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Anna had been taking prescription medication before her death, indicating that she was likely diagnosed with a bacterial infection, later discovered to be a urinary tract infection acquired through improper sterilization. The pathogen was Serratia Marcescens.

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Serratia Marcescens was found in Anna's urine. It is a pathogen commonly found in hospital-acquired illnesses that can cause urinary tract infections.

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During Anna's hospital stay, the pain in her legs was so bad that she was confined to her bed and required a urinary catheter to empty her bladder. After a five day stay in the hospital, she was released. One day later she started noticing strange urinary symptoms. She was feeling a persistent urge to urinate and then when she would urinate, only a very small amount of urine would be passed. The urine appeared cloudy and was slightly pink in color, indicating a urinary tract infection. Since she was recently in the hospital with a catheter, it is suspected that the infection was acquired during the hospital stay. Therefore, a urinalysis is requested to positively diagnose the urinary tract infection. A sample of Anna’s urine was sent to the laboratory to identify the exact pathogen responsible for the infection.

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Anna Garcia was taking 40 mg of statins daily. Statins reduce cardiovascular disease for those with hypercholesterolemia. A prescription bottle for Vasotec, an ACE inhibitor, was also found at the scene, although there was no evidence of this drug in her blood. She may have not taken the medication for 3-4 days. Vasotec is a type of blood pressure medication.

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On August 15th, Anna Garcia had blood glucose levels at 280 mg/dL. The normal range is 70-125 mg/dL.

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Anna had concentric left ventricular hypertrophy, where the left wall of the pumping chamber becomes thickened. She had stents in her left anterior descending coronary artery. She also has mild peripheral vascular disease in her left leg.

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Anna Garcia had a blood pressure of 142/85 over the course of her cardiac work-up, showing she had stage 1 hypertension.

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Positive lifestyle habits:
- She is a non-smoker.
- Does a yoga home video as needed to help her deal with stress of her illnesses and her job.
Negative lifestyle habits:
- Eats a diet high in calories and fat
- Consumes three glasses of wine after work every day
- Has not kept up with formalized exercise
- Family history of heart disease and uncontrolled hypertension
- Father had a heart attack at 41 years old
Anna Garcia also has tachycardia. She mentions a tingling sensation in her right calf. Her waist circumference was 33 inches.

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Anna's breathing was abnormal, she seemed to be short of breath. She had pale skin, nails, and lips. She was running a fever, was extremely lethargic, experienced breathing problems, and appeared to be in a lot of pain. She didn't have much of an appetite for the last couple of days. She had a bright red diaper rash on her bottom and her mother said she had been experiencing diarrhea for two days. Her pulse was very high, 175 bpm. She also had a higher urine output than normal and seemed very lethargic.

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Anna's family pedigree for Hypercholesterolemia

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Anna's family pedigree for Hypercholesterolemia

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Her mother is a carrier for the disease.
In many cases the defect is due to a single mutation in the receptor gene and is inherited as an autosomal dominant trait.

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A pill bottle for blood pressure medication was found in the home of Anna Garcia; however, the autopsy reports that she was most likely not taking her pills.
Blood pressure is caused by the movement of blood through the vessels in your body, the veins, and arteries. It measures the force applied to the arterial walls as the heart pumps blood. The pressure is determined by the amount of force and the quantity of blood being pumped. High blood pressure can be dangerous and even fatal. Many factors can influence changes in blood pressure. In fact, blood pressure continually changes based on activity, diet, temperature, emotional state, body position, medication use, and overall health.

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Anna's family pedigree for Sickle Cell Disorder

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Anna's family pedigree for Sickle Cell Disorder

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Anna's parents are both carriers for sickle cell disorder.

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Trace amounts of hydroxyurea were found in Anna Garcia's blood at death, a medicine used to treat sickle cell disease. In her microscopic analysis of blood, some of Anna's blood cells were sickled and there were less total red blood cells and sickle cells than in regular blood. Her hematocrit was 66%. Possible cause of death: Loss of oxygen to cells.

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As a result of Anna’s diabetes, Anna has kidney disease due to the significant amounts of protein in urine. Her body has also been producing ketones, a result of DKA. DKA occurs when cells cannot get glucose they need for energy (caused by diabetes). Her blood glucose levels are higher than normal (70-110 is considered “normal”).
High levels of blood glucose make the kidneys filter too much blood, causing them to work to hard and eventually leak.
Anna also has cataracts and glaucoma in her eyes, resulting from her diabetes. Her severely receding gums are due to gingivitis, a consequence of diabetes as well.

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Anna has a family history of high cholesterol and heart disease.

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The vomit found at the crime scene contained glucose and protein.

