Donor Abstract 

IDENTIFICATION NO. RR354 DATE 11/02

 

 PHYSICAL AND PERSONAL CHARACTERISTICS
DOB (M/Y) 12/1977 PLACE OF BIRTH  Michigan
HEIGHT 6'0" WEIGHT 198
EYE COLOR  Blue-green COMPLEXION Medium
HAIR Brown, Wavy RIGHT HANDED  X LEFT HANDED
RELIGION BORN INTO Methodist MARRIED Yes NO. OF CHILDREN 0
YRS OF COLLEGE 1 OCCUPATION College student and in Military HERITAGE English, German, Dutch, Czec, trace Native American 
INTEREST Playing bass guitar and painting

 

 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, IgM Nonreactive, 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

 None

BLOOD

 None None
RESPIRATORY Pneumonia         Sister-Asthma          
GASTROINTESTINAL None None
METABOLIC/ENDOCRINE None None
URINARY None   None 
GENITAL/REPRODUCTIVE SYSTEM None  Maternal Grandfather - prostate cancer
NEUROLOGICAL None None
MENTAL HEALTH None  None
MUSCLES/BONES/JOINTS None Paternal Grandmother - Arthritis
SIGHT/SOUND/SMELL None None
SKIN None None
OTHER None None

 

 FAMILY HISTORY

 
LEVEL OF SCHOOLING: Mother 3 Years of College Father  BA
OCCUPATION: Mother Homemaker Father Administrator
 
  AGE IF LIVING AGE AT DEATH CAUSE OF DEATH
MOTHER 46       
FATHER 50      
MATERNAL GRANDFATHER 82      
MATERNAL GRANDMOTHER 76      
PATERNAL GRANDFATHER    86 Old age
PATERNAL GRANDMOTHER 92      
BROTHERS None      
SISTERS 27      

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