A 20-year old African woman underwent
anesthesia for interruption of an unwanted pregnancy. As a consequence of the
anesthesia, she went into
coma because of an as yet unknown and untested homozygotic state of
sickle cell anemia. Her vital functions were maintained for more than 1 year by intensive medicine, but she died finally in multiorgan failure and
aspiration pneumonia. Because of the complications under
anesthesia and the missing preanesthetic test for
hemoglobinopathy, autopsy was conducted in the forensic medicine department and not in the department of pathology. The
sickle cell disease was diagnosed by electrophoresis of the blood, by molecular detection of mutation in the
hemoglobin gene, as well as by postmortem light and electron microscopy. Sickle cells were found in capillaries of brain, liver, lung, bone marrow, and spleen. Electrophoretic analysis revealed 80.2% HbS in addition to 3.2% HbA2 and 16.6% HbF, whereas no
HbA0 could be detected in blood, confirming the homozygosity of
sickle cell anemia. Because of sickle cell crisis, occluded blood vessels, and severe brain cortex
necrosis, the patient died in spite of reanimation and intensive medicine. This case demonstrates that it is still important to realize the possibility of this disease and diagnostic obstacles even in regions where its manifestation is not endemic, as in Northern and Central Europe.