ID

42852

Description

ODM form derived from 119pp EBMT SLE 16SLE please refer to: http://www.ebmt.org/Contents/Data-Management/Registrystructure/MED-ABdatacollectionforms/Pages/MED-AB-data-collection-forms.aspx

Link

http://www.ebmt.org/Contents/Data-Management/Registrystructure/MED-ABdatacollectionforms/Pages/MED-AB-data-collection-forms.aspx

Keywords

Versions (3)
  1. 7/21/16 7/21/16 -
  2. 8/10/16 8/10/16 -
  3. 9/17/21 9/17/21 -
Uploaded on

September 17, 2021

DOI

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License

Creative Commons BY-NC 3.0
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Systemic lupus erythematosus EBMT General Information Form

English

Systemic lupus erythematosus EBMT General Information Form

1 forms  
GENERAL INFORMATION
Description

GENERAL INFORMATION

EBMT Centre Identification Code (CIC)
Description

EBMT Centre Identification Code (CIC)

Data type

text

Alias
UMLS CUI [1]
C2348585
Name of the hospital
Description

Hospital

Data type

text

Alias
UMLS CUI [1]
C0019994
Unit
Description

Unit

Data type

text

Name of contact person
Description

Contact person

Data type

text

Alias
UMLS CUI [1]
C0337611
Telephone number of contact person
Description

Telephone

Data type

text

Alias
UMLS CUI [1]
C1515258
Fax
Description

Fax

Data type

integer

Alias
UMLS CUI [1]
C1549619
E-Mail
Description

E-Mail

Data type

integer

Alias
UMLS CUI [1]
C1705961
Date of this report
Description

Date of this report

Data type

date

Alias
UMLS CUI [1]
C1302584
Patient following national / international study / trial
Description

Patient following national / international study / trial

Data type

integer

Alias
UMLS CUI [1]
C1997894
Name of study / trial
Description

Name of study / trial

Data type

text

Alias
UMLS CUI [1]
C0008976
Patient
Description

Patient

To be entered only if patient previously reported
Description

Unique Identification Code (UIC)

Data type

text

Alias
UMLS CUI [1]
C2348585
Hospital Unique Patient Number or Code
Description

Hospital Unique Patient Number or Code

Data type

text

Alias
UMLS CUI [1]
C1827636
First name(s)_surname(s)
Description

Initials

Data type

text

Alias
UMLS CUI [1]
C2986440
Date of birth
Description

Date of birth

Data type

date

Alias
UMLS CUI [1]
C0421451
Sex
Description

Sex

Data type

integer

Alias
UMLS CUI [1]
C0079399
ABO Group
Description

ABO Group

Data type

integer

Alias
UMLS CUI [1]
C0000778
Rh factor
Description

Rh factor

Data type

integer

Alias
UMLS CUI [1]
C0035403
Disease
Description

Disease

Date of diagnosis
Description

Date of diagnosis

Data type

date

Alias
UMLS CUI [1]
C2316983
Primary Disease Diagnosis: Check the disease for which this transplant was performed
Description

Primary Disease Diagnosis

Data type

integer

Alias
UMLS CUI [1]
C0277554
SYSTEMIC LUPUS ERITHEMATOSUS (SLE)
Description

SYSTEMIC LUPUS ERITHEMATOSUS (SLE)

Name of Referring Physician
Description

Name of Referring Physician

Data type

integer

Alias
UMLS CUI [1]
C1709880
Address
Description

Address

Data type

integer

Alias
UMLS CUI [1]
C0421449
Fax
Description

Fax

Data type

integer

Alias
UMLS CUI [1]
C1549619
Email
Description

Email

Data type

integer

Alias
UMLS CUI [1]
C0013849
INITIAL DIAGNOSIS
Description

INITIAL DIAGNOSIS

Has the information requested in this section been submitted with a previous transplant registration?
Description

Has the information requested in this section been submitted with a previous transplant registration?

Data type

integer

Alias
UMLS CUI [1]
C0585727
DIAGNOSTIC CRITERIA FOR SYSTEMIC LUPUS ERYTHEMATOSUS
Description

DIAGNOSTIC CRITERIA FOR SYSTEMIC LUPUS ERYTHEMATOSUS

Malar rash
Description

Fixed erythema, flat or raised, over the malar eminences, tending to spare the nasolabial folds

Data type

integer

Alias
UMLS CUI [1]
C3805720
Discoid rash
Description

Erythematous raised patches with adherent keratotic scaling and follicular plugging; atrophic scarring may occur in older lesions

Data type

integer

Alias
UMLS CUI [1]
C3805721
Photosensitivity
Description

Skin rash as a result of unusual reaction to sunlight, by patient history or physician observation

Data type

integer

Alias
UMLS CUI [1]
C0349506
Oral ulcers
Description

Oral or nasopharyngeal ulceration, usually painless, observed by a physician

Data type

integer

Alias
UMLS CUI [1]
C0149745
Arthritis
Description

Non-erosive arthritis involving two or more peripheral joints, characterized by tenderness, swelling or effusion

Data type

integer

Alias
UMLS CUI [1]
C0003864
Serositis
Description

a) Pleuritis – convincing history of pleuritic pain or rub heard by a physician or evidence of pleural effusion ~OR~ b) Pericarditis – documented by ECG or rub or evidence of pericardial effusion

Data type

integer

Alias
UMLS CUI [1]
C0036749
Renal disorder
Description

a) Persistent proteinuria >0.5 grams per day or >3+ on urine dipsCheck if quantitation not performed ~OR~ b) Cellular casts – may be red cell, hemoglobulin, granular, tubular or mixed

Data type

integer

Alias
UMLS CUI [1]
C0022658
Neurologic disorder
Description

a) Seizures – in the absence of offending drugs or known metabolic derangements; e.g., uremia, ketoacidosis or electrolyte imbalance ~OR~ b) Psychosis – in the absence of offending drugs or known metabolic derangements, e.g., uremia, ketoacidosis or electrolyte imbalance

