Donor Abstract
| IDENTIFICATION NO RR276 | DATE 4/01/97 | ||||
PHYSICAL AND PERSONAL CHARACTERISTICS |
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| DOB (M/Y) 11/73 | PLACE OF BIRTH Czechoslovakia | ||||
| HEIGHT 6'1" | WEIGHT 189 | ||||
| EYE COLOR Brown | COMPLEXION Fair | ||||
| HAIR Brown, wavy | RIGHT HANDED X | LEFT HANDED | |||
| RELIGION BORN INTO
Roman Catholic |
MARRIED No | NO. OF CHILDREN none | |||
| YRS OF COLLEGE 6 | OCCUPATION Graduate student in architectural engineering | HERITAGE Czech, Croatian, Italian, Greek, Gypsy | |||
| INTERESTS sports, reading, travel | |||||
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TEST RESULTS |
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| Blood Type O Positive | HIV 1/2 Ab. & HIV 1 Ag. Nonreactive | ||||
| Chlamydia Swab and Urine Nonreactive | HTLV-1 Ab. Nonreactive | ||||
| Chromosome analysis Normal Male | Neisseria gonorrhea No Growth | ||||
| CMV, IgM/Culture Nonreactive/No Growth | SGPT Within Normal Limits | ||||
| Cystic
Fibrosis Noncarrier of common deletions |
Sickle cell Not Applicable | ||||
| Group B streptococcus No Growth | Syphilis, antibody Nonreactive | ||||
| HbsAg & HbcAb Nonreactive | Tay Sachs Not Applicable | ||||
| Hepatitis C, Ab Nonreactive | Thalassemia Normal Adult Hemoglobin | ||||
| Trichomonas & yeast None Seen | |||||
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DONOR AND FAMILY HEALTH HISTORY |
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| MEDICAL PROBLEM | DONOR | RELATIVE | |||
| HEART |
None |
Paternal Grandfather: heart attack, high blood pressure, hardening of the arteries | |||
BLOOD |
None | Cousin: anemia | |||
| RESPIRATORY | None | None | |||
| GASTROINTESTINAL | None | Mother: ulcer | |||
| METABOLIC/ENDOCRINE | None | None | |||
| URINARY | None | None | |||
| GENITAL/REPRODUCTIVE SYSTEM | Undescended testicle | None | |||
| NEUROLOGICAL | None | Aunt: migraine headaches | |||
| MENTAL HEALTH | None | None | |||
| MUSCLES/BONES/JOINTS | None | None | |||
| SIGHT/SOUND/SMELL | None | None | |||
| SKIN | None | None | |||
| OTHER | None | Grandmother: cancer | |||
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FAMILY HISTORY |
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| LEVEL OF SCHOOLING: | Mother B.A. degree | Father B.A. degree | |||
| OCCUPATION: | Mother
Director of child care center |
Father
Business sales manager |
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| AGE IF LIVING | AGE AT DEATH | CAUSE OF DEATH | |||
| MOTHER | 54 | ||||
| FATHER | 58 | ||||
| MATERNAL GRANDFATHER | 78 | ||||
| MATERNAL GRANDMOTHER | 77 | ||||
| PATERNAL GRANDFATHER | 57 | Heart attack | |||
| PATERNAL GRANDMOTHER | 55 | Cancer | |||
| BROTHERS | |||||
| SISTERS | |||||