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Toxicology:
1. Preliminary Blood Results:
o BAC (% by volume), 0.015.
o Trace amounts of acetylsalicylic acid present.
o No evidence of overdose of non-prescription or prescription drugs.
General Appearance:
The body is that of a well-developed, well-nourished adult Hispanic female who appears to be her stated age of 38. Body height is 64 inches and body weight is 165 lbs. No evidence of post-mortem tampering is present and rigor mortis is generalized.
Clothing and Valuables:
The body is admitted to the morgue clothed and within a body bag. One ring is present on the right ring finger. Clothes are not torn but are stained with blood. A small amount of vomit is present on the shoulder area of the blouse.
Head and Neck:
The head is normally shaped with medium length, multi colored hair. There is an injury to the right temple, including an open wound where pre-mortem bruising is evident. Neck shows no sign of injury.
Trunk:
The chest and torso are an appropriate size; no visible sign of trauma. Abdomen is distended.
Extremities:
The extremities are symmetrical and without abnormalities. The ankles are swollen and signs of edema are positive with moderate fluid accumulation. The fingernails show substantial graying, indicative of low oxygen. The right proximal humerus
shows signs of a recently healed break, as does the left distal tibia. Inflamed, red injection sites on left thigh.
Injuries:
A head wound at the right temple, 2 cm in length, and 5 mm in depth at the center. Surrounding area bruised, limited bleeding evident. No skull fracture. Right elbow bruise, 2 cm in diameter, limited contusion.
No other visible injuries.
Physical Examination Results:
1. Generalized pallor and evidence of oxygen deprivation.
2. Fingernails and toenails blue/gray color.
3. Evidence of vomit in oral cavity.
4. Blunt trauma to the head, wound indicative of a fall against a solid object, light
bleeding suggesting lack of blood flow.
5. Edema of ankles visible.

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Saturday – August 11, 2012

Breakfast

2 egg whites, scrambled, no butter

2 slices thick turkey bacon

1 slice whole wheat toast with 1 pat butter

1 cup coffee with artificial sweetener and 1 tbsp. light coffee creamer

Lunch

1 12oz can Sprite

1 turkey sandwich (2 slices whole wheat bread, 3 slices turkey lunch meat, 1 slice cheddar cheese, ½  tbsp. mayonnaise)

16 fat-free tortilla chips with salsa

Snack

1/4 cup dry roasted peanuts

1 small apple

Dinner

½ cup apple juice

6 ounces salmon filet

1 cup brown rice cooked with salt and butter

1 cup steamed broccoli

Dessert

½ cup sugar free lemon gelatin

Sunday – August 12, 2012

Breakfast

1 cup Shredded Wheat

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 12oz 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

Monday – August 13, 2012

Breakfast

1 cup whole milk

1 biscui

Anna's entries stopped on the morning of August 13th. The entry for breakfast appears to be incomplete.

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Toxicology reports ordered during Anna’s autopsy reveal that Anna had high amounts of glucose in her blood at the time of her death. This finding suggests that Anna most likely ate a large meal near the time of her death.
Anna's blood glucose level at death: 280mg/DL. Normally after a meal, blood glucose levels should be up to 140 mg/DL.

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Toxicology:
1. Blood:
● No evidence of alcohol.
● No evidence of non-prescription drugs or overdose of prescription drugs.
2. Blood glucose level 280 mg/dL
3. Stomach Contents:
● No evidence of toxins or poisons
● 125 mL of partially digested food present
Gastrointestinal System:
The mucosa and wall of the esophagus are intact and gray-pink, without lesions or injuries. The gastric mucosa is intact and pink without injury. The mucosa of the three parts of the small intestine, the duodenum, the jejunum, and the ileum, and the mucosa of the large intestine, the colon and rectum, appears normal. Approximately 125 ml of partially digested semisolid food is found in the stomach.

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At the scene of Anna’s death, the medical examiner noted she was wearing a
Medical Alert bracelet labeling her as a diabetic. Anna is a Type 1 diabetic. Her pancreas does not make insulin, therefore her cells cannot take in glucose. The glucose remains in her blood, allowing for levels to get high. We can clearly see this in the chart, as her insulin levels were low and stayed low.

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The shoe print belonged to Anna Garcia.

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This fingerprint most closely resembles Alex Garcia's.

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The hair was found to have belonged to Erica Piedmont.

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Blood Found at Crime Scene: Type B
Anna Garcia: Type B
Alex Garcia: Type B
Doug Greene: Type AB
Erica Piedmont: Type A
Lucy Leffingwell: Type O

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An experiment conducted on September 13th, 2017, concludes that the blood gathered at the crime scene dripped from an altitude of 10 inches.

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- Best friend of Anna
- Co-owned bakery with Anna, but the two have been arguing over expanding business
- Anna left work early the day before her death to "take care of something"
- Conflict with business has worsened friendship
- Reported that Anna had no longer been taking antibiotics prescribed to her, and that Anna was experiencing side back pain

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- New wife of Alex Garcia
- Seen sitting in a car parked in front of Anna's house the day before her death
- Seen at a local diner with Anna having a heated argument

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- Anna's next door neighbor, called police
- Saw Anna when she walked her dog at 6:30 AM last morning
- Notes that Anna has been skipping daily morning walk with dog, and that she lives only with her dog
- Used to be involved romantically with Anna but Anna ended it last week

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- Anna's former husband
- Went through a nasty divorce with Anna and as soon as divorce was finalized, he married another woman
- New wife is expecting baby
- Still on beneficiary of Anna's insurance
- Saw Anna last night when he went to discuss paperwork