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A hematocrit is a blood test that measures the percentage of the volume of whole blood that is made up of red blood cells. This measurement depends on the number of red blood cells and the size of red blood cells.
Annas hematocrit result- 31%

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Anna is tachycardic; average resting heart rate ranged from 90-105 over the course of the day.

The pateint (ANNA) was only able to walk for 8 minutes before the test was concluded – max speed 3.5 mph at an elevation of 2%, and max blood pressure of 190/110.

Patient shows no signs of edema (swelling) in her feet or lower legs, although she does mention an occasional tingling sensation in her right calf.

Blood pressure values averaged 142/85 over the course of the workup.

The patient, Anna experienced drastic increases in blood pressure as well as a few premature ventricular contractions (PVCs) on EKG during the exam.

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Autopsy report- summarize findings (4.1.2)

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Autopsy report- summarize findings (4.1.2)

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Toxicology

Blood

No evidence of alcohol.

Evidence of statins, equivalent to 40mg/day. NOTE: A prescription bottle for Vasotec, an ACE inhibitor, was found at the scene, although there is no evidence of this drug in the blood. The decedent most likely had not taken this medication for at least 3-4 days.

Blood glucose level 280 mg/dL (normal range 70-125 mg/dL)
Cardiovascular System

Examination of the heart revealed concentric left ventricular hypertrophy. There is also evidence of mild mitral valve prolapse (this means that the mitral valve does not close properly).

A stent is present in the left anterior descending coronary artery; however, scar tissue and clots partially block or occlude the lumen of the vessel. The right coronary artery is 80% occluded. Narrowing is also noted in the renal arteries as well as the cerebral arteries and provides evidence of atherosclerosis.
Evidence of mild peripheral vascular disease in the left leg.

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Urinalysis - The results of the urinalysis test indicate positive for bacterial infection. The bacteria is Serratia marcescens, which is problematic, but not deadly.

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CBC results are normal – no abnormalities in red blood cell, white blood cell, or platelet count.

Full cholesterol panel

Total Cholesterol – 389 mg/dL

LDL – 243 mg/dL

HDL – 60 mg/dL

Triglycerides – 145 mg/dL

Fasting blood sugar – 85 mg/dL

Hemoglobin A1c – 7.1%

Anna has a family history of early heart disease as well as uncontrolled hypertension. Her father had a heart attack when he was only 41 years old.

The Patient was evaluated by physical exam, blood work, cardiac stress test with electrocardiogram (EKG), and an echo cardiogram. Results later prompted an angiogram.

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Physical Exam

Patient’s pulse is normal.

Patient shows no signs of edema (swelling) in her feet or lower legs, although she does mention an occasional tingling sensation.

Patient said she has no ear pain or a sore throat. Upon inspection, her ears, nose, and throat all look normal.

Patient’s glands are not swollen.

Patient’s speech, hearing, and vision appear normal.

Laboratory Analysis

CBC results are normal – no abnormalities in red blood cell, white blood cell, or platelet count.

Cultures for strep are negative.

Routine urinalysis shows glucose in the urine.

Given Anna’s family history of cardiovascular disease and her stated symptoms, Anna will be sent for glucose tolerance testing to rule out diabetes.

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Anna Garcia needs a pacemaker because she needs to track her abnormal heart beat. Pacemaker's are also used to to help collect data about your heart rhythm.

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Nails on fingers blue and gray
Trace amounts of hydroxyurea suggest death by sickle cell disease.

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They said this medicine is pretty new but that it can actually help me live longer. It should make me have fewer pain episodes and keep me from getting acute chest syndrome again.

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Statin drugs are drugs that lower your cholesterol. People use these to lower their cholesterol so they can stop the clogging of arteries or blood vessels so their blood can flow better.

Statin drugs can cause severe muscle pain, liver damage, and can also cause kidney failure.

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Age 16: She pushed herself too hard is a soccer game, and ended up fainting. She felt dizzy and clammy, was trembling, and had blurry vision.
Age 25: She went on vacation and did not keep track of a healthy lifestyle. She had to go to the bathroom often, drank tons of water, was sick, confused and disoriented.
Age 29: A wedding reception went longer than usual. She got dizzy, but a juice box helped.

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Autopsy report results and analysis (2.3.3)

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Autopsy report results and analysis (2.3.3)

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Toxicology

Blood

No evidence of alcohol.

No evidence of non-prescription drugs or overdose of prescription drugs.

Blood glucose level 280 mg/dL

A1C - 11%

Urine

No evidence of non-prescription drugs or overdose of prescription drugs.

Microalbumin test reveals significant protein in the urine.

Ketones in urine.

