Unusual intravascular hemolysis in a case of fatal hypothermia

A 55-year-old man was discovered dead inside a deep freezer maintained at -40 degrees C. After consuming a large quantity of alcohol, the man had become trapped in the freezer approximately 11 h before his body was found. The body was still frozen at the time of autopsy, but subcutaneous dendriform vessel repletion phenomenon was observed on the upper and lower extremities. Although this intravascular hemolysis resembled that which develops during putrefaction, in this case it was thought to be due to pooling and freezing of blood in subcutaneous vessels. Contributory factors included alcohol ingestion, vasodilation following vasoconstriction, vasomotor paralysis, and red cell sludging. Hemolysis followed freezing of the blood. When such phenomena are observed in a corpse, exposure to extreme cold should be suspected.