Data type

integer

Alias
UMLS CUI [1]
C0027765
Hematologic disorder
Description

a) Hemolytic anemia – with reticulocytosis ~OR~ b) Thrombocytopenia – <100,000/mm 3 platelets in the absence of offending drugs

Data type

integer

Alias
UMLS CUI [1]
C0018939
Immunologic disorder
Description

a) Anti-DNA: antibody to native DNA in abnormal titer ~OR~ b) Anti-Sm: presence of antibody to Sm nuclear antigen ~OR~ c) Positive finding of antiphospholipid antibodies based on (1) an abnormal serum level of IgG or IgM anticardiolipin antibodies, (2) a positive test result for lupus anticoagulant using a standard method, or (3) a false positive serologic test for Syphilis known to be positive for at least 6 months and confirmed by Treponema pallidum immobilisation or fluorescent treponemal antibody absorption test ~OR d) False positive serologic test for syphilis known to be positive for at least 6 months and confirmed by Treponema pallidum immobilisation or fluorescent treponemal antibody absorption test

Data type

integer

Alias
UMLS CUI [1]
C0021053
Antinuclear antibody
Description

An abnormal titer of antinuclear antibody by immunofluorescence or an equivalent assay at any point in time and in the absence of drugs known to be associated with “drug-induced lupus” syndrome.

Data type

integer

Alias
UMLS CUI [1]
C0003243
FIRST LINE THERAPIES
Description

FIRST LINE THERAPIES

Date started
Description

Date started

Data type

date

Alias
UMLS CUI [1]
C3173309
Androgen
Description

(including antibodies, GF, hormones, etc.)

Data type

text

Alias
UMLS CUI [1]
C0002844
Anti-malarials
Description

(including antibodies, GF, hormones, etc.)

Data type

integer

Alias
UMLS CUI [1]
C0003374
Azathioprine
Description

Azathioprin

Data type

integer

Alias
UMLS CUI [1]
C0004482
Corticosteroids
Description

Corticosteroids

Data type

integer

Alias
UMLS CUI [1]
C0001617
Cyclophosphamide
Description

Cyclophosphamide

Data type

integer

Alias
UMLS CUI [1]
C0010583
Cyclosporine
Description

Cyclosporine

Data type

integer

Alias
UMLS CUI [1]
C0010592
Mycophenolate mofetil
Description

Mycophenolate mofetil

Data type

integer

Alias
UMLS CUI [1]
C0209368
Intravenous immune globulin (IVIG)
Description

Intravenous immune globulin (IVIG)

Data type

integer

Alias
UMLS CUI [1]
C0085297
Other drugs (additional text)
Description

Other drugs

Data type

integer

Alias
UMLS CUI [1]
C2729346
Lymphocytopheresis
Description

Lymphocytopheresis

Data type

integer

Alias
UMLS CUI [1]
C0024226
Plasmapheresis
Description

Plasmapheresis

Data type

integer

Alias
UMLS CUI [1]
C0032134
Other drugs, please specify
Description

Other drugs

Data type

boolean

Alias
UMLS CUI [1]
C2729346
DATE OF HSCT
Description

DATE OF HSCT

Date of Transplant
Description

Date of Transplant

Data type

date

Alias
UMLS CUI [1,1]
C0472699
UMLS CUI [1,2]
C0011008
TRANSPLANT TYPE
Description

TRANSPLANT TYPE

Data type

integer

Alias
UMLS CUI [1]
C3840412
Autologous
Description

Date of 1st collection or pheresis

Data type

date

STATUS OF DISEASE AT MOBILISATION
Description

STATUS OF DISEASE AT MOBILISATION

Was lupus nephritis present at anytime prior to mobilisation?
Description

Was lupus nephritis present at anytime prior to mobilisation?

Data type

integer

Alias
UMLS CUI [1]
C0024143
Renal biopsy done?
Description

Renal biopsy

Data type

integer

Alias
UMLS CUI [1]
C0194073
if renal biopsy done, date of most recent renal biopsy
Description

date of most recent renal biopsy

Data type

date

Alias
UMLS CUI [1,1]
C0194073
UMLS CUI [1,2]
C2963433
Grade Histology
Description

Grade Histology

Data type

integer

Alias
UMLS CUI [1]
C1317415
Grade Histology: if other, please specify
Description

Grade Histology

Data type

text

Alias
UMLS CUI [1,1]
C1317415
UMLS CUI [1,2]
C0205394
SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) score
Description

SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) score

Seizures
Description

Recent onset (last 10 days). Exclude metabolic, infectious or drug cause, or seizure due to past irreversible CNS damage.

Data type

integer

Alias
UMLS CUI [1]
C0036572
Psychosis
Description

Altered ability to function in normal activity due to severe disturbance in the perception of reality. Include hallucinations, incoherence, marked loose associations, impoverished thought content, marked illogical thinking, bizarre, disorganized or catatonic behavior. Exclude uremia and drug causes.

Data type

integer

Alias
UMLS CUI [1]
C0033975
Organic brain syndrome
Description

Altered mental function with impaired orientation, memory or other intellectual function, with rapid onset and fluctuating clinical features. Include clouding of consciousness with reduced capacity to focus and inability to sustain attention to environment, plus at least 2 of the following: perceptual disturbance, incoherent speech, insomnia or daytime drowsiness or increased or decreased psychomotor activity. Exclude metabolic, infectious or drug causes.

Data type

integer

Alias
UMLS CUI [1]
C0029221
Visual disturbance
Description

Retinal and eye changes of SLE. Include cytoid bodies, retinal hemorrhages, serous exudate or hemorrhages in the choroid, optic neuritis, scleritis or episcleritis. Exclude hypertension, infection or drug causes.

Data type

integer

Alias
UMLS CUI [1]
C0547030
Cranial nerve disorder
Description

New onset of sensory or motor neuropathy involving cranial nerves. Include vertigo due to lupus.

