Original Communication
Biochemical blood markers and sampling sites in forensic autopsy

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Abstract

Forensic pathologists often hesitate to use biochemical blood markers due to the risk of large postmortem changes and deviations from healthy subjects. Biochemical analyses of postmortem blood, if possible, may help to evaluate pathological status and determining the cause of death in forensic diagnosis, for example, in sudden unexpected death without obvious cause, or young adults with no apparent cause of death or antemortem information. Even commercially available biochemical markers were re-evaluated in the blood samples of 164 forensic autopsy cases. Biochemical markers examined were HbA1c, fructosamine, blood nitrogen urea (BUN), creatinine, total protein, total bilirubin, γ-glutamyl transpeptidase (γ-GTP), triglyceride, total cholesterol, C-reactive protein (CRP) and pseudocholine esterase (pChE). We collected cardiac blood (left cardiac blood and right cardiac blood) and peripheral blood (femoral vein blood) to clarify the differences in measured values by sampling site. The measured values were analyzed in relation to postmortem interval, etiology of death and sampling sites. Of all eleven markers, HbA1c is the most useful and reliable because of its negligible postmortem changes and small deviation from healthy subjects. Total bilirubin, BUN, CRP and total cholesterol can be useful if we set appropriate limit ranges and pay attention to the interpretation. For the evaluation of changes due to postmortem intervals, none of the markers except for triglyceride showed significant changes up to three days postmortem. As for sampling sites, femoral vein blood is generally recommended considering postmortem changes, but left cardiac blood was suitable for creatinine, pChE, and total cholesterol. For clinical forensic diagnosis of biochemical blood markers, we must determine the “forensic abnormal value” after collecting more cases by known causes with more information about the population.

Introduction

In forensic autopsies, antemortem information such as present and past illnesses is rarely available, and the forensic pathologist must make a decision on the basis of autopsy findings. In clinical medicine, a lot of information, including biochemical markers in the blood, is available and contributes to the diagnosis of disease, in addition to physical findings. For forensic pathologists, biochemical analysis of the postmortem blood, if possible, may help in evaluating pathological status and determining cause of death in such cases. However, to date, forensic pathologists have often hesitated to use biochemical markers in the blood for forensic diagnosis due to concern about large postmortem changes and large deviations from healthy subjects.

There is a complete review by Coe on autopsy samples, covering a lot of markers1 and a report by Tsuji et al. on an animal study,2 with respect to postmortem changes in the markers. Additionally, there are several reports on the usefulness of the individual markers in autopsy diagnosis.[3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15] However, there is insufficient information on commercially available blood markers and differences in sampling sites in forensic autopsy cases. We chose to measure eleven clinically available biochemical markers in the blood from three sampling sites. The cost for measuring these eleven markers by one sample was very low because these markers are routinely measured in clinical medicine. The cost/benefit factor is very important for low-budget forensic facilities.

Our aim was to re-examine and evaluate commercially available blood markers and their usefulness in forensic diagnosis. We investigated how biochemical markers in the blood suffer from postmortem changes and showed differences due to the etiology of death, while determining suitable sampling sites. These will be useful for taking postmortem changes into consideration when selecting markers and interpreting results.

Section snippets

Blood samples

With the permission of the Ethics Committee of Graduate School of Medicine, The University of Tokyo (No. 690), blood was obtained from 164 consecutive autopsy cases in our department from April 2003 to March 2006 (age 0–98, average age 54.9 ± 21.8, median age 57.0, male 112, female 52). The postmortem interval of the sampling of specimens are as following: 0–12 h (25 cases), 13–69 h (69 cases), 25–48 h (54 cases), 49–72 h (16 cases). Causes of death were as follows: blunt injury (52 cases), sharp

Results

We summarized the data for right cardiac blood, which were obtained in almost all cases (Table 1). First, HbA1c showed almost the same mean value as healthy subjects, and a very low ratio of abnormal values (24.8%), as compared with fructosamine (77.7%), another marker for chronic hyperglycemia. The next group of markers showed much higher mean values than the healthy subjects, and a higher ratio of abnormal values (37.3–95.1%). This group included total bilirubin, triglyceride, BUN, CRP,

Discussion

Of all eleven markers examined, HbA1c showed the smallest deviation from healthy subjects (24.8%, Table 1), negligible postmortem changes (Table 2) and no difference due to etiology of death (Table 3). We confirmed that HbA1c showed negligible postmortem changes. Glycated albumin,9 glycated hemoglobin,[10], [11], [12], [13], [14] and fructsamine14 were shown to indicate chronic hyperglycemia in autopsy samples. However, in this study fructsamine showed a large deviation from healthy subjects.

Conclusion

In our postmortem biochemistry study of 164 consecutive autopsy cases, HbA1c was clearly a reliable marker. Total bilirubin, BUN, CRP and total cholesterol would have been useful if we had set an appropriate limit range and been careful in the interpretation. For the evaluation of changes due to postmortem intervals, the triglyceride value decreased according to the postmortem interval, but other markers did not show significant changes up to three days of postmortem. As for the etiology of

Acknowledgements

We thank Mr. Kakuji Kawai and Ms. Mihoko Nakamura for collecting blood samples in autopsies.

References (15)

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