ID
44071
Beschrijving
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
Trefwoorden
Versies (5)
- 25-07-16 25-07-16 -
- 04-08-16 04-08-16 -
- 28-11-17 28-11-17 - Julian Varghese
- 15-03-21 15-03-21 - Dr. rer. medic Philipp Neuhaus
- 20-09-21 20-09-21 -
Houder van rechten
EBMT
Geüploaded op
20 september 2021
DOI
Voor een aanvraag inloggen.
Licentie
Creative Commons BY-NC 3.0
Model Commentaren :
Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.
Itemgroep Commentaren voor :
Item Commentaren voor :
U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.
16760_General Info EBMT Aplastic Anemia
General Info EBMT Aplastic Anemia
- StudyEvent: ODM
Beschrijving
GENERAL INFORMATION
Beschrijving
Unique Identification Code (UIC)
Datatype
text
Alias
- UMLS CUI [1]
- C2348585
Beschrijving
Hospital Unique Patient Number or Code
Datatype
text
Alias
- UMLS CUI [1]
- C1827636
Beschrijving
Initials
Datatype
text
Alias
- UMLS CUI [1]
- C2986440
Beschrijving
Date of birth
Datatype
date
Alias
- UMLS CUI [1]
- C0421451
Beschrijving
Sex
Datatype
text
Alias
- UMLS CUI [1]
- C0079399
Beschrijving
ABO Group
Datatype
integer
Alias
- UMLS CUI [1]
- C0000778
Beschrijving
Rh factor
Datatype
integer
Alias
- UMLS CUI [1]
- C0035403
Beschrijving
GENERAL INFORMATION
Beschrijving
Date of diagnosis
Datatype
date
Alias
- UMLS CUI [1,1]
- C2316983
- UMLS CUI [1,2]
- C1274082
Beschrijving
Primary Disease Diagnosis
Datatype
text
Alias
- UMLS CUI [1]
- C0277554
Beschrijving
BONE MARROW FAILURE SYNDROME (INCLUDING APLASTIC ANAEMIA)
Beschrijving
SUBCLASSIFICATION
Beschrijving
Acquired
Datatype
boolean
Alias
- UMLS CUI [1]
- C0439661
Beschrijving
Aplastic anaemia
Datatype
integer
Alias
- UMLS CUI [1]
- C0002874
Beschrijving
Pure red cell aplasia (non constitutional PRCA)
Datatype
boolean
Alias
- UMLS CUI [1]
- C0034902
Beschrijving
Paroxysmal nocturnal haemoglobinuria (PNH)
Datatype
boolean
Alias
- UMLS CUI [1]
- C0024790
Beschrijving
Haemolytic
Datatype
boolean
Alias
- UMLS CUI [1]
- C0002878
Beschrijving
Aplastic
Datatype
boolean
Alias
- UMLS CUI [1]
- C1368107
Beschrijving
Thrombotic
Datatype
boolean
Alias
- UMLS CUI [1]
- C2674163
Beschrijving
Pure white cell aplasia
Datatype
boolean
Alias
- UMLS CUI [1]
- C2242624
Beschrijving
Amegakaryocytic thrombocytopenia (non constitutional)
Datatype
boolean
Alias
- UMLS CUI [1]
- C0398639
Beschrijving
Genetic
Datatype
boolean
Alias
- UMLS CUI [1]
- C0813145
Beschrijving
Fanconi
Datatype
boolean
Alias
- UMLS CUI [1]
- C0015625
Beschrijving
FANC complementation group
Datatype
integer
Alias
- UMLS CUI [1]
- C1563385
Beschrijving
Diamond-Blackfan (congenital / constitutional PRCA)
Datatype
boolean
Alias
- UMLS CUI [1]
- C1260899
Beschrijving
Shwachman-Diamond Syndrome
Datatype
boolean
Alias
- UMLS CUI [1]
- C0272170
Beschrijving
Dyserythropoietic Anaemia
Datatype
boolean
Alias
- UMLS CUI [1]
- C0002876
Beschrijving
Dyskeratosis congenita
Datatype
boolean
Alias
- UMLS CUI [1]
- C0265965
Beschrijving
Amegakaryocytic thrombocytopenia
Datatype
boolean
Alias
- UMLS CUI [1]
- C0398639
Beschrijving
ETIOLOGY
Datatype
integer
Alias
- UMLS CUI [1]
- C1314792
Beschrijving
CYTOGENETICS
Beschrijving
Chromosome analysis
Datatype
text
Alias
- UMLS CUI [1]
- C0200867
Beschrijving
CYTOGENETICS If done: Technique used
