The case of an elderly man who succumbed to prolonged bleeding raises questions regarding the cause of death…
While the doctor who carried out the examination of the body concluded that there was gastrointestinal bleeding, the judicial police officers did not agree and asked for the analysis of the forensic doctors. [1]
Presentation
The 90-year-old, who had been living alone for a few days, had been seen the day before in ‘good health’ by relatives, but the next day his daughter found him lifeless in a pool of blood, say medical examiners . The doctor who carried out the examination of the body indicated as cause of death a hemorrhagic shock with suspected discharge of blood through the rectum following a long intake of painkillers.
The judicial police called in the forensic service, because large stains potentially of blood and a bloody razor blade, wrapped in kitchen paper, were found not far from the body. No origin of bleeding, however, might not be determined with certainty on the body. In addition, a bowl containing partly clotted and partly liquid blood was in front of a seat.
Further examination of the man revealed only a small wound on his left kneecap.
Analyses
The source of the bleeding was a superficial skin lesion approximately 2 cm long with section of the smooth-edged skin layers. There is a smooth opening, with a maximum diameter of 0.2 cm at the center, of a sinuous superficial cutaneous vessel (see images).
There are also no signs of taking or injecting medication, no signs of outside intervention, no evidence of taking anticoagulants, no indication of taking ibuprofen, which can trigger thrombocytopathy. Other NSAIDs were not detectable with available methods.
Finally, there were no signs of congenital or acquired hemophilia A.
Discussion
As summarized by the medical examiners, the man died of an external hemorrhage.[1] The only possible source of bleeding was a small injury to a superficial cutaneous vein in the left knee. It was a venous influx towards the great saphenous vein.
The injury is plausibly explained by the use of a razor blade with several superimposed cuts and nicks. The man, right-handed, was able to reach the left knee without problem. The authors speculate that the self-harm likely resulted in prolonged (up to several hours) blood flow from the injured vein. The numerous traces of blood at the scene might be explained by the fact that the man moved around the apartment in a confused state following an increasing lack of blood and oxygen in the brain.
This article was adapted by Dr. Thomas Kron and originally published on Medscape.de.