Emedinews:Insights on Medicoleagl Issues:Immunization death and legal autopsy

• It is recommended that an autopsy in a death suspected to be due to an adverse event following immunization (AEFI) be performed as soon as possible (within 72 hours) to avoid tissue damage, development of post mortem artifacts and autolysis of the adrenal glands, which can alter diagnosis.
• The detailed patient’s history is included in the autopsy form that it is submitted to the team (autopsy surgeon/pathologist/forensic specialist) conducting autopsy. The additional specific information to the autopsy team will help them look for any underlying disease/pathologies in the deceased, which may be cause of death or contributed in the cause of death.
• Samples for both histopathological and toxicological examination should be sent to approved and accredited government reference labs through investigating police agencies. The samples should be collected and transported to forensic labs as early as possible to avoid loss of biological samples due to decomposition.
• All samples should be labeled with the name, number and autopsy report/form number along with the necessary documents requesting the examination and investigation, and the conclusions from the autopsy, which should list the cause of death, utilizing International Classification of Disease (ICD 10) and, if possible, the causative agents/drugs.
• Samples for histopathology to be sent to a pathologist to detect underlying disease/pathologies in the deceased that may have caused or contributed to death. The samples should be representative of the suspicious area of disease/pathology; however, in general liver (80–100gm), brain (100 gm) with meninges, fragments from both adrenal glands, half of transverse section of kidneys, half of spleen and whole heart should be sent.
• All the visceral specimens should be collected in separate containers or a wide–mouthed bottle as prescribed; 10% formalin should be added as preservatives. The quantity of the formalin should be sufficient to cover all the pieces of specimen viscera in bottle.
• The specimens should be sealed, signed, labeled by the doctor/autopsy surgeon and should be handed over to police/investigating officer for further pathological examination.