ID
42041
Beskrivning
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
Länk
Nyckelord
Versioner (5)
- 2016-07-25 2016-07-25 -
- 2016-08-04 2016-08-04 -
- 2017-11-28 2017-11-28 - Julian Varghese
- 2021-03-15 2021-03-15 - Dr. rer. medic Philipp Neuhaus
- 2021-09-20 2021-09-20 -
Rättsinnehavare
EBMT
Uppladdad den
15 mars 2021
DOI
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Licens
Creative Commons BY-NC 3.0
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16760_General Info EBMT Aplastic Anemia
General Info EBMT Aplastic Anemia
- StudyEvent: ODM
Beskrivning
GENERAL INFORMATION
Beskrivning
Unique Identification Code (UIC)
Datatyp
text
Alias
- UMLS CUI [1]
- C2348585
Beskrivning
Hospital Unique Patient Number or Code
Datatyp
text
Alias
- UMLS CUI [1]
- C1827636
Beskrivning
Initials
Datatyp
text
Alias
- UMLS CUI [1]
- C2986440
Beskrivning
Date of birth
Datatyp
date
Alias
- UMLS CUI [1]
- C0421451
Beskrivning
Sex
Datatyp
text
Alias
- UMLS CUI [1]
- C0079399
Beskrivning
ABO Group
Datatyp
integer
Alias
- UMLS CUI [1]
- C0000778
Beskrivning
Rh factor
Datatyp
integer
Alias
- UMLS CUI [1]
- C0035403
Beskrivning
GENERAL INFORMATION
Beskrivning
Date of diagnosis
Datatyp
date
Alias
- UMLS CUI [1,1]
- C2316983
- UMLS CUI [1,2]
- C1274082
Beskrivning
Primary Disease Diagnosis
Datatyp
text
Alias
- UMLS CUI [1]
- C0277554
Beskrivning
BONE MARROW FAILURE SYNDROME (INCLUDING APLASTIC ANAEMIA)
Beskrivning
SUBCLASSIFICATION
Beskrivning
Acquired
Datatyp
boolean
Alias
- UMLS CUI [1]
- C0439661
Beskrivning
Aplastic anaemia
Datatyp
integer
Alias
- UMLS CUI [1]
- C0002874
Beskrivning
Pure red cell aplasia (non constitutional PRCA)
Datatyp
boolean
Alias
- UMLS CUI [1]
- C0034902
Beskrivning
Paroxysmal nocturnal haemoglobinuria (PNH)
Datatyp
boolean
Alias
- UMLS CUI [1]
- C0024790
Beskrivning
Haemolytic
Datatyp
boolean
Alias
- UMLS CUI [1]
- C0002878
Beskrivning
Aplastic
Datatyp
boolean
Alias
- UMLS CUI [1]
- C1368107
Beskrivning
Thrombotic
Datatyp
boolean
Alias
- UMLS CUI [1]
- C2674163
Beskrivning
Pure white cell aplasia
Datatyp
boolean
Alias
- UMLS CUI [1]
- C2242624
Beskrivning
Amegakaryocytic thrombocytopenia (non constitutional)
Datatyp
boolean
Alias
- UMLS CUI [1]
- C0398639
Beskrivning
Genetic
Datatyp
boolean
Alias
- UMLS CUI [1]
- C0813145
Beskrivning
Fanconi
Datatyp
boolean
Alias
- UMLS CUI [1]
- C0015625
Beskrivning
FANC complementation group
Datatyp
integer
Alias
- UMLS CUI [1]
- C1563385
Beskrivning
Diamond-Blackfan (congenital / constitutional PRCA)
Datatyp
boolean
Alias
- UMLS CUI [1]
- C1260899
Beskrivning
Shwachman-Diamond Syndrome
Datatyp
boolean
Alias
- UMLS CUI [1]
- C0272170
Beskrivning
Dyserythropoietic Anaemia
Datatyp
boolean
Alias
- UMLS CUI [1]
- C0002876
Beskrivning
Dyskeratosis congenita
Datatyp
boolean
Alias
- UMLS CUI [1]
- C0265965
Beskrivning
Amegakaryocytic thrombocytopenia
Datatyp
boolean
Alias
- UMLS CUI [1]
- C0398639
Beskrivning
ETIOLOGY
Datatyp
integer
Alias
- UMLS CUI [1]
- C1314792
Beskrivning
CYTOGENETICS
Beskrivning
Chromosome analysis
Datatyp
text
Alias
- UMLS CUI [1]
- C0200867
Beskrivning
CYTOGENETICS If done: Technique used
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C0010802
- UMLS CUI [1,2]
- C0449851