Data type

integer

Alias
UMLS CUI [1]
C0010266
Lupus headache
Description

Severe, persistent headache: may be migrainous, but must be nonresponsive to narcotic analgesia.

Data type

integer

Alias
UMLS CUI [1]
C3898566
CVA
Description

New onset of cerebrovascular accident(s). Exclude arteriosclerosis or hypertensive causes.

Data type

integer

Alias
UMLS CUI [1]
C0038454
Vasculitis
Description

Ulceration, gangrene, tender finger nodules, periungual infarction, splinter hemorrhages or biopsy or angiogram proof of vasculitis.

Data type

integer

Alias
UMLS CUI [1]
C0042384
Arthritis
Description

More than 2 joints with pain and signs of inflammation (i.e., tenderness, swelling or effusion).

Data type

integer

Alias
UMLS CUI [1]
C0003864
Myositis
Description

Proximal muscle aching/weakness, associated with elevated creatine phosphokinase/aldolase or electromyogram changes or a biopsy showing myositis.

Data type

integer

Alias
UMLS CUI [1]
C0027121
Urinary casts
Description

Heme-granular or red blood cell casts.

Data type

integer

Alias
UMLS CUI [1]
C4048266
Hematuria
Description

>5 red blood cells/high power field. Exclude stone, infection or other cause.

Data type

integer

Alias
UMLS CUI [1]
C0018965
Proteinuria
Description

>0.5 gm/24 hours. New onset or recent increase of >0.5 gm/24 hours

Data type

integer

Alias
UMLS CUI [1]
C0033687
Pyuria
Description

>5 white blood cells/high power field. Exclude infection

Data type

integer

Alias
UMLS CUI [1]
C0034359
New rash
Description

Ongoing inflammatory lupus rash

Data type

integer

Alias
UMLS CUI [1]
C0015230
Alopecia
Description

Ongoing abnormal, patchy or diffuse loss of hair due to active lupus.

Data type

integer

Alias
UMLS CUI [1]
C0002171
Mucosal ulcers
Description

Ongoing oral or nasal ulcerations due to active lupus

Data type

integer

Alias
UMLS CUI [1]
C0236053
Pleurisy
Description

Classic and severe pleuritic chest pain or pleural rub or effusion or new pleural thickening due to lupus.

Data type

integer

Alias
UMLS CUI [1]
C0032231
Pericarditis
Description

Classic and severe pericardial pain or rub or effusion or electrocardiogram confirmation.

Data type

integer

Alias
UMLS CUI [1]
C1963211
Low complement
Description

Low complement

Data type

integer

Alias
UMLS CUI [1]
C3897137
Increased DNA binding
Description

>25% binding by Farr assay or above normal range for testing laboratory.

Data type

integer

Alias
UMLS CUI [1]
C1148673
Fever >38°C. Exclude infectious cause
Description

Fever

Data type

integer

Alias
UMLS CUI [1]
C1556366
Thrombocytopenia
Description

<100,000 platelets/mm 3 (x 10 9 /L).

Data type

integer

Alias
UMLS CUI [1]
C0040034
Leukopenia
Description

<3,000 white blood cells/mm 3 (x 10 9 /L). Exclude drug causes.

Data type

integer

Alias
UMLS CUI [1]
C0023530
LABORATORY VALUES
Description

LABORATORY VALUES

Haemoglobin
Description

Haemoglobin

Data type

float

Measurement units
  • g/dL
Alias
UMLS CUI [1]
C0019046
g/dL
Erythrocyte Sedimentation Rate
Description

ESR

Data type

integer

Measurement units
  • mm/hr
Alias
UMLS CUI [1]
C1176468
mm/hr
Erythrocyte sedimentation rate
Description

Erythrocyte sedimentation rate

Data type

integer

Alias
UMLS CUI [1]
C1176468
Platelets
Description

platelets

Data type

integer

Measurement units
  • x10^9 /l
Alias
UMLS CUI [1]
C0005821
x10^9 /l
WBC
Description

WBC

Data type

float

Measurement units
  • x10^9/l
Alias
UMLS CUI [1]
C0023508
x10^9/l
Serum creatinine
Description

Serumcreatinine

Data type

float

Alias
UMLS CUI [1]
C0201976
Creatinine Clearance
Description

Creatinine Clearance

Data type

float

Measurement units
  • mL/min
Alias
UMLS CUI [1]
C0373595
mL/min
Total urinary protein excretion (mg/24 h)
Description

Total urinary protein excretion (mg/24 h)

Data type

float

Alias
UMLS CUI [1]
C3897352
CH50 Complement reduced
Description

CH50 Complement reduced

Data type

integer

Alias
UMLS CUI [1]
C0369025
Complement component C3 reduced
Description

Complement component reduced

Data type

integer

Alias
UMLS CUI [1]
C0009506
Antibodies studied
Description

Antibodies studied

Data type

integer

Alias
UMLS CUI [1]
C0003241
anti-dsDNA: Antibodies studied, if yes
Description

anti-dsDNA

Data type

integer

Alias
UMLS CUI [1]
C2746079
anti-cardiolipin IgG
Description

anti-cardiolipin IgG

Data type

integer

Alias
UMLS CUI [1]
C0368842
anti-cardiolipin IgM
Description

anti-cardiolipin IgM

Data type

integer

Alias
UMLS CUI [1]
C0368843
antinuclear antibody (ANA) test
Description

antinuclear antibody (ANA) test

Data type

integer

Alias
UMLS CUI [1]
C0003243
anti-Sm
Description

anti-Sm

Data type

integer

Alias
UMLS CUI [1]
C0241910
anti-SSA (anti-Ro)
Description

anti-SSA (anti-Ro)

Data type

integer

Alias
UMLS CUI [1]
C0075128
anti-SSB (anti-La)
Description

anti-SSB (anti-La)

