This section of the CIBMTR Forms Instruction Manual is intended to be a resource for completing the Aplastic Anemia Pre-Infusion Data Form (Form 2028 – Revision 3).
Aplastic Anemia Pre-Infusion Data
The Aplastic Anemia Pre-Infusion Data Form is one of the Comprehensive Report Forms. This form captures aplastic anemia specific pre-Infusion data such as: disease assessment at diagnosis, laboratory studies at diagnosis, transfusion status prior to the start of the preparative regimen, and laboratory studies prior to the start of the preparative regimen.
This form must be completed for all recipients whose primary disease is reported on the Pre-TED Disease Classification Form (Form 2402) as aplastic anemia or one of the following inherited bone marrow failure syndromes: Shwachman-Diamond syndrome, Diamond-Blackfan anemia (pure red cell aplasia), Dyskeratosis congenita, or other inherited bone marrow failure syndrome. Fanconi Anemia and Sickle Cell Anemia each have their own forms to complete (Forms 2029 and 2030, respectively).
Q1: Subsequent Infusion
Q2-33: Disease Assessment
Q34-58: Laboratory Studies at Diagnosis
Q59-70: Pre-Infusion Therapy
Q71 – 79: Transfusion Status from Diagnosis to the Start of the Preparative Regimen / Infusion
Q80 – 97: Laboratory Findings Prior to the Start of the Preparative Regimen / Infusion
Sections of the Forms Instruction Manual are frequently updated. The most recent updates to the manual can be found below. For additional information, select the manual section and review the updated text.
|10/23/2020||2028: Aplastic Anemia Pre-HCT||Modify||Version 2 of the 2028: Aplastic Anemia Pre-HCT Data section of the Forms Instructions Manual released. Version 2 corresponds to revision 3 of the Form 2028.|
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