Question 89: Date complete blood count (CBC) sample drawn:

These questions are intended to determine the clinical status of the recipient prior to the start of lymphodepleting therapy for cellular therapy. Testing may be performed multiple times within the pre-infusion work-up time period; report the most recent CBC obtained. Laboratory values obtained on the first day of the lymphodepleting therapy may be reported as long as the blood was drawn before any lymphodepleting therapy was administered.
If no lymphodepleting therapy is given, report most recent CBC result prior to the cellular infusion.

Questions 90-97: Complete blood count results available: (check all that apply)

For each cell type listed, checking the box will indicate a result is available. Provide the most recent laboratory values from the CBC on the date reported in the prior question.

WBC: The white blood cell count is a value that represents all of the white blood cells in the blood. If the count is too high or too low, the ability to fight infection may be impaired.

Neutrophils: Neutrophils are a subtype of white blood cell that fights infection. The value on the laboratory report may be a percentage or an absolute value. If an absolute value is reported, divide it by the white blood cell count for a percentage. Neutrophils are also known as polymorphonuclear leukocytes (PMNs).

Lymphocytes: Lymphocytes are another subtype of white blood cell that fights infection. The value on the laboratory report may be a percentage of an absolute value. If an absolute value is reported, divide it by the white blood cell count for a percentage.

Hemoglobin: Hemoglobin is a molecule in red blood cells that delivers oxygen to tissues throughout the body. A low hemoglobin count is considered “anemia” and blood transfusions, or growth factors may be required to increase the hemoglobin level.

Hematocrit: The hematocrit is the percentage (sometimes displayed as a proportion) of red blood cells relative to the total blood volume. A low hematocrit may require red blood cell transfusions or growth factors. Indicate if the recipient received a red blood cell transfusion within 30 days prior to obtaining the blood sample.

If a hematocrit value is reported, also indicate if the recipient received a red blood cell transfusion within 30 days prior to the date of the CBC reported in question 85.

Platelets: Platelets are formed elements within the blood that help with coagulation. A low platelet count, called thrombocytopenia, may lead to easy bleeding or bruising. Thrombocytopenia may require platelet transfusions. Indicate if the recipient received a platelet transfusion within 7 days prior to testing.

If a platelet value is reported, also indicate if the recipient received a platelet transfusion within 7 days prior to the date of the CBC reported in question 85.

Question 99: Did the recipient receive any growth factors <7 days before the start of systemic therapy?

Indicate if the recipient received any growth factor (e.g. GCS-F) within 7 days prior to the start of systemic therapy (i.e. lymphodepleting therapy). If no systemic therapy was given, indicate if the recipient received any growth factor (e.g. GCS-F) within 7 days prior to the infusion. In the event of a long acting growth factor (e.g. pegfilgrastim (Neulasta®), please answer this question as yes if the recipient received it within 14 days prior.

Section Updates:

Question Number Date of Change Add/Remove/Modify Description Reasoning (If applicable)
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Last modified: Jan 22, 2021

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