Data type

integer

Alias
UMLS CUI [1]
C1168480
lupus-anticoagulant
Description

lupus-anticoagulant

Data type

integer

Alias
UMLS CUI [1]
C1142517
PATIENT’S SELF ASSESSMENT PRIOR TO MOBILISATION
Description

PATIENT’S SELF ASSESSMENT PRIOR TO MOBILISATION

SF-36 Health Survey completed
Description

SF-36 Health Survey

Data type

integer

Alias
UMLS CUI [1]
C3640521
Physical Functioning
Description

Physical Functioning

Data type

float

Alias
UMLS CUI [1]
C0516981
Role Functioning-Physical
Description

Role Functioning-Physical

Data type

float

Alias
UMLS CUI [1]
C0516981
Role Functioning-Emotional
Description

Role Functioning-Emotional

Data type

float

Alias
UMLS CUI [1]
C0013987
Social Functioning
Description

Social Functioning

Data type

float

Alias
UMLS CUI [1]
C2585826
Bodily Pain
Description

Bodily Pain

Data type

float

Alias
UMLS CUI [1]
C3890602
Mental Health
Description

Mental Health

Data type

float

Alias
UMLS CUI [1]
C0025353
Vitality
Description

Vitality

Data type

float

Alias
UMLS CUI [1]
C0424589
General Health
Description

General Health

Data type

float

Alias
UMLS CUI [1]
C0516984
HEALTH ASSESSMENT QUESTIONNAIRE (HAQ)
Description

HEALTH ASSESSMENT QUESTIONNAIRE (HAQ)

Did the patient complete a Health Assessment Questionnaire (HAQ)?
Description

Health Assessment Questionnaire

Data type

integer

Alias
UMLS CUI [1]
C0451208
Patient’s score
Description

health score

Data type

float

Alias
UMLS CUI [1]
C2960025
Worst possible score
Description

Worst possible score

Data type

float

Alias
UMLS CUI [1,1]
C0449820
UMLS CUI [1,2]
C1522166
Best possible score
Description

Best possible score

Data type

float

Alias
UMLS CUI [1,1]
C0449820
UMLS CUI [1,2]
C1299381
STATUS OF DISEASE AT HSCT
Description

STATUS OF DISEASE AT HSCT

Was lupus nephritis present at anytime prior to HSCT?
Description

Was lupus nephritis present at anytime prior to HSCT?

Data type

integer

Alias
UMLS CUI [1]
C0024143
if yes, date of most recent renal biopsy
Description

Was lupus nephritis present at anytime prior to HSCT?

Data type

date

Alias
UMLS CUI [1]
C0194073
Grade Histology
Description

Grade Histology

Data type

integer

Alias
UMLS CUI [1]
C1317415
Renal biopsy done?
Description

Renal biopsy done?

Data type

text

Alias
UMLS CUI [1]
C0194073
ADDITIONAL TREATMENT POST-HSCT
Description

ADDITIONAL TREATMENT POST-HSCT

ADDITIONAL DISEASE TREATMENT
Description

ADDITIONAL DISEASE TREATMENT

Data type

boolean

Alias
UMLS CUI [1]
C1706712
FORMS TO BE FILLED IN
Description

FORMS TO BE FILLED IN

TYPE OF TRANSPLANT
Description

TYPE OF TRANSPLANT

Data type

integer

Alias
UMLS CUI [1,1]
C0559189
UMLS CUI [1,2]
C0040739
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Similar models

