Sudden unexpected death due to B-cell acute lymphocytic leukaemia (B-ALL) in a 3-year-old child.

IF 1.5 4区 医学 Q2 MEDICINE, LEGAL
Elke Doberentz, Glen Kristiansen, Marit Bernhardt, Frank Musshoff, Burkhard Madea
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Abstract

Sudden unexpected death due to haematologic disease in children is unusual. A 3-year-old girl had been ill for several weeks, but her parents did not consult a doctor. Her complaints included a cough, fever, vomiting and fatigue. On the day of her death, the girl fell from the toilet and was unresponsive. In hospital, severe dyspnoea and a haemoglobin value of only 1.7 mg/dl were diagnosed, as well as hypothermia and haemorrhaging from mouth and nose. Despite intensive medical care and cardiopulmonary resuscitation, the girl died. Main autopsy findings were severe anaemia and the underlying disease, B-cell acute lymphocytic leukaemia (B-ALL). In particular, liver, spleen, lymph nodes, kidneys and bone marrow showed marked infiltration of atypical mononuclear cells replacing haematopoiesis. Intra-alveolar exudation, consistent with the early phase of acute pneumonia, was identified as cause of death. Toxicological investigations revealed positive findings of morphine (53.3 ng/ml), as well as amphetamine and THC in femoral blood, respectively, in hair samples. This paper discusses the medicolegal implications of the case (omitted duty of care by the parents).

1例3岁儿童因b细胞急性淋巴细胞白血病(B-ALL)猝死。
儿童因血液病而突然意外死亡并不常见。一个3岁的女孩已经病了几个星期,但她的父母没有去看医生。她的症状包括咳嗽、发烧、呕吐和疲劳。在她死亡的那天,女孩从厕所里摔了下来,没有反应。在医院,诊断出严重的呼吸困难和血红蛋白值仅为1.7毫克/分升,以及体温过低和口鼻出血。尽管进行了重症监护和心肺复苏,女孩还是死了。主要的尸检结果是严重贫血和潜在的疾病,b细胞急性淋巴细胞白血病(B-ALL)。特别是肝脏、脾脏、淋巴结、肾脏和骨髓均可见明显的非典型单核细胞浸润,取代造血。肺泡内渗出,符合急性肺炎的早期阶段,被确定为死亡原因。毒理学调查显示,毛发样本中吗啡(53.3 ng/ml)、安非他明和四氢大麻酚分别在股血中呈阳性。本文讨论了该案件的医学法律含义(忽略父母的注意义务)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Forensic Science, Medicine and Pathology
Forensic Science, Medicine and Pathology MEDICINE, LEGAL-PATHOLOGY
CiteScore
3.90
自引率
5.60%
发文量
114
审稿时长
6-12 weeks
期刊介绍: Forensic Science, Medicine and Pathology encompasses all aspects of modern day forensics, equally applying to children or adults, either living or the deceased. This includes forensic science, medicine, nursing, and pathology, as well as toxicology, human identification, mass disasters/mass war graves, profiling, imaging, policing, wound assessment, sexual assault, anthropology, archeology, forensic search, entomology, botany, biology, veterinary pathology, and DNA. Forensic Science, Medicine, and Pathology presents a balance of forensic research and reviews from around the world to reflect modern advances through peer-reviewed papers, short communications, meeting proceedings and case reports.
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