Question 23: Date of most recent complete blood count (CBC) sample drawn:

These questions are intended to determine the clinical status of the recipient at time of follow-up for this reporting period post cellular therapy. Testing may be performed multiple times post-infusion; report the most recent CBC obtained.

Questions 24-32: 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 the white blood cells in the blood. If the count is too high or too low, the ability to fight infection may be impaired. Report the WBC value in question 25.

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). Report the neutrophil value in question 26.

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. Report the lymphocyte value in question 27.

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. Report the hemoglobin value in question 28.

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 sample draw date. Report the hematocrit value in question 29.

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 30.

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. Report the platelet value in question 31.

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 23.

Questions 33: Did the recipient receive any growth factors <7 days before the date the sample was drawn?

Indicate if the recipient received any growth factor (e.g., GCS-F) within 7 days prior to the date the CBC sample was drawn. 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 to the date the CBC sample was drawn.

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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