Systemic lupus erythematosus EBMT General Information Form

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
GENERAL INFORMATION
EBMT Centre Identification Code (CIC)
Item
EBMT Centre Identification Code (CIC)
text
C2348585 (UMLS CUI [1])
Hospital
Item
Name of the hospital
text
C0019994 (UMLS CUI [1])
Unit
Item
Unit
text
Contact person
Item
Name of contact person
text
C0337611 (UMLS CUI [1])
Telephone
Item
Telephone number of contact person
text
C1515258 (UMLS CUI [1])
Fax
Item
Fax
integer
C1549619 (UMLS CUI [1])
E-Mail
Item
E-Mail
integer
C1705961 (UMLS CUI [1])
Date of this report
Item
Date of this report
date
C1302584 (UMLS CUI [1])
Item
Patient following national / international study / trial
integer
C1997894 (UMLS CUI [1])
Patient following national / international study / trial
Code List
Patient following national / international study / trial
CL Item
no (1)
C1298908 (UMLS CUI-1)
CL Item
yes (2)
C1705108 (UMLS CUI-1)
CL Item
unknown (3)
C0439673 (UMLS CUI-1)
Name of study / trial
Item
Name of study / trial
text
C0008976 (UMLS CUI [1])
Item Group
Patient
Unique Identification Code (UIC)
Item
To be entered only if patient previously reported
text
C2348585 (UMLS CUI [1])
Hospital Unique Patient Number or Code
Item
Hospital Unique Patient Number or Code
text
C1827636 (UMLS CUI [1])
Initials
Item
First name(s)_surname(s)
text
C2986440 (UMLS CUI [1])
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
Item
Sex
integer
C0079399 (UMLS CUI [1])
Sex
Code List
Sex
CL Item
Male (1)
C1706180 (UMLS CUI-1)
CL Item
Female (2)
C0086287 (UMLS CUI-1)
ABO Group
Item
ABO Group
integer
C0000778 (UMLS CUI [1])
Item
Rh factor
integer
C0035403 (UMLS CUI [1])
Rh factor
Code List
Rh factor
CL Item
Absent (1)
C0332197 (UMLS CUI-1)
CL Item
Present  (2)
C0150312 (UMLS CUI-1)
CL Item
Not evaluated (3)
C3846720 (UMLS CUI-1)
Item Group
Disease
Date of diagnosis
Item
Date of diagnosis
date
C2316983 (UMLS CUI [1])
Item
Primary Disease Diagnosis: Check the disease for which this transplant was performed
integer
C0277554 (UMLS CUI [1])
Primary Disease Diagnosis
Code List
Primary Disease Diagnosis: Check the disease for which this transplant was performed
CL Item
Acute Leukaemia (Acute Leukaemia)
C0085669 (UMLS CUI-1)
CL Item
Acute Lymphoblastic Leukaemia (ALL) (Acute Lymphoblastic Leukaemia (ALL))
C0023449 (UMLS CUI-1)
CL Item
Acute Myelogenous Leukaemia (AML) (Acute Myelogenous Leukaemia (AML))
C0023467 (UMLS CUI-1)
CL Item
Autoimmune disease (Autoimmune disease)
C0004364 (UMLS CUI-1)
CL Item
Bone marrow failure including Aplastic anaemia (Bone marrow failure including Aplastic anaemia)
C0002874 (UMLS CUI-1)
CL Item
Chronic Leukaemia (Chronic Leukaemia)
C0856053 (UMLS CUI-1)
CL Item
Chronic Lymphocytic Leukaemia (Chronic Lymphocytic Leukaemia)
C0023434 (UMLS CUI-1)
CL Item
Chronic Myeloid Leukaemia (CML) (Chronic Myeloid Leukaemia (CML))
C0023473 (UMLS CUI-1)
CL Item
Haemoglobinopathy (Haemoglobinopathiy)
C0019045 (UMLS CUI-1)
CL Item
Histiocytic disorders (Histiocytic disorders)
C0398597 (UMLS CUI-1)
CL Item
Hodgkin´s Disease (Hodgkin´s Disease)
C0019829 (UMLS CUI-1)
CL Item
Inherited disorders (Inherited disorders)
C0019247 (UMLS CUI-1)
CL Item
Juvenile Idiopathic Arthritis (Juvenile Idiopathic Arthritis)
C1444841 (UMLS CUI-1)
CL Item
Lymphoma (Lymphoma)
C0024299 (UMLS CUI-1)
CL Item
MD/ MPN (MD/ MPN)
C1292778 (UMLS CUI-1)
CL Item
MDS (MDS)
C3463824 (UMLS CUI-1)
CL Item
Metabolic disorders (Metabolic disorders)
C0025517 (UMLS CUI-1)
CL Item
Multiple Sclerosis (Multiple Sclerosis)
C0026769 (UMLS CUI-1)
CL Item
Myelodysplastic syndromes (Myelodysplastic syndromes)
C0280450 (UMLS CUI-1)
CL Item
Myeloma/ Plasma cell disorder (Myeloma/ Plasma cell disorder)
C0026764 (UMLS CUI-1)
CL Item
Myeloproliferative neoplasm (Myeloproliferative neoplasm)
C1333046 (UMLS CUI-1)
CL Item
Non Hodgkin (Non Hodgkin)
C0024305 (UMLS CUI-1)
CL Item
Other diagnosis (Other diagnosis)
C0205394 (UMLS CUI-1)
CL Item
Primary immune deficiencies (Primary immune deficiencies)
C0398686 (UMLS CUI-1)
CL Item
Secondary Acute Leukaemia (do not use if transformed from MDS/MPN) (Secondary Acute Leukaemia (do not use if transformed from MDS/MPN))
C0856053 (UMLS CUI-1)
CL Item
Solid Tumour (Solid Tumour)
C0006826 (UMLS CUI-1)
CL Item
Systemic Lupus (Systemic Lupus)
C0024141 (UMLS CUI-1)
CL Item
Systemic Sclerosis (Systemic Sclerosis)
C0036421 (UMLS CUI-1)
Item Group
SYSTEMIC LUPUS ERITHEMATOSUS (SLE)
Name of Referring Physician
Item
Name of Referring Physician
integer
C1709880 (UMLS CUI [1])
Address
Item
Address
integer
C0421449 (UMLS CUI [1])
Fax
Item
Fax
integer
C1549619 (UMLS CUI [1])
Email
Item
Email
integer
C0013849 (UMLS CUI [1])
Item Group
INITIAL DIAGNOSIS
Item
Has the information requested in this section been submitted with a previous transplant registration?
integer
C0585727 (UMLS CUI [1])
Has the information requested in this section been submitted with a previous transplant registration?
Code List
Has the information requested in this section been submitted with a previous transplant registration?
CL Item
Yes: proceed to “Status of Disease at mobilisation” on page 3 (Yes: proceed to “Status of Disease at mobilisation” on page 3)
CL Item
No: proceed with this section (No: proceed with this section)
Item Group
DIAGNOSTIC CRITERIA FOR SYSTEMIC LUPUS ERYTHEMATOSUS
Item
Malar rash
integer
C3805720 (UMLS CUI [1])
