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Sara Sharif showed signs of starvation and had “unusual” injuries, the fourth day of her murder trial has heard. An osteoarticular pathologist told the Old Bailey on Thursday that the 10-year-old’s bone marrow had been “unusual” in his examination of her body, and had shown up with a “bluey tinge”, which revealed itself to be gelatinous transformation of the bone marrow. This can often be associated with starvation or the rapid removal of nutrition, although Professor Anthony Freemont could not say if this was a direct cause.

Sara’s father Urfan Sharif, 42, her stepmother Beinash Batool, 30, and her uncle Faisal Malik, 29, all deny her murder. The court heard on Wednesday that the 10-year-old died as a result of “complications arising from multiple injuries and neglect”, according to a pathologist.

She had suffered two traumatic injuries in the days before her death, as well as 71 recent injuries including bruises, abrasions, skin ulcers consistent with burns and probable bite marks. Surrey Police discovered the schoolgirl dead in a bedroom at her home in Woking on 10 August last year.

The court heard earlier in the week that Sara’s head was covered with “homemade hoods” made of plastic bags and parcel tape in the weeks before her death. Jurors were also told neighbour Chloe Redwin would hear “shockingly loud” sounds of “smacking” from their family home followed by “gut-wrenching screams”.

Detailing her injuries, Professor Freemont said that Sara’s injury to the capitate bone in her left hand was “rare” in children, and was usually caused by “falling onto the outstretched hand or a direct blow to the hand”. Asked if the fractures to her fingers were unusual, he responded: “They’re seen relatively frequently and they’re commonly associated with pulling the fingers apart.” Of the fracture to her hyoid bone, he said: “It depends on the setting but in the setting of neck compression, it’s fractured in 25 per cent of cases, the most common type of cases is manual strangulation.”

The trial of Urfan Sharif, Beinash Batool, and Faisal Malik has been adjourned for the day and will resume on Friday. Cell site data shows that in the weeks before Sara’s death, the defendants continued life as usual, with both Urfan Sharif and Faisal Malik attending work. Meanwhile, Beinash Batool had spent time organizing a child’s birthday party and visited the hairdresser.

The jury was also told that Sara had been strangled until a bone in her neck broke up to three months before she died. Other injuries analyzed included two fractures in the girl’s fingers that had occurred between 12 and 18 days before her death, based on the analysis of the stage of healing the injuries were at.