Donor Abstract
| IDENTIFICATION NO RR 370 | DATE 05/2007 | ||||
PHYSICAL AND PERSONAL CHARACTERISTICS |
|||||
| DOB (M/Y) 05/77 | Place of Birth: Louisiana | ||||
| HEIGHT6'0" | WEIGHT 220 | ||||
| EYE COLOR Blue | COMPLEXION Medium | ||||
| HAIR Light Brown, Curly | RIGHT HANDED X | LEFT HANDED | |||
| RELIGION BORN INTO Catholic | MARRIED Yes | NO. OF CHILDREN 5 | |||
| YRS OF COLLEGE 2 | OCCUPATION Architecture student | HERITAGE German, Irish, Italian | |||
| INTERESTS sports, music | |||||
|
TEST RESULTS |
|||||
| Blood Type A Positive | HIV 1/2 Ab. & HIV 1 Ag. Nonreactive | ||||
| Chlamydia Nonreactive | HTLV-1 Ab. Nonreactive | ||||
| Chromosome analysis Normal Male 46XY;normal variant 2 | Neisseria gonorrhea Nonreactive | ||||
| CMV, IgG Nonreactive | SGPT Within Normal Limits | ||||
| Cystic Fibrosis Negative for 51 mutations | Sickle cell Not Applicable | ||||
| Group B streptococcus Not applicable | Syphilis, antibody Nonreactive | ||||
| HbsAg & HbcAb Nonreactive | Tay Sachs Not Applicable | ||||
| Hepatitis C, Ab Nonreactive | Thalassemia Normal Adult Hemoglobin | ||||
| Trichomonas & yeast None present | |||||
|
DONOR AND FAMILY HEALTH HISTORY |
|||||
| MEDICAL PROBLEM | DONOR | RELATIVE | |||
| HEART |
None |
Grandfather died of heart attack; Father has high blood pressure | |||
BLOOD |
None | None | |||
| RESPIRATORY | None | Maternal Grandmother died of lung cancer (long time smoker) | |||
| GASTROINTESTINAL | None | None | |||
| METABOLIC/ENDOCRINE | None | Father has adult onset diabetes | |||
| URINARY | None | None | |||
| GENITAL/REPRODUCTIVE SYSTEM | None | None | |||
| NEUROLOGICAL | None | None | |||
| MENTAL HEALTH | None | None | |||
| MUSCLES/BONES/JOINTS | None | None | |||
| SIGHT/SOUND/SMELL | None | None | |||
| SKIN | None | None | |||
| OTHER | None | None | |||
|
FAMILY HISTORY |
|||||
| LEVEL OF SCHOOLING: | Mother High School | Father High School | |||
| OCCUPATION: | Mother Secretary | Father Electrician | |||
| AGE IF LIVING | AGE AT DEATH | CAUSE OF DEATH | |||
| MOTHER | 50 | ||||
| FATHER | 52 | ||||
| MATERNAL GRANDFATHER | 60 | Lung Cancer (smoker) | |||
| MATERNAL GRANDMOTHER | 72 | ||||
| PATERNAL GRANDFATHER | 70 | Heart Attack | |||
| PATERNAL GRANDMOTHER | 75 | ||||
| BROTHERS | 17 | ||||
| SISTERS | 14, 26, 35 | ||||