Malar rash [250]
Code List
Malar rash
CL Item
Yes (Yes)
C1705108 (UMLS CUI-1)
CL Item
No  (No )
C1298908 (UMLS CUI-1)
CL Item
Not evaluated  (Not evaluated )
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
Discoid rash
integer
C3805721 (UMLS CUI [1])
Discoid rash [251]
Code List
Discoid rash
CL Item
Yes  (Yes )
C1705108 (UMLS CUI-1)
CL Item
No  (No )
C1298908 (UMLS CUI-1)
CL Item
Not evaluated (Not evaluated)
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
Photosensitivity
integer
C0349506 (UMLS CUI [1])
Photosensitivity [253]
Code List
Photosensitivity
CL Item
Yes (Yes)
C1705108 (UMLS CUI-1)
CL Item
No (No)
C1298908 (UMLS CUI-1)
CL Item
Not evaluated (Not evaluated)
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
Oral ulcers
integer
C0149745 (UMLS CUI [1])
Oral ulcers [252]
Code List
Oral ulcers
CL Item
Yes (Yes)
C1705108 (UMLS CUI-1)
CL Item
No (No)
C1298908 (UMLS CUI-1)
CL Item
Not evaluated (Not evaluated)
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
Arthritis
integer
C0003864 (UMLS CUI [1])
Arthritis [226]
Code List
Arthritis
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Item
Serositis
integer
C0036749 (UMLS CUI [1])
Serositis [225]
Code List
Serositis
CL Item
Yes (Yes)
C1705108 (UMLS CUI-1)
CL Item
No  (No )
C1298908 (UMLS CUI-1)
CL Item
Not evaluated (Not evaluated)
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
Renal disorder
integer
C0022658 (UMLS CUI [1])
Renal disorder [213]
Code List
Renal disorder
CL Item
Yes (Yes)
C1705108 (UMLS CUI-1)
CL Item
No  (No )
C1298908 (UMLS CUI-1)
CL Item
Not evaluated (Not evaluated)
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
Neurologic disorder
integer
C0027765 (UMLS CUI [1])
Neurologic disorder [221]
Code List
Neurologic disorder
CL Item
Yes (Yes)
C1705108 (UMLS CUI-1)
CL Item
No (No)
C1298908 (UMLS CUI-1)
CL Item
Not evaluated (Not evaluated)
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
Hematologic disorder
integer
C0018939 (UMLS CUI [1])
Hematologic disorder [230]
Code List
Hematologic disorder
CL Item
Yes (Yes)
C1705108 (UMLS CUI-1)
CL Item
No  (No )
C1298908 (UMLS CUI-1)
CL Item
Not evaluated (Not evaluated)
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
Immunologic disorder
integer
C0021053 (UMLS CUI [1])
Immunologic disorder [254]
Code List
Immunologic disorder
CL Item
Yes (Yes)
C1705108 (UMLS CUI-1)
CL Item
No  (No )
C1298908 (UMLS CUI-1)
CL Item
Not evaluated (Not evaluated)
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
Antinuclear antibody
integer
C0003243 (UMLS CUI [1])
Antinuclear antibody
Code List
Antinuclear antibody
CL Item
Yes (Yes)
C1705108 (UMLS CUI-1)
CL Item
No  (No )
C1298908 (UMLS CUI-1)
CL Item
Not evaluated (Not evaluated)
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item Group
FIRST LINE THERAPIES
Date started
Item
Date started
date
C3173309 (UMLS CUI [1])
Item
Androgen
text
C0002844 (UMLS CUI [1])
Androgen
Code List
Androgen
CL Item
Yes (Yes)
C1705108 (UMLS CUI-1)
CL Item
No  (No )
C1298908 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
Anti-malarials
integer
C0003374 (UMLS CUI [1])
Anti-malarials
Code List
Anti-malarials
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Azathioprine
integer
C0004482 (UMLS CUI [1])
Azathioprin
Code List
Azathioprine
CL Item
no (0)
CL Item
yes (1)
CL Item
unknown (9)
Item
Corticosteroids
integer
C0001617 (UMLS CUI [1])
Corticosteroids
Code List
Corticosteroids
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Cyclophosphamide
integer
C0010583 (UMLS CUI [1])
Cyclophosphamide
Code List
Cyclophosphamide
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Cyclosporine
integer
C0010592 (UMLS CUI [1])
Cyclosporine
Code List
Cyclosporine
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Mycophenolate mofetil
integer
C0209368 (UMLS CUI [1])
Mycophenolate mofetil
Code List
Mycophenolate mofetil
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Intravenous immune globulin (IVIG)
integer
C0085297 (UMLS CUI [1])
Intravenous immune globulin (IVIG)
Code List
Intravenous immune globulin (IVIG)
CL Item
Yes (Yes)
C1705108 (UMLS CUI-1)
CL Item
No  (No )
C1298908 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
Other drugs (additional text)
integer
C2729346 (UMLS CUI [1])
Other drugs
Code List
Other drugs (additional text)
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Lymphocytopheresis
integer
C0024226 (UMLS CUI [1])
Lymphocytopheresis
Code List
Lymphocytopheresis
CL Item
no (1)
CL Item
yes (2)
CL Item
unknown (3)
Item
Plasmapheresis
integer
C0032134 (UMLS CUI [1])
Plasmapheresis
Code List
Plasmapheresis
CL Item
no (1)
CL Item
yes (2)
CL Item
unknown (3)
Other drugs
Item
Other drugs, please specify
boolean
C2729346 (UMLS CUI [1])
Item Group
DATE OF HSCT
Date of Transplant
Item
Date of Transplant
date
C0472699 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
TRANSPLANT TYPE
integer
C3840412 (UMLS CUI [1])
TRANSPLANT TYPE
Code List
TRANSPLANT TYPE
CL Item
Allogeneic (1)
C2242529 (UMLS CUI-1)
CL Item
Autologous (2)
C0194037 (UMLS CUI-1)
Date of 1st collection or pheresis
Item
Autologous
date
Item Group
STATUS OF DISEASE AT MOBILISATION
Item
Was lupus nephritis present at anytime prior to mobilisation?
integer
C0024143 (UMLS CUI [1])
Was lupus nephritis present at anytime prior to mobilisation?
Code List
Was lupus nephritis present at anytime prior to mobilisation?
CL Item
