In his autopsy report, Bay County’s medical examiner concluded that the 14-year-old who died after an altercation with guards was killed by complications of sickle cell trait.
But as the controversy over Martin Lee Anderson’s death mounted Friday, medical experts questioned the report’s conclusion that the teen died of "natural causes," which they said failed to explain his internal bleeding.
"That report is not plausible at all," said Dr. Kenneth Bridges, former head of the Center for Sickle Cell and Thalassemic Disorders in Boston and a former associate professor at Harvard Medical School.
But Charles Siebert, Bay’s medical examiner, defended his findings and said he used information — hospital records, a surveillance video of the altercation and statements from medical personnel — not included in the report.
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"I appreciate the comments from other doctors, but it’s hard for them to make comments when they don’t haveall the information," Siebert said.
About 8 percent of African Americans have the sickle cell trait. The vast majority, including scores of professional athletes, live without any symptoms. Sickle cell trait is related to sickle cell anemia, but it’s much less serious and isn’t considered a disease.In extremely rare cases, the condition may contribute to sudden death from extremely vigorous exercise coupled with dehydration.
Siebert attributed Anderson’s death to "the stress of the exercise itself in the environment he was in — you’ve got your Adrenalin pumping, you’re in a new situation at boot camp. Plus the situation with the guards . . . the resisting, the increased physicalstress of being in a physical altercation."
Siebert said this situation set off a crisis in which Anderson’s blood cells changed into a rigid, sickle shape and began clogging his arteries. This in turn triggered a problem called disseminated intravascular coagulation, or DIC.
During DIC, tiny clots form throughout the bloodstream. Eventually, the blood’s clotting factors are used up, and widespread bleeding can occur.
According to the autopsy report, Anderson suffered a hemorrhage at the back of the abdomen, in the space behind the kidneys. This bleeding sent him into shock and he never recovered, Siebert said. Experts were skeptical.
‘‘The DIC issue in particular does not make sense,’’ Bridges said.
Dr. Stuart Toledano, who treats children with sickle cell disease at the University of Miami, agreed. He said DIC is not typically associated with sickle cell disease, particularly if the patient has not been seriously ill for a prolonged period of time. Toledanoadded that it was "extremely unlikely" that Anderson died as a result of complications from sickle cell trait.
"Bleeding is not part and parcel of sickle cell disease or sickle cell trait," he said. DIC is more commonlyassociated with an infection of the blood, or with trauma, Bridges said.
The hemorrhage behind Anderson’s kidneys could also have been caused by a blow to the back, but Siebert said he ruled this out because there was no sign of such a blow. The report noted that several organs were congested with sickle-shaped cells, butSiebert said this can occur as a result of death and does not prove the cause of death.
"The hemorrhage is the real problem here," said Dr. Michael Norenberg, a Universityof Miami pathologist who reviewed the autopsy report at The Miami Herald’s request. "Where does the blood come from? Because bleeding is not a problem in these people" with sickle cell trait.
Still, Norenberg would not rule out that Siebert’s conclusion may be correct.
"The possibility that he did actually die from sickle cell trait for some strange reason is still there," Norenberg said. "But we don’t have any evidence for it based on this report."