Questions 74 – 75: Was hemoglobin electrophoresis performed?

Indicate if hemoglobin electrophoresis studies were performed since the date of last report. If hemoglobin electrophoresis studies were performed, report Yes and provide the date of the most recent hemoglobin electrophoresis study performed in the current reporting period.

If hemoglobin studies were not performed or if no information is available to determine if hemoglobin electrophoresis studies were conducted in the current reporting period, select No or Unknown and go to question 89.

If RBC transfusion(s) were given within four weeks of the hemoglobin electrophoresis, report Not applicable and go to question 89.

Questions 76 – 88: Specify the hemoglobin allele types based on the sample tested in question 75

Specify the hemoglobin allele types identified in the reported hemoglobin electrophoresis study (reported above in question 75). If the hemoglobin allele type was assessed, report Yes and specify the percentage. If additional sickle related hemoglobin allele types are identified and not listed as options on the form, report Yes for Other sickle related hemoglobin allele type in question 86, specify the other hemoglobin type, and provide the percentage.

Report No if the specified hemoglobin allele type was not assessed.

Questions 89 – 91: Were red blood cell counts tested?

Red blood cell counts are part of a complete blood count panel. Indicate if red blood cell counts were measured since the date of last report. If red blood cell counts were assessed during the current reporting period, report Yes, provide the RBC cell count in cells / µL and specify the date the sample was collected for examination. If RBC counts were measured multiple times in the reporting period, report the most recent results.

If RBC counts were not measured in the current reporting period or if no information is available to determine if RBC counts were assessed, select No or Unknown, respectively.

If the sample collection date is partially known (i.e., the recipient’s RBC counts were measured in mid-July 2019), use the process described in reporting partial or unknown dates in General Instructions, Guidelines for Completing Forms.

Questions 92 – 94: Were reticulocyte counts tested?

Indicate if reticulocyte counts were assessed since the date of last report. If reticulocyte counts were measured in the current reporting period, report Yes, provide the reticulocyte cell count, and specify the date the sample was collected for examination. If reticulocyte counts were measured multiple times in the current reporting period, report the most recent results.

If reticulocyte counts were not measured since the date of last report or if no information is available to determine if reticulocyte counts were assessed, select No or Unknown, respectively.

If the sample collection date is partially known (i.e., the recipient’s reticulocyte counts were measured in mid-July 2019), use the process described for reporting partial or unknown dates in General Instructions, Guidelines for Completing Forms.

Questions 95 – 97: Were soluble transferrin receptors (sTfR) tested?

Soluble transferring receptors (sTfR) are proteins found in the blood and are used as a measure of functional iron status. These levels are typically elevated in individuals with an iron deficiency (i.e., iron deficiency anemia).

Indicate if sTfR was tested since the date of last report. If sTfR counts were assessed in the current reporting period, report Yes, provide the sTfR value in mg / L, and specify the date the sample was collected for. If sTfR was measured multiple times in the current reporting period, report the most recent results.

If sTfR counts were not measured since the date of last report or if no information is available to determine if sTfR counts were measured, select No or Unknown, respectively.

If the sample collection date is partially known (i.e., the recipient’s sTfR counts were measured in mid-July 2019), use the process described for reporting partial or unknown dates in General Instructions, Guidelines for Completing Forms.

Questions 98 – 100: Was an erythropoietin (EPO) level obtained?

Erythropoietin (EPO) is a hormone predominantly produced in the kidneys which plays a critical role in the production of red blood cells.
Indicate if EPO was tested since the date of last report. If EPO levels were assessed in the current reporting period, report Yes, specify the EPO level in IU / L, and report the date the sample was collected for examination. If EPO was measured multiple dates in the reporting period, report the results of the most recent assessment.

If EPO levels were not measured or if no information is available to determine if EPO levels were assessed since the date of last report, select No or Unknown, respectively.

If the sample collection date is partially known (i.e., the recipients sTfR counts were measured in mid-2019), use the process described for reporting partial or unknown dates in General Instructions, Guidelines for Completing Forms.

Last modified: Jul 26, 2020

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