Beskrivning
Number of metaphases with anomalies
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C1621812
- UMLS CUI [1,2]
- C0449788
Beskrivning
number of metaphases examined
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C0582103
- UMLS CUI [1,2]
- C1621812
Beskrivning
trisomy 8
Datatyp
integer
Alias
- UMLS CUI [1]
- C0432412
Beskrivning
trisomy 3
Datatyp
integer
Alias
- UMLS CUI [1]
- C1519652
Beskrivning
Other or associated abnormalities (specify)
Datatyp
integer
Alias
- UMLS CUI [1]
- C0008625
Beskrivning
Chromosomal breakage test
Datatyp
integer
Alias
- UMLS CUI [1]
- C0398791
Beskrivning
HAEMATOLOGICAL VALUES
Beskrivning
Haemoglobin
Datatyp
float
Måttenheter
- g/dL
Alias
- UMLS CUI [1]
- C0518015
Beskrivning
Platelets
Datatyp
float
Alias
- UMLS CUI [1]
- C0005821
Beskrivning
Neutrophils
Datatyp
integer
Alias
- UMLS CUI [1]
- C0948762
Beskrivning
Reticulocytes
Datatyp
float
Alias
- UMLS CUI [1]
- C0035286
Beskrivning
Ferritin
Datatyp
float
Alias
- UMLS CUI [1]
- C0015879
Beskrivning
Haemoglobin
Datatyp
integer
Alias
- UMLS CUI [1]
- C0518015
Beskrivning
Platelets
Datatyp
integer
Alias
- UMLS CUI [1]
- C0005821
Beskrivning
COMPLICATIONS
Beskrivning
PNH TESTS
Beskrivning
Date of PNH test
Datatyp
date
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C2826247
Beskrivning
PNH diagnostics by flow cytometry
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C0016263
Beskrivning
Size of the PNH
Datatyp
integer
Måttenheter
- %
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C0456389
Beskrivning
Flow cytometry assessment done on
Datatyp
integer
Alias
- UMLS CUI [1]
- C0016263
Beskrivning
(if type of test unknown, write “unknown” here)
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0024790
- UMLS CUI [1,3]
- C3845569
Beskrivning
PNH diagnostics by other test
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0024790
Beskrivning
Clinical manifestations of PNH
Datatyp
boolean
Alias
- UMLS CUI [1]
- C0024790
Beskrivning
FIRST IMMUNOSUPPRESSIVE TREATMENT EPISODE
Beskrivning
WAS THE PATIENT TREATED BEFORE THE HSCT PROCEDURE?
Datatyp
integer
Alias
- UMLS CUI [1]
- C1514463
Beskrivning
FIRST TREATMENT EPISODE FOR THIS REGISTRATION
Datatyp
date
Alias
- UMLS CUI [1,1]
- C3173309
- UMLS CUI [1,2]
- C0392920
Beskrivning
SEQUENTIAL NUMBER
Datatyp
integer
Alias
- UMLS CUI [1]
- C1115395
Beskrivning
IF 1ST TREATMENT EPISODE FOR THE PATIENT EVER
Beskrivning
NUMBER OF TRANSFUSIONS BEFORE HSCT
Datatyp
text
Alias
- UMLS CUI [1]
- C0014772
Beskrivning
RBC irradiated
Datatyp
integer
Alias
- UMLS CUI [1]
- C1548980
Beskrivning
Platelets
Datatyp
integer
Alias
- UMLS CUI [1]
- C0005821
Beskrivning
Platelets irradiated
Datatyp
integer
Alias
- UMLS CUI [1]
- C0443117
Beskrivning
IF PATIENT HAS BEEN TREATED BEFORE
Beskrivning
Haemoglobin
Datatyp
integer
Alias
- UMLS CUI [1]
- C0518015
Beskrivning
Platelets
Datatyp
float
Måttenheter
- 1000/uL
Alias
- UMLS CUI [1]
- C0005821
Beskrivning
Platelets
Datatyp
integer
Alias
- UMLS CUI [1]
- C0005821
Beskrivning
Neutrophils
Datatyp
integer
Alias
- UMLS CUI [1]
- C0948762
Beskrivning
Reticulocytes
Datatyp
float
Alias
- UMLS CUI [1]
- C0035286
Beskrivning
Ferritin
Datatyp
float
Alias
- UMLS CUI [1]
- C0373607
Beskrivning
