QNo.

Questions and Instructions

Response

Code

1

At what age did the child first present with signs and symptoms of SCA?

Which one?

2

Has the child ever received blood transfusion?

Yes…total number of BT

When was the last BT?

No

3

What was the age of the first blood transfusion?

4

Total number of admissions since diagnosis SCA, of days/weeks hospitalized in the last admission?

5

Total number of admissions in the past six months