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Registration Form for BM Histology

1 forms  
Show identification of patient
Description

Show identification of patient

Dummy
Description

Dummy

Data type

text

Bone marrow biopsy basic data
Description

Bone marrow biopsy basic data

Report number
Description

Report number

Data type

text

Date of bone marrow biopsy
Description

Date of bone marrow biopsy

Data type

date

Reference center
Description

Center

Data type

integer

Size of bone marrow biopsy 1
Description

Size of bone marrow biopsy 1

Data type

integer

Measurement units
  • mm
mm
Size of bone marrow biopsy 2
Description

Size of bone marrow biopsy 2

Data type

integer

Measurement units
  • mm
mm
Fixation
Description

Fixation

Data type

integer

Decalcification
Description

Decalcification

Data type

integer

Quality of bone marrow biopsy
Description

Quality of bone marrow trephine

Data type

integer

Other center
Description

Other center

Other center
Description

Other center

Data type

text

Type of fixation
Description

Type of fixation

Type of fixation
Description

Type of fixation

Data type

integer

Other type of fixation
Description

Other type of fixation

Data type

text

Cellularity
Description

Cellularity

Total
Description

Total

Data type

integer

Granulopoiesis
Description

Granulopoiesis

Data type

integer

Erythropoiesis
Description

Erythropoiesis

Data type

integer

Megakaryopoiesis
Description

Megakaryopoiesis

Data type

integer

Megakaryopoiesis immunohistochemically proven
Description

Megakaryopoiesis immunohistochemically proven

Data type

integer

Patch areas - Erythropoiesis
Description

Patch areas - Erythropoiesis

Data type

integer

Patch areas - Granulopoiesis
Description

Patch areas - Granulopoiesis

Data type

integer

Fat tissue from
Description

Fat tissue from

Data type

integer

Measurement units
  • %
%
Fat tissue to
Description

Fat tissue to

Data type

integer

Measurement units
  • %
%
Fe
Description

Fe

Data type

integer

Maturation defects
Description

Maturation defects

Erythropoiesis - maturing
Description

Erythropoiesis - maturing

Data type

integer

Erythropoiesis - left shifted
Description

Erythropoiesis - left shifted

Data type

integer

Erythropoiesis - increased mitoses
Description

Erythropoiesis - increased mitoses

Data type

integer

Granulopoiesis - maturing
Description

Granulopoiesis - maturing

Data type

integer

Granulopoiesis - left shifted
Description

Granulopoiesis - left shifted

Data type

integer

Megakaryopoiesis - micromegakaryocytes
Description

Megakaryopoiesis - maturing

Data type

integer

Megakaryopoiesis - other dysplastic features
Description

Megakaryopoiesis - other dysplastic features

Data type

integer

Myelofibrosis
Description

Myelofibrosis

Myelofibrosis
Description

Myelofibrosis

Data type

integer

Type of myelofibrosis
Description

Type of myelofibrosis

Data type

integer

Patchy myelofibrosis
Description

Patchy myelofibrosis

Data type

integer

Blasts
Description

Blasts

Percentage of blasts
Description

Percentage of blasts

Data type

integer

Distribution of blasts
Description

Distribution of blasts

Data type

integer

Immunophenotype of blasts
Description

Immunophenotype of blasts

Data type

integer

Specify immunophenotype
Description

Specify immunophenotype

Data type

integer

Other type of immunophenotype
Description

Other type of immunophenotype

Data type

text

Diagnosis
Description

Diagnosis

Diagnosis
Description

Diagnosis

Data type

integer

Other type of diagnosis
Description

Other type of diagnosis

Data type

text

Other features of diagnosis
Description

Other features of diagnosis

PB blood smear was available for review of biopsy
Description

PB blood smear was available for review of biopsy

Data type

integer

BM aspirate was available for review of biopsy
Description

BM aspirate was available for review of biopsy

Data type

integer

Comment
Description

Comment

Data type

text

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Similar models

Registration Form for BM Histology

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Dummy
Item
Dummy
text
Report number
Item
Report number
text
Date of bone marrow biopsy
Item
Date of bone marrow biopsy
date
Item
Reference center
integer
Biopsy center
Code List
Reference center
CL Item
Simonitsch-Klupp (Vienna) (2)
CL Item
De Paepe (Ghent) (3)
CL Item
Campr (Prague) (4)
CL Item
Baumann (Böblingen) (5)
CL Item
Schwarz-Furlan (Kaufbeuren) (6)
CL Item
O´Sullivan (Dublin) (7)
CL Item
Devito (Rome) (8)
CL Item
Leguit (Utrecht) (9)
CL Item