REASON FOR THIS TREATMENT
Datatyp
integer
Alias
- UMLS CUI [1]
- C1443309
Beskrivning
Medication
Datatyp
integer
Alias
- UMLS CUI [1]
- C0013227
Beskrivning
RESPONSE TO THIS IMMUNOSUPPRESSIVE TREATMENT EPISODE
Datatyp
integer
Alias
- UMLS CUI [1]
- C0521982
Beskrivning
Date response evaluated
Datatyp
date
Alias
- UMLS CUI [1,1]
- C1269701
- UMLS CUI [1,2]
- C1269701
Beskrivning
SECONDARY CLONAL COMPLICATIONS
Datatyp
boolean
Alias
- UMLS CUI [1]
- C2939419
Beskrivning
Date of diagnosis of MDS
Datatyp
date
Alias
- UMLS CUI [1,1]
- C3463824
- UMLS CUI [1,2]
- C2316983
Beskrivning
MDS WHO classification
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C1301142
- UMLS CUI [1,2]
- C3463824
Beskrivning
Date of diagnosis of PNH
Datatyp
date
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C2826247
Beskrivning
Size of the PNH clone
Datatyp
float
Måttenheter
- %
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C0456389
Beskrivning
Flow cytometry assessment done on
Datatyp
integer
Alias
- UMLS CUI [1]
- C0016263
Beskrivning
Clinical manifestations of PNH
Datatyp
boolean
Alias
- UMLS CUI [1]
- C0024790
Beskrivning
If HSCT registration also, please proceed to “Status before HSCT” on page 6 If only Immunosuppressive treatment continue to follow-up form
Datatyp
boolean
Alias
- UMLS CUI [1]
- C0279085
Beskrivning
ADDITIONAL IMMUNOSUPPRESSIVE TREATMENT EPISODE
Beskrivning
Date treatment started
Datatyp
date
Beskrivning
SEQUENTIAL NUMBER OF THIS TREATMENT EPISODE
Datatyp
text
Beskrivning
REASON FOR THIS TREATMENT
Datatyp
text
Beskrivning
REASON FOR THIS TREATMENT
Datatyp
text
Beskrivning
Haemoglobin
Datatyp
integer
Alias
- UMLS CUI [1]
- C0518015
Beskrivning
Platelets
Datatyp
float
Måttenheter
- 1000/uL
Alias
- UMLS CUI [1]
- C0005821
Beskrivning
Platelets
Datatyp
integer
Alias
- UMLS CUI [1]
- C0005821
Beskrivning
Neutrophils
Datatyp
integer
Alias
- UMLS CUI [1]
- C0948762
Beskrivning
Reticulocytes
Datatyp
float
Alias
- UMLS CUI [1]
- C0035286
Beskrivning
Ferritin
Datatyp
float
Alias
- UMLS CUI [1]
- C0373607
Beskrivning
REASON FOR THIS TREATMENT
Datatyp
integer
Alias
- UMLS CUI [1]
- C1443309
Beskrivning
Medication
Datatyp
integer
Alias
- UMLS CUI [1]
- C0013227
Beskrivning
RESPONSE TO THIS IMMUNOSUPPRESSIVE TREATMENT EPISODE
Datatyp
integer
Alias
- UMLS CUI [1]
- C0521982
Beskrivning
Date response evaluated
Datatyp
date
Alias
- UMLS CUI [1,1]
- C1269701
- UMLS CUI [1,2]
- C1269701
Beskrivning
SECONDARY CLONAL COMPLICATIONS
Datatyp
boolean
Alias
- UMLS CUI [1]
- C2939419
Beskrivning
Date of diagnosis of MDS
Datatyp
date
Alias
- UMLS CUI [1,1]
- C3463824
- UMLS CUI [1,2]
- C2316983
Beskrivning
MDS WHO classification
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C1301142
- UMLS CUI [1,2]
- C3463824
Beskrivning
Date of diagnosis of PNH
Datatyp
date
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C2826247
Beskrivning
Size of the PNH clone
Datatyp
float
Måttenheter
- %
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C0456389
Beskrivning
Flow cytometry assessment done on
Datatyp
integer
Alias
- UMLS CUI [1]
- C0016263
Beskrivning
Clinical manifestations of PNH
Datatyp
boolean
Alias
- UMLS CUI [1]
- C0024790
Beskrivning
