Donor Abstract
| IDENTIFICATION NO. RR345 | DATE 11/02 | ||||
|
PHYSICAL AND PERSONAL CHARACTERISTICS |
|||||
| DOB (M/Y) 08/1978 | PLACE OF BIRTH Louisiana | ||||
| HEIGHT 5'11" | WEIGHT 175 | ||||
| EYE COLOR Brown | COMPLEXION Medium | ||||
| HAIR Brown, Straight | RIGHT HANDED X | LEFT HANDED | |||
| RELIGION BORN INTO Methodist | MARRIED No | NO. OF CHILDREN none | |||
| YRS OF COLLEGE 5 | OCCUPATION Respiratory Therapy School | HERITAGE English, German, Czech | |||
| INTERESTS Sports, Music | |||||
|
TEST RESULTS |
|||||
| Blood Type A Positive | HIV 1/2 Ab. & HIV 1 Ag. Nonreactive | ||||
| Chlamydia Negative | HTLV-1,2 Ab. Nonreactive | ||||
| Chromosome analysis 46, XY | Neisseria gonorrhea Negative | ||||
| CMV, IgM & Culture 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 Grandfather died of heart disease | |||
|
BLOOD |
None | None | |||
| RESPIRATORY | None | Maternal Grandfather - Emphysema and Chronic Bronchitis | |||
| GASTROINTESTINAL | None | Father - Gallstones | |||
| METABOLIC/ENDOCRINE | None | None | |||
| URINARY | None | None | |||
| GENITAL/REPRODUCTIVE SYSTEM | None | Paternal Grandfather - Prostate Cancer | |||
| NEUROLOGICAL | None | None | |||
| MENTAL HEALTH | None | None | |||
| MUSCLES/BONES/JOINTS | None | None | |||
| SIGHT/SOUND/SMELL | None | None | |||
| SKIN | Non-scarring acne as a teen | None | |||
| OTHER | None | None | |||
|
FAMILY HISTORY
|
|||||
| LEVEL OF SCHOOLING: | Mother 1 year of college | Father BS | |||
| OCCUPATION: | Mother Office Manager | Father Electrical Engineer | |||
| AGE IF LIVING | AGE AT DEATH | CAUSE OF DEATH | |||
| MOTHER | 53 | ||||
| FATHER | 54 | ||||
| MATERNAL GRANDFATHER | 60 | Heart Disease | |||
| MATERNAL GRANDMOTHER | 70 | ||||
| PATERNAL GRANDFATHER | 73 | Prostate Cancer | |||
| PATERNAL GRANDMOTHER | 72 | ||||
| BROTHERS | 31 | ||||
| SISTERS | None | ||||