Donor Abstract 

IDENTIFICATION NO. RR343 DATE 11/02

 PHYSICAL AND PERSONAL CHARACTERISTICS
DOB (M/Y) 04/1976 PLACE OF BIRTH  New Mexico
HEIGHT 5'9" WEIGHT 142
EYE COLOR  Brown COMPLEXION Fair
HAIR Brown, Wavy RIGHT HANDED  X LEFT HANDED
RELIGION BORN INTO Episcopal MARRIED No NO. OF CHILDREN None
YRS OF COLLEGE 7 OCCUPATION Medical Student HERITAGE German, Irish, Scandinavian
INTERESTS Athletics, Film making

 TEST RESULTS
Blood Type O Positive HIV 1/2 Ab. & HIV 1 Ag.  Nonreactive
Chlamydia Negative  HTLV-1,2 Ab. Nonreactive
Chromosome analysis 46, XY Neisseria gonorrhea Negative
CMV, IgG Negative SGPT Normal
Cystic Fibrosis 37 Common Mutations - Negative Sickle cell Not Applicable
Group B streptococcus  Negative Syphilis, antibody Nonreactive
HbsAg & HbcAb Nonreactive Tay Sachs & Canavan Not Tested
Hepatitis C, Ab Nonreactive Thalassemia Normal Adult Hemoglobin
Trichomonas & yeast  Not Present  

 

 DONOR AND FAMILY HEALTH HISTORY

 
MEDICAL PROBLEM DONOR RELATIVE

HEART

None

 Maternal Grandmother-hypertension; Paternal Grandfather - Heart Disease

BLOOD

 None None
RESPIRATORY None None
GASTROINTESTINAL None Maternal Grandmother - Gallstones
METABOLIC/ENDOCRINE None None
URINARY None   None 
GENITAL/REPRODUCTIVE SYSTEM None  None
NEUROLOGICAL None Paternal Cousin is mildly retarded - undiagnosed; Paternal Grandmother -  brain tumor
MENTAL HEALTH None  None
MUSCLES/BONES/JOINTS None
SIGHT/SOUND/SMELL None None
SKIN None None
OTHER None Paternal Grandfather - alcoholic

 

 FAMILY HISTORY

 
LEVEL OF SCHOOLING: Mother RN Father MD
OCCUPATION: Mother Nurse Father Physician
 
  AGE IF LIVING AGE AT DEATH CAUSE OF DEATH
MOTHER 51
FATHER 59
MATERNAL GRANDFATHER 83
MATERNAL GRANDMOTHER 77
PATERNAL GRANDFATHER 68 Heart Attack
PATERNAL GRANDMOTHER 62 Brain Tumor
BROTHERS 36    
SISTERS 34    

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