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0010802
- UMLS CUI [1,2]
- C0449851
Beschrijving
Number of metaphases with anomalies
Datatype
integer
Alias
- UMLS CUI [1,1]
- C1621812
- UMLS CUI [1,2]
- C0449788
Beschrijving
number of metaphases examined
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0582103
- UMLS CUI [1,2]
- C1621812
Beschrijving
trisomy 8
Datatype
integer
Alias
- UMLS CUI [1]
- C0432412
Beschrijving
trisomy 3
Datatype
integer
Alias
- UMLS CUI [1]
- C1519652
Beschrijving
Other or associated abnormalities (specify)
Datatype
integer
Alias
- UMLS CUI [1]
- C0008625
Beschrijving
Chromosomal breakage test
Datatype
integer
Alias
- UMLS CUI [1]
- C0398791
Beschrijving
HAEMATOLOGICAL VALUES
Beschrijving
Haemoglobin
Datatype
float
Maateenheden
- g/dL
Alias
- UMLS CUI [1]
- C0518015
Beschrijving
Platelets
Datatype
float
Alias
- UMLS CUI [1]
- C0005821
Beschrijving
Neutrophils
Datatype
integer
Alias
- UMLS CUI [1]
- C0948762
Beschrijving
Reticulocytes
Datatype
float
Alias
- UMLS CUI [1]
- C0035286
Beschrijving
Ferritin
Datatype
float
Alias
- UMLS CUI [1]
- C0015879
Beschrijving
Haemoglobin
Datatype
integer
Alias
- UMLS CUI [1]
- C0518015
Beschrijving
Platelets
Datatype
integer
Alias
- UMLS CUI [1]
- C0005821
Beschrijving
COMPLICATIONS
Beschrijving
PNH TESTS
Beschrijving
Date of PNH test
Datatype
date
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C2826247
Beschrijving
PNH diagnostics by flow cytometry
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C0016263
Beschrijving
Size of the PNH
Datatype
integer
Maateenheden
- %
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C0456389
Beschrijving
Flow cytometry assessment done on
Datatype
integer
Alias
- UMLS CUI [1]
- C0016263
Beschrijving
(if type of test unknown, write “unknown” here)
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0024790
- UMLS CUI [1,3]
- C3845569
Beschrijving
PNH diagnostics by other test
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0024790
Beschrijving
Clinical manifestations of PNH
Datatype
boolean
Alias
- UMLS CUI [1]
- C0024790
Beschrijving
FIRST IMMUNOSUPPRESSIVE TREATMENT EPISODE
Beschrijving
WAS THE PATIENT TREATED BEFORE THE HSCT PROCEDURE?
Datatype
integer
Alias
- UMLS CUI [1]
- C1514463
Beschrijving
FIRST TREATMENT EPISODE FOR THIS REGISTRATION
Datatype
date
Alias
- UMLS CUI [1,1]
- C3173309
- UMLS CUI [1,2]
- C0392920
Beschrijving
SEQUENTIAL NUMBER
Datatype
integer
Alias
- UMLS CUI [1]
- C1115395
Beschrijving
IF 1ST TREATMENT EPISODE FOR THE PATIENT EVER
Beschrijving
NUMBER OF TRANSFUSIONS BEFORE HSCT
Datatype
text
Alias
- UMLS CUI [1]
- C0014772
Beschrijving
RBC irradiated
Datatype
integer
Alias
- UMLS CUI [1]
- C1548980
Beschrijving
Platelets
Datatype
integer
Alias
- UMLS CUI [1]
- C0005821
Beschrijving
Platelets irradiated
Datatype
integer
Alias
- UMLS CUI [1]
- C0443117
Beschrijving
IF PATIENT HAS BEEN TREATED BEFORE
Beschrijving
Haemoglobin
Datatype
integer
Alias
- UMLS CUI [1]
- C0518015
Beschrijving
Platelets
Datatype
float
Maateenheden
- 1000/uL
Alias
- UMLS CUI [1]
- C0005821
Beschrijving
Platelets
Datatype
integer
Alias
- UMLS CUI [1]
- C0005821
Beschrijving
Neutrophils
Datatype
integer
Alias
- UMLS CUI [1]
- C0948762
Beschrijving
Reticulocytes
Datatype
float
Alias
- UMLS CUI [1]
- C0035286
Beschrijving
