Contents

Purpose

Record the patient's received transfusions.

Transfusions eCRF

Field Name

Description / Instructions

Format

Visit Date

The Visit Date is optional on this case report form. Hit the "Tab" key to leave it empty and move to the Date field.

DD-MMM-YYYY

Course #(d)

Indicates the course number the transfusion is related to based on their date and the Course Initiation start dates.

5 digits

Day in Course(d)

Indicates the day since the beginning of course the transfusion is related to based on their date and the Course Initiation start dates.

5 digits

Date(m)

Enter the date that the transfusion was done.

DD-MMM-YYYY

Time(m)

Enter the time the transfusion was done.

HH(24):MM

Transfusion Component(m)

Select the transfusion component from the pick list.

Use pick list.

(#) of Units(m)

Enter the blood component number of units transfused (in Units)

3 digits

Legend: (d) derived field, (m) RDC mandatory, (c) for CTEP reporting only.

Validations

Code

Description

Resolutions

TF01

Transfusion date is in the future.

Enter a date that is equal to or prior to the current date.

TF02

Two or more transfusions with the same date and time.

There can only be one transfusion for a date and time.

Derivations

Code

Field Name

Description

TF1001

Course #

Course number is derived based on the course initiation start dates and the transfusion date.

TF1002

Day in Course

Number of days since the beginning of the course is derived from the course initiation start date and the transfusion date.