Sudden Death in Diabetic Ketoacidosis Complicated by Sickle Cell Trait

In a sudden death investigation of a service member with sickle cell trait (SCT), evidence of sickle cell crisis further complicated by coexisting, undiagnosed diabetic ketoacidosis called into question the synergistic effects of diabetic ketoacidosis on red blood cell sickling. Sickle cell trait affects more than 4 million people in the United States (US) with the highest prevalence in non-Hispanic Blacks (7%–9%; Mil Med 2017;182(3):e1819–e1824). The heterozygous state of sickled hemoglobin was previously considered a benign condition causing sickling during hypoxic, high-stress conditions such as exercise and high altitude (Am Assoc Clin Chem 2017). However, research within the last decade shows evidence of sudden death among SCT patients (J Forensic Sci 2011;56(5):1352–1360). It has been shown that the presence of sickled hemoglobin artificially lowers levels of hemoglobin A1c making it a less effective biomarker for red blood cell glycosylation over time in sickle cell patients (JAMA 2017;317(5):507–515). The limited scope of medical understanding of the effects of SCT in combination with other comorbidities requires further investigation and better diagnostic criteria. The uniqueness of the US Military and its screening program for sickle cell disease (SCD) and SCT allows for more detection. Since May 2006, newborn screening for SCD/SCT has been a national requirement; however, anyone older than 14 years may not know their SCD/SCT status (Semin Perinatol 2010;34(...
Source: The American Journal of Forensic Medicine and Pathology - Category: Forensic Medicine Tags: Case Reports Source Type: research