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Sickle cell disease is a group of inherited disorder due to substitution of valine for glutamic acid at position 6 of beta globin chain of hemoglobin [1] leading to sickling of red blood cells. It is most common in African ancestry. The sickled RBC’s can cause vaso-occlusive crisis leading to dreadful complications. We report a case of a 56-year-old female with past medical history of sickle cell disease, atrial fibrillation and prior history of stroke. She presented to the emergency department with chief complaint of left leg pain. After few hours the pain moved to the lower and upper back. Accompanying symptoms included shortness of breath, nausea and vomiting. Laboratory findings were significant for mild lactic acidosis, elevated LDH, hyperbilirubinemia and leukocytosis. She was started with opioids and intravenous fluids for sickle cell crisis. Unfortunately, overnight, the patient expired. On autopsy, the cause of death was found to be bone marrow necrosis and bone marrow and fat embolism to lungs causing fatal impairment of lung function.

Bone Marrow Necrosis and Fat Embolism in a Patient with Sickle Cell Crisis, a Fatal Complication