Kerndrup (Vejle) (10)
CL Item
Hernandez (Valencia) (11)
CL Item
Other (99)
CL Item
Reference pathology not further specified (1)
Size of bone marrow biopsy 1
Item
Size of bone marrow biopsy 1
integer
Size of bone marrow biopsy 2
Item
Size of bone marrow biopsy 2
integer
Item
Fixation
integer
NoYes
Code List
Fixation
CL Item
No (1)
CL Item
Yes (2)
Item
Decalcification
integer
Decalcification
Code List
Decalcification
CL Item
EDTA (1)
CL Item
Formic acid (2)
Item
Quality of bone marrow biopsy
integer
Biopsy quality
Code List
Quality of bone marrow biopsy
CL Item
OK (1)
CL Item
Insufficient (2)
CL Item
Not evaluable (3)
Item Group
Other center
Item
Other center
text
Item
Type of fixation
integer
Fixation
Code List
Type of fixation
CL Item
Formaldehyde 4-5% (1)
CL Item
Other (99)
Other type of fixation
Item
Other type of fixation
text
Item Group
Item
Total
integer
Cellularity of biopsy
Code List
Total
CL Item
Absent (1)
CL Item
Decreased (2)
CL Item
Normal (3)
CL Item
Increased (4)
Item
Granulopoiesis
integer
Cellularity of biopsy
Code List
Granulopoiesis
CL Item
Absent (1)
CL Item
Decreased (2)
CL Item
Normal (3)
CL Item
Increased (4)
Item
Erythropoiesis
integer
Cellularity of biopsy
Code List
Erythropoiesis
CL Item
Absent (1)
CL Item
Decreased (2)
CL Item
Normal (3)
CL Item
Increased (4)
Item
Megakaryopoiesis
integer
Cellularity of biopsy
Code List
Megakaryopoiesis
CL Item
Absent (1)
CL Item
Decreased (2)
CL Item
Normal (3)
CL Item
Increased (4)
Item
Megakaryopoiesis immunohistochemically proven
integer
NoYes
Code List
Megakaryopoiesis immunohistochemically proven
CL Item
No (1)
CL Item
Yes (2)
Item
Patch areas - Erythropoiesis
integer
NoYes
Code List
Patch areas - Erythropoiesis
CL Item
No (1)
CL Item
Yes (2)
Item
Patch areas - Granulopoiesis
integer
NoYes
Code List
Patch areas - Granulopoiesis
CL Item
No (1)
CL Item
Yes (2)
Fat tissue from
Item
Fat tissue from
integer
Fat tissue to
Item
Fat tissue to
integer
Item
Fe
integer
Fe
Code List
Fe
CL Item
None (1)
CL Item
Low (2)
CL Item
Normal (3)
CL Item
High (4)
Item
Erythropoiesis - maturing
integer
NoYes
Code List
Erythropoiesis - maturing
CL Item
No (1)
CL Item
Yes (2)
Item
Erythropoiesis - left shifted
integer
NoYes
Code List
Erythropoiesis - left shifted
CL Item
No (1)
CL Item
Yes (2)
Item
Erythropoiesis - increased mitoses
integer
NoYes
Code List
Erythropoiesis - increased mitoses
CL Item
No (1)
CL Item
Yes (2)
Item
Granulopoiesis - maturing
integer
NoYes
Code List
Granulopoiesis - maturing
CL Item
No (1)
CL Item
Yes (2)
Item
Granulopoiesis - left shifted
integer
NoYes
Code List
Granulopoiesis - left shifted
CL Item
No (1)
CL Item
Yes (2)
Item
Megakaryopoiesis - micromegakaryocytes
integer
NoYes
Code List
Megakaryopoiesis - micromegakaryocytes
CL Item
No (1)
CL Item
Yes (2)
Item
Megakaryopoiesis - other dysplastic features
integer
NoYes
Code List
Megakaryopoiesis - other dysplastic features
CL Item
No (1)
CL Item
Yes (2)
Item Group
Item
Myelofibrosis
integer
NoYes
Code List
Myelofibrosis
CL Item
No (1)
CL Item
Yes (2)
Item
Type of myelofibrosis
integer
Myelofibrosis
Code List
Type of myelofibrosis
CL Item
Slight (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Item
Patchy myelofibrosis
integer
NoYes
Code List
Patchy myelofibrosis
CL Item
No (1)
CL Item
Yes (2)
Item Group
Item
Percentage of blasts
integer
Percentage of blasts
Code List
Percentage of blasts
CL Item
< 5% (1)
CL Item
5-9% (2)
CL Item
10-19% (3)
CL Item
20-29% (4)
CL Item
30-50% (5)
CL Item
> 50% (6)
Item
Distribution of blasts
integer
Type of blasts
Code List
Distribution of blasts
CL Item
Focal (1)
CL Item
Diffuse (2)
Item
Immunophenotype of blasts
integer
NoYes
Code List
Immunophenotype of blasts
CL Item
No (1)
CL Item
Yes (2)
Item
Specify immunophenotype
integer
Immunophenotype
Code List
Specify immunophenotype
CL Item
Negative (1)
CL Item
CD 34 pos. (2)
CL Item
Other (99)
Other type of immunophenotype
Item
Other type of immunophenotype
text
Item Group
Item
Diagnosis
integer
MDS biopsy diagnosis
Code List
Diagnosis
CL Item
RC (41)
CL Item
RARS (42)
CL Item
RAEB (43)
CL Item
RAEB-t (44)
CL Item
MDR-AML (40)
CL Item
JMML (45)
CL Item
Myelofibrotic MDS (60)
CL Item
Aplasia (20)
CL Item
Other (99)
Other type of diagnosis
Item
Other type of diagnosis
text
Item
PB blood smear was available for review of biopsy
integer
NoYes
Code List
PB blood smear was available for review of biopsy
CL Item
No (1)
CL Item
Yes (2)
Item
BM aspirate was available for review of biopsy
integer
NoYes
Code List
BM aspirate was available for review of biopsy
CL Item
No (1)
CL Item
Yes (2)
Comment
Item
Comment
text
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