title: Sudden death due to sickle cell crisis during law enforcement restraint.
abstract: We report a case of vaso-occlusive sickle cell crisis in a young schizophrenic man with undiagnosed sickle cell trait who was restrained. Prior to being restrained he had locked himself in his apartment for two days without food or water. He was subsequently restrained, and transferred to hospital while handcuffed to the stretcher. He died suddenly during restraint. At autopsy, there was acute vaso-occlusive sickle cell crisis associated with hypernatremic dehydration. There were no injuries present. We conclude that the death was due to vaso-occlusive sickle cell crisis secondary to dehydration. It is important for the forensic pathologist to remember that death may occur suddenly during restraint from an unexpected mechanism other than excited delirium leading to cardiac arrhythmia or restraint asphyxia.
authors.affiliation: Provincial Forensic Pathology Unit, Office of the Chief Coroner, 26 Grenville Street, Toronto, Ont., Canada M7A 2G9.
authors.forename: S D
authors.initials: SD
authors.lastname: Channa Perera
authors.forename: Michael S
authors.initials: MS
authors.lastname: Pollanen
mesh_terms: D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications*; D003645:Death, Sudden / Q000209:etiology*; D003681:Dehydration / Q000209:etiology; D049429:Forensic Pathology; D006801:Humans; D006955:Hypernatremia / Q000150:complications; D008297:Male; D016495:Police; D011329:Prisoners; D012149:Restraint, Physical; D012559:Schizophrenia