Saved Items (0)
Cart (0)
Total: 0.00 USD
Sign In
Create An Account
Products
Services
Technical Resources
Contact Us
About Us
Order Online
Home
Forms
Proficiency Testing
Proficiency Testing Fresh Cord Blood
Proficiency Testing Fresh Cord Blood
Submit data from proficiency testing using this form.
First Name
*
Last Name
*
Email Address
*
Institution
*
Participant ID
Session
January 2012
Comments
We will send an electronic copy of your results. If you require a hard copy, please request one here. Electronic and hard copies of results are identical. If you have any other comments to add to your data submission, please enter them here. (Max 150 characters)
Part I - Cell Processing and Inoculation
Date of Assay Setup
Year
Month
Day
2010
2011
2012
2013
2014
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
Volume of CB Sample (mL)
(no commas only periods)
*
Volume of CB Sample Used in 10X Cell Dilution (mL)
(no commas only periods)
*
Volume of IMDM+2% FBS Used in 10X Cell Dilution (mL)
(no commas only periods)
*
Part II - Cell Counting
Nucleated Cell Concentration (nucleated cells/mL)
*
Method of Assessing Nucleated Cell Concentration
Manual
Automated
*
Part III - CD34 Enumeration
CD34 Enumeration is optional for non-NMDP members.
Instrument Supplier
Instrument Model
Methodology
ISHAGE Protocol
Modified ISHAGE
Double Platform
Single Platform
Other (describe)
Other (describe)
Reagents - CD34
Reagents - CD45
Reagents - Other
% CD34+ Gated on Viable Cells
% CD45+CD34+ Gated on Viable Cells
Part IV - Colony Enumeration
Count colonies on day 14 and record results below
Date counted
Year
Month
Day
2010
2011
2012
2013
2014
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
Dish 1: BFU-E
Dish 1: CFU-GM
Dish 1: CFU-GEMM
Dish 1: Total CFC
If you prefer, enter the total CFC rather than numbers for each colony type.
Dish 2: BFU-E
Dish 2: CFU-GM
Dish 2: CFU-GEMM
Dish 2: Total CFC
If you prefer, enter the total CFC rather than numbers for each colony type.
Dish 3: BFU-E
Dish 3: CFU-GM
Dish 3: CFU-GEMM
Dish 3: Total CFC
If you prefer, enter the total CFC rather than numbers for each colony type.
Dish 4: BFU-E
Dish 4: CFU-GM
Dish 4: CFU-GEMM
Dish 4: Total CFC
If you prefer, enter the total CFC rather than numbers for each colony type.
Part V - Colony Identification
Identify photographs A-H below.
Photo A Colony
BFU-E
CFU-GM
CFU-GEMM
Not submitted
*
Photo B Colony
BFU-E
CFU-GM
CFU-GEMM
Not submitted
*
Photo C Colony
BFU-E
CFU-GM
CFU-GEMM
Not submitted
*
Photo D Colony
BFU-E
CFU-GM
CFU-GEMM
Not submitted
*
Photo E Colony
BFU-E
CFU-GM
CFU-GEMM
Not submitted
*
Photo F Colony
BFU-E
CFU-GM
CFU-GEMM
Not submitted
*
Photo G Colony
BFU-E
CFU-GM
CFU-GEMM
Not submitted
*
Photo H Colony
BFU-E
CFU-GM
CFU-GEMM
Not submitted
*