If HSCT registration also, please proceed to “Status before HSCT” on page 6 If only Immunosuppressive treatment continue to follow-up form
Datatyp
boolean
Alias
- UMLS CUI [1]
- C0279085
Beskrivning
STATUS AT HSCT
Beskrivning
Date of HSCT
Datatyp
date
Alias
- UMLS CUI [1]
- C2584899
Beskrivning
Chromosome analysis
Datatyp
integer
Alias
- UMLS CUI [1]
- C0200867
Beskrivning
Chromosome analysis
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C0200867
- UMLS CUI [1,2]
- C0200888
Beskrivning
Number of metaphases with anomalies
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C1621812
- UMLS CUI [1,2]
- C0449788
Beskrivning
number of metaphases examined
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C1621812
- UMLS CUI [1,2]
- C0449788
Beskrivning
Chromosome analysis
Datatyp
text
Beskrivning
Other or associated abnormalities (specify)
Datatyp
text
Beskrivning
Haemoglobin
Datatyp
float
Måttenheter
- g/dL
Alias
- UMLS CUI [1]
- C0518015
Beskrivning
Platelets
Datatyp
float
Alias
- UMLS CUI [1]
- C0005821
Beskrivning
Neutrophils
Datatyp
integer
Alias
- UMLS CUI [1]
- C0948762
Beskrivning
Reticulocytes
Datatyp
float
Alias
- UMLS CUI [1]
- C0035286
Beskrivning
Ferritin
Datatyp
float
Alias
- UMLS CUI [1]
- C0015879
Beskrivning
Haemoglobin
Datatyp
integer
Alias
- UMLS CUI [1]
- C0518015
Beskrivning
Platelets
Datatyp
integer
Alias
- UMLS CUI [1]
- C0005821
Beskrivning
Haemorrhages
Datatyp
integer
Alias
- UMLS CUI [1]
- C0019080
Beskrivning
Resistance to random platelets
Datatyp
integer
Alias
- UMLS CUI [1]
- C1277097
Beskrivning
Systemic infection
Datatyp
integer
Alias
- UMLS CUI [1]
- C0243026
Beskrivning
Date of PNH test
Datatyp
date
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C2826247
Beskrivning
PNH diagnostics by flow cytometry
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C0016263
Beskrivning
Size of the PNH
Datatyp
integer
Måttenheter
- %
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C0456389
Beskrivning
Flow cytometry assessment done on
Datatyp
integer
Alias
- UMLS CUI [1]
- C0016263
Beskrivning
(if type of test unknown, write “unknown” here)
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0024790
- UMLS CUI [1,3]
- C3845569
Beskrivning
PNH diagnostics by other test
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0024790
Beskrivning
Clinical manifestations of PNH
Datatyp
boolean
Alias
- UMLS CUI [1]
- C0024790
Beskrivning
NUMBER OF TRANSFUSIONS BEFORE HSCT
Datatyp
text
Alias
- UMLS CUI [1]
- C0014772
Beskrivning
RBC irradiated
Datatyp
integer
Alias
- UMLS CUI [1]
- C1548980
Beskrivning
Platelets
Datatyp
integer
Alias
- UMLS CUI [1]
- C0005821
Beskrivning
Platelets irradiated
Datatyp
integer
Alias
- UMLS CUI [1]
- C0443117
Beskrivning
ADDITIONAL TREATMENT POST-HSCT
Beskrivning
BEST DISEASE RESPONSE AT 100 DAYS POST-HSCT
Beskrivning
BEST RESPONSE AT 100 DAYS AFTER HSCT
Datatyp
integer
Alias
- UMLS CUI [1]
- C1704632
Beskrivning
BEST RESPONSE AT 100 DAYS AFTER HSCT
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C1704632
- UMLS CUI [1,2]
- C3845569
Beskrivning
Date response evaluated
Datatyp
date
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C1269701
Beskrivning
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])