Ferritin
Datatype
float
Alias
- UMLS CUI [1]
- C0373607
Beschrijving
REASON FOR THIS TREATMENT
Datatype
integer
Alias
- UMLS CUI [1]
- C1443309
Beschrijving
Medication
Datatype
integer
Alias
- UMLS CUI [1]
- C0013227
Beschrijving
RESPONSE TO THIS IMMUNOSUPPRESSIVE TREATMENT EPISODE
Datatype
integer
Alias
- UMLS CUI [1]
- C0521982
Beschrijving
Date response evaluated
Datatype
date
Alias
- UMLS CUI [1,1]
- C1269701
- UMLS CUI [1,2]
- C1269701
Beschrijving
SECONDARY CLONAL COMPLICATIONS
Datatype
boolean
Alias
- UMLS CUI [1]
- C2939419
Beschrijving
Date of diagnosis of MDS
Datatype
date
Alias
- UMLS CUI [1,1]
- C3463824
- UMLS CUI [1,2]
- C2316983
Beschrijving
MDS WHO classification
Datatype
integer
Alias
- UMLS CUI [1,1]
- C1301142
- UMLS CUI [1,2]
- C3463824
Beschrijving
Date of diagnosis of PNH
Datatype
date
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C2826247
Beschrijving
Size of the PNH clone
Datatype
float
Maateenheden
- %
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C0456389
Beschrijving
Flow cytometry assessment done on
Datatype
integer
Alias
- UMLS CUI [1]
- C0016263
Beschrijving
Clinical manifestations of PNH
Datatype
boolean
Alias
- UMLS CUI [1]
- C0024790
Beschrijving
If HSCT registration also, please proceed to “Status before HSCT” on page 6 If only Immunosuppressive treatment continue to follow-up form
Datatype
boolean
Alias
- UMLS CUI [1]
- C0279085
Beschrijving
ADDITIONAL IMMUNOSUPPRESSIVE TREATMENT EPISODE
Beschrijving
Date treatment started
Datatype
date
Beschrijving
SEQUENTIAL NUMBER OF THIS TREATMENT EPISODE
Datatype
text
Beschrijving
REASON FOR THIS TREATMENT
Datatype
text
Beschrijving
REASON FOR THIS TREATMENT
Datatype
text
Beschrijving
Haemoglobin
Datatype
integer
Alias
- UMLS CUI [1]
- C0518015
Beschrijving
Platelets
Datatype
float
Maateenheden
- 1000/uL
Alias
- UMLS CUI [1]
- C0005821
Beschrijving
Platelets
Datatype
integer
Alias
- UMLS CUI [1]
- C0005821
Beschrijving
Neutrophils
Datatype
integer
Alias
- UMLS CUI [1]
- C0948762
Beschrijving
Reticulocytes
Datatype
float
Alias
- UMLS CUI [1]
- C0035286
Beschrijving
Ferritin
Datatype
float
Alias
- UMLS CUI [1]
- C0373607
Beschrijving
REASON FOR THIS TREATMENT
Datatype
integer
Alias
- UMLS CUI [1]
- C1443309
Beschrijving
Medication
Datatype
integer
Alias
- UMLS CUI [1]
- C0013227
Beschrijving
RESPONSE TO THIS IMMUNOSUPPRESSIVE TREATMENT EPISODE
Datatype
integer
Alias
- UMLS CUI [1]
- C0521982
Beschrijving
Date response evaluated
Datatype
date
Alias
- UMLS CUI [1,1]
- C1269701
- UMLS CUI [1,2]
- C1269701
Beschrijving
SECONDARY CLONAL COMPLICATIONS
Datatype
boolean
Alias
- UMLS CUI [1]
- C2939419
Beschrijving
Date of diagnosis of MDS
Datatype
date
Alias
- UMLS CUI [1,1]
- C3463824
- UMLS CUI [1,2]
- C2316983
Beschrijving
MDS WHO classification
Datatype
integer
Alias
- UMLS CUI [1,1]
- C1301142
- UMLS CUI [1,2]
- C3463824
Beschrijving
Date of diagnosis of PNH
Datatype
date
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C2826247
Beschrijving
Size of the PNH clone
Datatype
float
Maateenheden
- %
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C0456389
Beschrijving
Flow cytometry assessment done on
Datatype
integer
Alias
- UMLS CUI [1]
- C0016263
Beschrijving
Clinical manifestations of PNH
Datatype
boolean
Alias
- UMLS CUI [1]
