Original CommunicationBiochemical blood markers and sampling sites in forensic autopsy
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.
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