Yes (1)
CL Item
No  (2)
CL Item
Unknown (3)
Item
Renal biopsy done?
integer
C0194073 (UMLS CUI [1])
Renal biopsy done?
Code List
Renal biopsy done?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
date of most recent renal biopsy
Item
if renal biopsy done, date of most recent renal biopsy
date
C0194073 (UMLS CUI [1,1])
C2963433 (UMLS CUI [1,2])
Item
Grade Histology
integer
C1317415 (UMLS CUI [1])
Grade Histology
Code List
Grade Histology
CL Item
Normal (I Normal)
C0205307 (UMLS CUI-1)
CL Item
Mesangial (II Mesangial)
C0227651 (UMLS CUI-1)
CL Item
Focal proliferative (III Focal proliferative)
C1265837 (UMLS CUI-1)
CL Item
Diffuse proliferative (IV Diffuse proliferative)
C0744422 (UMLS CUI-1)
CL Item
Membranous (V Membranous)
C0017665 (UMLS CUI-1)
CL Item
Other (Other)
C0205394 (UMLS CUI-1)
Grade Histology
Item
Grade Histology: if other, please specify
text
C1317415 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Item Group
SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) score
Item
Seizures
integer
C0036572 (UMLS CUI [1])
Seizures [255]
Code List
Seizures
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Item
Psychosis
integer
C0033975 (UMLS CUI [1])
Psychosis [256]
Code List
Psychosis
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Item
Organic brain syndrome
integer
C0029221 (UMLS CUI [1])
Organic brain syndrome [257]
Code List
Organic brain syndrome
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Item
Visual disturbance
integer
C0547030 (UMLS CUI [1])
Visual disturbance [109]
Code List
Visual disturbance
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Item
Cranial nerve disorder
integer
C0010266 (UMLS CUI [1])
Cranial nerve disorder [258]
Code List
Cranial nerve disorder
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Item
Lupus headache
integer
C3898566 (UMLS CUI [1])
Lupus headache [259]
Code List
Lupus headache
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
CL Item
No  (2)
C1298908 (UMLS CUI-1)
CL Item
Not evaluated (3)
C3846720 (UMLS CUI-1)
CL Item
Unknown (4)
C0439673 (UMLS CUI-1)
Item
CVA
integer
C0038454 (UMLS CUI [1])
CVA [260]
Code List
CVA
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Item
Vasculitis
integer
C0042384 (UMLS CUI [1])
Vasculitis [234]
Code List
Vasculitis
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Item
Arthritis
integer
C0003864 (UMLS CUI [1])
Arthritis [226]
Code List
Arthritis
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Item
Myositis
integer
C0027121 (UMLS CUI [1])
Myositis [261]
Code List
Myositis
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Item
Urinary casts
integer
C4048266 (UMLS CUI [1])
Urinary casts [262]
Code List
Urinary casts
CL Item
Yes (1)
CL Item
No  (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Item
Hematuria
integer
C0018965 (UMLS CUI [1])
Hematuria [263]
Code List
Hematuria
CL Item
Yes (1)
CL Item
No  (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Item
Proteinuria
integer
C0033687 (UMLS CUI [1])
Proteinuria [264]
Code List
Proteinuria
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Item
Pyuria
integer
C0034359 (UMLS CUI [1])
Pyuria [265]
Code List
Pyuria
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Item
New rash
integer
C0015230 (UMLS CUI [1])
New rash [249]
Code List
New rash
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Item
Alopecia
integer
C0002171 (UMLS CUI [1])
Alopecia [266]
Code List
Alopecia
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Item
Mucosal ulcers
integer
C0236053 (UMLS CUI [1])
Mucosal ulcers [252]
Code List
Mucosal ulcers
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Item
Pleurisy
integer
C0032231 (UMLS CUI [1])
Pleurisy [267]
Code List
Pleurisy
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Item
Pericarditis
integer
C1963211 (UMLS CUI [1])
Pericarditis [268]
Code List
Pericarditis
CL Item
Yes (1)
CL Item
No  (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Item
Low complement
integer
C3897137 (UMLS CUI [1])
Low complement [269]
Code List
Low complement
CL Item
Yes (1)
CL Item
No  (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Item
Increased DNA binding
integer
C1148673 (UMLS CUI [1])
Increased DNA binding [270]
Code List
Increased DNA binding
CL Item
Yes (1)
CL Item
No  (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Item
Fever >38°C. Exclude infectious cause
integer
C1556366 (UMLS CUI [1])
Fever [271]
Code List
Fever >38°C. Exclude infectious cause
CL Item
Yes (1)
CL Item
No  (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Item
Thrombocytopenia
integer
C0040034 (UMLS CUI [1])
Thrombocytopenia [272]
Code List
Thrombocytopenia
CL Item
Yes (1)
CL Item
No  (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Item
Leukopenia
integer
C0023530 (UMLS CUI [1])
Leukopenia [272]
Code List
Leukopenia
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Item Group
LABORATORY VALUES
Haemoglobin
Item
Haemoglobin
float
C0019046 (UMLS CUI [1])
ESR
Item
Erythrocyte Sedimentation Rate
integer
C1176468 (UMLS CUI [1])
Item
Erythrocyte sedimentation rate
integer
C1176468 (UMLS CUI [1])
Erythrocyte sedimentation rate
Code List
Erythrocyte sedimentation rate
CL Item
Not evaluated (1)
CL Item
Unknown (2)
platelets
Item
Platelets
integer
C0005821 (UMLS CUI [1])
WBC
Item
WBC
float
C0023508 (UMLS CUI [1])
Serumcreatinine
Item
Serum creatinine
float
C0201976 (UMLS CUI [1])