Head and Neck

Lens of the right eye appears cloudy. Blood vessels in both eyes are swollen. Abnormal blood vessels are present on the left retina. Vision was most likely compromised.

Examination of the oral cavity revealed significant plaque buildup on the teeth as well as severely receding gums. 4-5 unfilled dental cavities were visible.

Trunk

Left kidney appears pale and shows the beginning signs of necrosis. Right kidney appears normal.

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Stomach Contents

No evidence of toxins or poisons.

125 mL of partially digested food present.

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Sickle Cell Disease is caused by the mutation substitution. That is because the 2 nucleotide switch and that is substitution. How they interact causes the to their new pairs causes a abnormality and creates sickle cell disease.

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DNA can be used in crime scene investigation because everyone has unique DNA, so they can narrow down suspects easier. The DNA found at the crime scene belonged to Anna and Alex.

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Physical Exam

Respiratory. Patient’s breathing is abnormal. Respiratory rate is slightly elevated and patient seems to be short of breath.

Skin. Pale skin, nails, and lips.

Ears. Normal. No signs of fluid or infection.

Mouth/Throat. Normal. No signs of infection.

Gastro-Intestinal. Patient does not have any hernias. Patient has not had much of an appetite for the last couple of days. Patient has a bright red diaper rash on bottom and mother said she has been experiencing diarrhea for two days.

Cardiovascular. Pulse is 175 bpm. Heart rate is rapid and above normal range.

Urinary. Higher urine output than normal.

Other. Lymph nodes are normal. Patient seems very lethargic.
Tests Performed and Results

CBC

Red Blood Cell Count reduced levels

White Blood Cell Count increased levels

Sickle cell test

Positive for sickle cell anemia

CT scan

Abnormal spleen, indicative of splenic sequestration

Blood oxygen

Lower than normal levels

Hematocrit

Lower than normal hematocrit - 20%

Diagnosis

Sickle cell anemia

Severe anemia

Splenic sequestration (sickling in the splenic vein resulting in a collection of a large amount of blood in the spleen, causing the spleen to be enlarged).

Treatment

Intravenous hydration

Administration of pain medication

Red blood cell transfusion

Administration of antibiotics to prevent infection

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The wider that the blood drop is, the higher up it was dropped from. Similarly, the longer that the tail of the drop is, the faster it was and the more angular it hit the surface.

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What is sickle cell disease and what it means to be anemic

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What is sickle cell disease and what it means to be anemic

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Sickle cell disease is the abnormality of a blood cell and it is passed down genetically. It causes dizziness, pain areas in the joints, fatigue, and causes low oxygen in the body.

Anemic means that you have a loss of blood cells and it causes dizziness and fatigue. It can also cause a faster heart beat.

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Diabetes usually made because of a loss of insulin or your body is not reacting to insulin. In Anna's cause she has type 1 diabetes so she is making little to no insulin so she has to get insulin from implants or going to the doctor to add sugar to your body.

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After unit 2 when we learned about her diabetic problems we believe that she died from passing out and then she fell and hit her head on the desk and died.
Our final Theory
We believe that she died from sickle cell disease and a little because of her insulin levels from her diabetes because she probably passed out or her hips gave out and she fell and hit her head on the desk which broke the desk and she grabbed the phone but died right there.

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*A1C-11%
*Blood Glucose level 280 mg/dL
*No evidence of over dosing on prescription drugs in blood.
*Ketones in blood
*no evidence of alcohol

Has type 1 diabetes

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Why Anna had an Excessive thirst and Frequent urination.

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Why Anna had an Excessive thirst and Frequent urination.

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____ causes water to move out of the cell in attempt to dilute the high concentration of glucose in the plasma. The cell shrivels and shrinks due to the water loss. This dehydrates the cells, causes thirst and excessive urination.

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Recommendations for exercise and lifestyle for a diabetic diet

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Recommendations for exercise and lifestyle for a diabetic diet

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Lifestyle:

Exercise daily
watch food intake of meats
intake of proteins
and intake dairy

Exercise:

Should at least go for a walk a day for at least 30 minutes
Don't over work yourself in when exercising.

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no evidence of toxins or poisons
124 mL of partially digested food present

The walls of the stomach are a gray-pink.
the stomach does not look injured

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Basic Recommendations for a diabetic diet

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Basic Recommendations for a diabetic diet

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You would need

Vegetables:

like broccoli, carrots, greens, peppers, tomatoes, includes potatoes, corn, and green peas

Fruits:

like oranges, melon, berries, apples, bananas, and grapes

Grains:

like wheat, rice, oats, cornmeal, barley, and quinoa

Protein:

like lean meat, fish, eggs, nuts and peanuts, dried beans and certain peas, such as chickpeas and split peanuts.

