown, write “unknown” here)
Data type
integer
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0024790
- UMLS CUI [1,3]
- C3845569
Description
PNH diagnostics by other test
Data type
integer
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0024790
Description
Clinical manifestations of PNH
Data type
boolean
Alias
- UMLS CUI [1]
- C0024790
Description
NUMBER OF TRANSFUSIONS BEFORE HSCT
Data type
text
Alias
- UMLS CUI [1]
- C0014772
Description
RBC irradiated
Data type
integer
Alias
- UMLS CUI [1]
- C1548980
Description
Platelets
Data type
integer
Alias
- UMLS CUI [1]
- C0005821
Description
Platelets irradiated
Data type
integer
Alias
- UMLS CUI [1]
- C0443117
Description
ADDITIONAL TREATMENT POST-HSCT
Description
BEST DISEASE RESPONSE AT 100 DAYS POST-HSCT
Description
BEST RESPONSE AT 100 DAYS AFTER HSCT
Data type
integer
Alias
- UMLS CUI [1]
- C1704632
Description
BEST RESPONSE AT 100 DAYS AFTER HSCT
Data type
integer
Alias
- UMLS CUI [1,1]
- C1704632
- UMLS CUI [1,2]
- C3845569
Description
Date response evaluated
Data type
date
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C1269701
Description
FORMS TO BE FILLED IN
Similar models
General Info EBMT Aplastic Anemia
- StudyEvent: ODM
C3826859 (UMLS CUI [1,2])
C1274082 (UMLS CUI [1,2])
C0019158 (UMLS CUI-2)
C0449851 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,2])
C1621812 (UMLS CUI [1,2])
C2826247 (UMLS CUI [1,2])
C0016263 (UMLS CUI [1,2])
C0456389 (UMLS CUI [1,2])
C0024790 (UMLS CUI [1,2])
C3845569 (UMLS CUI [1,3])
C0024790 (UMLS CUI [1,2])
C0392920 (UMLS CUI [1,2])
C1269701 (UMLS CUI [1,2])
C2316983 (UMLS CUI [1,2])
C3463824 (UMLS CUI [1,2])
C2826247 (UMLS CUI [1,2])
C0456389 (UMLS CUI [1,2])
C1269701 (UMLS CUI [1,2])
C2316983 (UMLS CUI [1,2])
C3463824 (UMLS CUI [1,2])
C2826247 (UMLS CUI [1,2])
C0456389 (UMLS CUI [1,2])
C0200888 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,2])
C2826247 (UMLS CUI [1,2])
C0016263 (UMLS CUI [1,2])
C0456389 (UMLS CUI [1,2])
C0024790 (UMLS CUI [1,2])
C3845569 (UMLS CUI [1,3])
C0024790 (UMLS CUI [1,2])
C3845569 (UMLS CUI [1,2])
C1269701 (UMLS CUI [1,2])