Creatinine Clearance
Item
Creatinine Clearance
float
C0373595 (UMLS CUI [1])
Total urinary protein excretion (mg/24 h)
Item
Total urinary protein excretion (mg/24 h)
float
C3897352 (UMLS CUI [1])
Item
CH50 Complement reduced
integer
C0369025 (UMLS CUI [1])
CH50 Complement reduced
Code List
CH50 Complement reduced
CL Item
No (1)
CL Item
Yes  (2)
CL Item
Not evaluated  (3)
CL Item
Unknown (4)
Item
Complement component C3 reduced
integer
C0009506 (UMLS CUI [1])
Complement component reduced
Code List
Complement component C3 reduced
CL Item
No (1)
CL Item
Yes  (2)
CL Item
Not evaluated  (3)
CL Item
Unknown (4)
Item
Antibodies studied
integer
C0003241 (UMLS CUI [1])
Antibodies studied
Code List
Antibodies studied
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Item
anti-dsDNA: Antibodies studied, if yes
integer
C2746079 (UMLS CUI [1])
anti-dsDNA
Code List
anti-dsDNA: Antibodies studied, if yes
CL Item
Normal  (1)
CL Item
Elevated  (2)
CL Item
Not evaluated  (3)
CL Item
Unknown (4)
Item
anti-cardiolipin IgG
integer
C0368842 (UMLS CUI [1])
anti-cardiolipin IgG
Code List
anti-cardiolipin IgG
CL Item
Normal  (1)
CL Item
Elevated  (2)
CL Item
Not evaluated  (3)
CL Item
Unknown (4)
Item
anti-cardiolipin IgM
integer
C0368843 (UMLS CUI [1])
anti-cardiolipin IgM
Code List
anti-cardiolipin IgM
CL Item
Normal  (1)
CL Item
Elevated  (2)
CL Item
Not evaluated  (3)
CL Item
Unknown (4)
Item
antinuclear antibody (ANA) test
integer
C0003243 (UMLS CUI [1])
antinuclear antibody (ANA) test
Code List
antinuclear antibody (ANA) test
CL Item
Normal  (1)
CL Item
Elevated  (2)
CL Item
Not evaluated  (3)
CL Item
Unknown (4)
Item
anti-Sm
integer
C0241910 (UMLS CUI [1])
anti-Sm
Code List
anti-Sm
CL Item
Normal  (Normal )
CL Item
Elevated  (Elevated )
CL Item
Not evaluated  (Not evaluated )
CL Item
Unknown (Unknown)
Item
anti-SSA (anti-Ro)
integer
C0075128 (UMLS CUI [1])
anti-SSA (anti-Ro)
Code List
anti-SSA (anti-Ro)
CL Item
Normal  (Normal )
CL Item
Elevated  (Elevated )
CL Item
Not evaluated  (Not evaluated )
CL Item
Unknown (Unknown)
Item
anti-SSB (anti-La)
integer
C1168480 (UMLS CUI [1])
anti-SSB (anti-La)
Code List
anti-SSB (anti-La)
CL Item
Normal  (Normal )
CL Item
Elevated  (Elevated )
CL Item
Not evaluated  (Not evaluated )
CL Item
Unknown (Unknown)
Item
lupus-anticoagulant
integer
C1142517 (UMLS CUI [1])
lupus-anticoagulant
Code List
lupus-anticoagulant
CL Item
Normal  (Normal )
CL Item
Elevated  (Elevated )
CL Item
Not evaluated  (Not evaluated )
CL Item
Unknown (Unknown)
Item Group
PATIENT’S SELF ASSESSMENT PRIOR TO MOBILISATION
Item
SF-36 Health Survey completed
integer
C3640521 (UMLS CUI [1])
SF-36 Health Survey completed
Code List
SF-36 Health Survey completed
CL Item
No (1)
CL Item
Yes (2)
CL Item
Unknown (3)
Physical Functioning
Item
Physical Functioning
float
C0516981 (UMLS CUI [1])
Role Functioning-Physical
Item
Role Functioning-Physical
float
C0516981 (UMLS CUI [1])
Role Functioning-Emotional
Item
Role Functioning-Emotional
float
C0013987 (UMLS CUI [1])
Social Functioning
Item
Social Functioning
float
C2585826 (UMLS CUI [1])
Bodily Pain
Item
Bodily Pain
float
C3890602 (UMLS CUI [1])
Mental Health
Item
Mental Health
float
C0025353 (UMLS CUI [1])
Vitality
Item
Vitality
float
C0424589 (UMLS CUI [1])
General Health
Item
General Health
float
C0516984 (UMLS CUI [1])
Item Group
HEALTH ASSESSMENT QUESTIONNAIRE (HAQ)
Item
Did the patient complete a Health Assessment Questionnaire (HAQ)?
integer
C0451208 (UMLS CUI [1])
Did the patient complete a Health Assessment Questionnaire (HAQ)?
Code List
Did the patient complete a Health Assessment Questionnaire (HAQ)?
CL Item
No (1)
CL Item
Yes (2)
CL Item
Unknown (3)
health score
Item
Patient’s score
float
C2960025 (UMLS CUI [1])
Worst possible score
Item
Worst possible score
float
C0449820 (UMLS CUI [1,1])
C1522166 (UMLS CUI [1,2])
Best possible score
Item
Best possible score
float
C0449820 (UMLS CUI [1,1])
C1299381 (UMLS CUI [1,2])
Item Group
STATUS OF DISEASE AT HSCT
Item
Was lupus nephritis present at anytime prior to HSCT?
integer
C0024143 (UMLS CUI [1])
Was lupus nephritis present at anytime prior to HSCT?
Code List
Was lupus nephritis present at anytime prior to HSCT?
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Was lupus nephritis present at anytime prior to HSCT?
Item
if yes, date of most recent renal biopsy
date
C0194073 (UMLS CUI [1])
Item
Grade Histology
integer
C1317415 (UMLS CUI [1])
Grade Histology
Code List
Grade Histology
CL Item
I Normal (I Normal)
CL Item
II Mesangial (II Mesangial)
CL Item
III Focal proliferative (III Focal proliferative)
CL Item
IV Diffuse proliferative (IV Diffuse proliferative)
CL Item
V Membranous (V Membranous)
CL Item
Other, (Other,)
Item
Renal biopsy done?
text
C0194073 (UMLS CUI [1])
Renal biopsy done?
Code List
Renal biopsy done?
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item Group
ADDITIONAL TREATMENT POST-HSCT
ADDITIONAL DISEASE TREATMENT
Item
ADDITIONAL DISEASE TREATMENT
boolean
C1706712 (UMLS CUI [1])
Item Group
FORMS TO BE FILLED IN
Item
TYPE OF TRANSPLANT
integer
C0559189 (UMLS CUI [1,1])
C0040739 (UMLS CUI [1,2])
TYPE OF TRANSPLANT
Code List
TYPE OF TRANSPLANT
CL Item
AUTOgraft, proceed to Autograft form (1)
C0040736 (UMLS CUI-1)
CL Item
ALLOgraft or Syngeneic graft, proceed to Allograft form (2)
C0040739 (UMLS CUI-1)
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