Dairy:

Like milk, cheese, yogurt,

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Insulin level testing is used to tell what type of diabetics you have.
- Type 1 diabetics do not produce insulin.
- Type 2 diabetics produce insulin, but the body does not permit this hormone to effectively do its job.
Anna Garcia-
The insulin levels for Anna Garcia was 0 liters form 0-120 minutes. Since her insulin levels showed as 0, this means that she had type 1 diabetes.

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Glucose Tolerance Testing (GTT) monitors the amount of sugar in the liquid portion of blood called plasma, over a set time period and gives doctors information as to how the body utilizes sugar.
Anna Garcia-
Her glucose levels start at 150 milligrams and climb a bit to 250 at the 90 minute mark, but  eventually got to 200 milligrams in 120 minutes. (She has diabetes)

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Sunday – August 12th
- Breakfast
1 cup Cheerios
½ cup skim milk
½ cup blueberries
- Lunch
1 cup low-fat strawberry yogurt
6 Ritz crackers
1 cup canned, low-sodium vegetable soup
1 12 oz can cola
- Snack
1 single serving bag potato chips
- Dinner
2 slices thick crust pepperoni pizza (14" pizza)
2 cups tossed salad
4 tbsp. Caesar dressing
- Dessert
1 cup vanilla ice cream with ½ cup mini marshmallows
5 Oreo cookies

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1. No evidence of alcohol
2. No evidence of overdose or non-prescription or prescription drugs
3. Injury to right temple
4. No visible sign of trauma
5. Abdomen is distended
6. Ankles are swollen
7. Fingernails and toenails are gray
8. Inflamed red injection sights on left thigh
9. Evidence of vomit in oral cavity
10. Blunt trauma to the head
11. Generalized pallor and evidence of oxygen deprivation

Has type 1 diabetes

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Autopsy: Insulin in body
Medical history: Anna has type one diabetes.
Possible causes of death: Heart attack
Stoke.
Evidence: In her medical history Anna was diagnosed with type one diabetes

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The Hair at the crime scene was found to be matching with Anna Garcia's.

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Approximate time of death- 7:00AM
She was found at around 11 o'clock

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Accidental or Natural
-died of stroke
(brain cut off oxygen supply to her brain,causing a  stroke on the right side of her brain.

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The unknown substance found at the scene of the crime was acetylsalicylic acid (aspirin).

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The blood we found at the crime scene belonged could being to either Alex Garcia or Anna Garcia.

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pet of Anna Garcia. His motive was possible abuse.

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-Is Anna Garcia's neighbor and lives right next door.
-He found Anna Garcia's body and was the one who reported it.
- He knows Anna's walking schedule for her dog.
-He sees Anna Garcia walking her dog at 6;30 am yesterday morning.
-He had a relationship with Anna Garcia for two weeks but it was ended abruptly without Doug knowing why.
His motive could have been that after Anna left him he could have got mad at her and could've killed her.

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-Is Alex Garcia's new wife.
She was last seen parked in front of Anna Garcia's house the night before she died.
-Erica and Alex Garcia were seen arguing earlier in the week at a dinner.
-Erica was spotted sitting in her car at Anna's driveway the day before Anna's death
Motive is she thinks tat Alex has a soft spot for Anna.

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The fingerprints found at the crime scene matched Alex Garcia's fingerprint.

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-He divorced Anna and quickly moved on and married Erica his new wife.
- Alex was having financial problems and was still tied to Anna's life insurance plan.
- Anna wanted to finish some paperwork with Alex that night she died.
-He was seen at Anna Garcia's house the night before she died.
His motives could have been that he was still mad from the divorce and he could have killed Anna.

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-She was Anna's business partner also best friend.
-She also wanted to get rid of Anna and be the only business owner of the bakery that Lucy and Anna own.
They have a strife in their friendship.
-last saw Anna the day before her death. Lucy said Anna left early that day to take care of something.
Her Motive could have been that she wanted to get rid of Anna so she could have full power over the bakery.

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-She is the victim in this crime. -She is a divorced Hispanic woman who is 38 years old.
-She is also 5'4" and weighs 165 Lbs.
-She was in the hospital recently.
-She used to take antibiotics, but stop since she has gotten better.
- She has back problems.
-has million dollar life insurance fund with Alex as the beneficiary.

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Background information on the Anna Garcia case

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Background information on the Anna Garcia case

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-She was found in her entry hallway face down in front of the entry door.
-She previously was diagnosed with swine flu, but after hospitalization and recovery, was cleared.
-Her body temperature when she was found was 92.4 degrees Fahrenheit
-It was determined that she died at about 7 A.M.