- C0024790
Beschrijving
If HSCT registration also, please proceed to “Status before HSCT” on page 6 If only Immunosuppressive treatment continue to follow-up form
Datatype
boolean
Alias
- UMLS CUI [1]
- C0279085
Beschrijving
STATUS AT HSCT
Beschrijving
Date of HSCT
Datatype
date
Alias
- UMLS CUI [1]
- C2584899
Beschrijving
Chromosome analysis
Datatype
integer
Alias
- UMLS CUI [1]
- C0200867
Beschrijving
Chromosome analysis
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0200867
- UMLS CUI [1,2]
- C0200888
Beschrijving
Number of metaphases with anomalies
Datatype
integer
Alias
- UMLS CUI [1,1]
- C1621812
- UMLS CUI [1,2]
- C0449788
Beschrijving
number of metaphases examined
Datatype
integer
Alias
- UMLS CUI [1,1]
- C1621812
- UMLS CUI [1,2]
- C0449788
Beschrijving
Chromosome analysis
Datatype
text
Beschrijving
Other or associated abnormalities (specify)
Datatype
text
Beschrijving
Haemoglobin
Datatype
float
Maateenheden
- g/dL
Alias
- UMLS CUI [1]
- C0518015
Beschrijving
Platelets
Datatype
float
Alias
- UMLS CUI [1]
- C0005821
Beschrijving
Neutrophils
Datatype
integer
Alias
- UMLS CUI [1]
- C0948762
Beschrijving
Reticulocytes
Datatype
float
Alias
- UMLS CUI [1]
- C0035286
Beschrijving
Ferritin
Datatype
float
Alias
- UMLS CUI [1]
- C0015879
Beschrijving
Haemoglobin
Datatype
integer
Alias
- UMLS CUI [1]
- C0518015
Beschrijving
Platelets
Datatype
integer
Alias
- UMLS CUI [1]
- C0005821
Beschrijving
Haemorrhages
Datatype
integer
Alias
- UMLS CUI [1]
- C0019080
Beschrijving
Resistance to random platelets
Datatype
integer
Alias
- UMLS CUI [1]
- C1277097
Beschrijving
Systemic infection
Datatype
integer
Alias
- UMLS CUI [1]
- C0243026
Beschrijving
Date of PNH test
Datatype
date
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C2826247
Beschrijving
PNH diagnostics by flow cytometry
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C0016263
Beschrijving
Size of the PNH
Datatype
integer
Maateenheden
- %
Alias
- UMLS CUI [1,1]
- C0024790
- UMLS CUI [1,2]
- C0456389
Beschrijving
Flow cytometry assessment done on
Datatype
integer
Alias
- UMLS CUI [1]
- C0016263
Beschrijving
(if type of test unknown, write “unknown” here)
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0024790
- UMLS CUI [1,3]
- C3845569
Beschrijving
PNH diagnostics by other test
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0024790
Beschrijving
Clinical manifestations of PNH
Datatype
boolean
Alias
- UMLS CUI [1]
- C0024790
Beschrijving
NUMBER OF TRANSFUSIONS BEFORE HSCT
Datatype
text
Alias
- UMLS CUI [1]
- C0014772
Beschrijving
RBC irradiated
Datatype
integer
Alias
- UMLS CUI [1]
- C1548980
Beschrijving
Platelets
Datatype
integer
Alias
- UMLS CUI [1]
- C0005821
Beschrijving
Platelets irradiated
Datatype
integer
Alias
- UMLS CUI [1]
- C0443117
Beschrijving
ADDITIONAL TREATMENT POST-HSCT
Beschrijving
BEST DISEASE RESPONSE AT 100 DAYS POST-HSCT
Beschrijving
BEST RESPONSE AT 100 DAYS AFTER HSCT
Datatype
integer
Alias
- UMLS CUI [1]
- C1704632
Beschrijving
BEST RESPONSE AT 100 DAYS AFTER HSCT
Datatype
integer
Alias
- UMLS CUI [1,1]
- C1704632
- UMLS CUI [1,2]
- C3845569
Beschrijving
Date response evaluated
Datatype
date
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C1269701
Beschrijving
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])