Haemopoietic Stem Cell Services
Forms and Leaflets
All files are stored in a PDF format and require Adobe Acrobat Reader
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Form 2A: Request to Collect PBSC, Lymphocytes or Whole Blood
Form 2C: Request for Directed Cord Blood Collection
Form 2E: Request to Test or Process Fresh PBSC, Bone Marrow or Lymphocytes
Form 2F: Request for Issue of Cryopreserved PBSC, Bone Marrow or Lymphocytes
Form 2J: Request to Collect, Process and Test PBSC, Lymphocytes or Whole Blood
FRM/DDR/SB/012
Form 2G: Engraftment Report Form: 30 Days Post Stem Cell Transplantation
Form 2H: Clinical Outcome Report Form: 100 Days Post Stem Cell Transplantation
FRM/DDR/SB/011
Form 2Q: Clinical Outcome Report Form: 100 Days Post Donor Lymphocyte Infusion
FRM/DDR/SB/015
2B, Conent for the Testing, Storage and Discard of Stem Cells or Lymphocytes
2D, Consent for Directed Cord Blood Collection, Testing and Cryopreservation
2K, Guidance for Healthcare Professionals in Consenting for the Testing, Storage and Discard of Stem Cells or Lymphocytes
2L, Guidance fo Healthcare Professionals in Consenting for the Collection, Testing and Cryopreservation of Cord Blood for Directed Transplantation
Form 2M: Record of Transfer of Products Between Institutions
Form 2N: Stem Cell product Return Form
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The following forms and information leaflets are obtainable from Blood Centres or the BBMR.
British Bone Marrow Registry:
- BBMR Unrelated Marrow and Cord Blood Search Request Form
- BBMR Cord Blood Unit Request Form
- Example of a BBMR report listing possible stem cell donors
- Request for Confirmatory Typing Samples from BBMR Donors Form
- Formal Recruitment of a Stem Cell Donor (BBMR)
- Prescription for a Bone Marrow Harvest (BBMR)
- Prescription for a Stimulated Peripheral Blood Stem Cell Collection (BBMR)
Collection and Processing of Stem Cells and Lymphocytes:
- Consent for Microbiology Testing and Stem Cell Collection and Cryopreservation
- Request to Collect Bone Marrow or Whole Blood
- Request to Collect Stem Cells or Lymphocytes from Peripheral Blood
- Request for a Directed Cord Blood Collection
- Prescription for Stem Cell or Lymphocyte Processing
- Request for Thawing/Washing/Reinfusion of Cryopreserved Cells
- Engraftment and adverse reactions from stem cells
- Adverse Reactions from Donor Lymphocyte Infusions
Information Leaflets:
- Information leaflet for apheresis donors
- Information leaflet – care of your femoral line
Complaints:
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