I. Blunt force injuries
A. Cutaneous blunt force injuries of the forehead, face, and upper lip
B. Mucosal injuries of the lips
C. Cutaneous blunt force injuries of the shoulders, hands, elbows, and legs
D. Patterned contusions (in some areas abraded) of the wrists, consistent with restraints (handcuffs)
II. Natural diseases
A. Arteriosclerotic heart disease, multifocal, severe
B. Hypertensive heart disease 1. Cardiomegaly (540 g) with mild biventricular dilatation 2. Clinical history of hypertension
C. Left pelvic tumor (incidental, see microscopic description)
III. No life-threatening injuries identified
A. No facial, oral mucosal, or conjunctival petechiae
B. No injuries of anterior muscles of neck or laryngeal structures
C. No scalp soft tissue, skull, or brain injuries
D. No chest wall soft tissue injuries, rib fractures (other than a single rib fracture from CPR), vertebral column injuries, or visceral injuries
E. Incision and subcutaneous dissection of posterior and lateral neck, shoulders, back, flanks, and buttocks negative for occult trauma
IV. Viral testing (Minnesota Department of Health, postmortem nasal swab collected 5/26/2020): positive for 2019-nCoV RNA by PCR (see ‘Comments,’ below)
V. Hemoglobin S quantitation (postmortem femoral blood, HHC Laboratory): 38% (see ‘Comments,’ below)
VI. Toxicology (see attached report for full details; testing performed on antemortem blood specimens collected 5/25/20 at 9:00 p.m. at HHC and on postmortem urine)
A. Blood drug and novel psychoactive substances screens:
1. Fentanyl 11 ng/mL
2. Norfentanyl 5.6 ng/mL
3. 4-ANPP 0.65 ng/mL
4. Methamphetamine 19 ng/mL
5. 11-Hydroxy Delta-9 THC 1.2 ng/mL; Delta-9 Carboxy THC 42 ng/mL; Delta-9 THC 2.9 ng/mL
6. Cotinine positive
7. Caffeine positive
B. Blood volatiles: negative for ethanol, methanol, isopropanol, or acetone
C. Urine drug screen: presumptive positive for cannabinoids, amphetamines, and fentanyl/metabolite
D. Urine drug screen confirmation: morphine (free) 86 ng/mL
Comments: The finding of sickled-appearing cells in many of the autopsy tissue sections prompted the Hemoglobin S quantitation reported above. This quantitative result is indicative of sickle cell trait. Red blood cells in individuals with sickle cell trait are known to sickle as a postmortem artifact. The decedent’s antemortem peripheral blood smear (made from a complete blood count collected 5/25/20 at 9:00 p.m.) was reviewed by an expert HHC hematopathologist at the Medical Examiner’s request. This review found no evidence of antemortem sickling. The decedent was known to be positive for 2019-nCoV RNA on 4/3/2020. Since PCR positivity for 2019-nCoV RNA can persist for weeks after the onset and resolution of clinical disease, the autopsy result most likely reflects asymptomatic but persistent PCR positivity from previous infection. 6/1/2020 X