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Hematology Tissue Bank Sample Request

Justification of Request for Samples:

Sample Type Number of Samples Requested (max 100 total, yearly)
Fresh whole peripheral blood (PB)
Fresh bone marrow (BM)
Cryopreserved  PB mononuclear cells
Cryopreserved BM mononuclear cells
Cryopreserved plasma

Additional Sample Requests:

Principal Investigator:
Date:
Email:

 

 
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