Postmortem examination in death due to Adverse Events Following Immunization (AEFI)

The detailed history of the patient is included in the autopsy form that 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.

• It is recommended that an autopsy in a death suspected to be due to an AEFI be performed as soon as possible (within 72 hours) to avoid tissue damage, development of postmortem artifacts and autolysis of the adrenal glands, which can alter diagnosis.
• Samples for both histopathological and toxicological examination should be sent to approved and accredited government reference laboratories through investigating police agencies. The samples should be collected and transported to forensic laboratories 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.
• Sampling for histopathology examination to be sent to pathologist for underlying disease/pathologies in the deceased which may be the cause of death or contributed in the cause of death: The samples should be representative of the suspicious area of disease/pathology; however, in general 80 to 100 gms of liver, 100 gms of brain with meninges, fragments from both adrenal glands, half of transverse section of kidneys, half of Spleen and whole heart should be taken.
• All the visceral specimens should be collected in separate containers, a wide – mouthed bottle as prescribed and 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.

Emedinews:Insights on Medicolegal Issues:Postmortem examination in death due to Adverse Events Following Immunization (AEFI)

·         It is recommended that an autopsy in a death suspected to be due to an AEFI be performed as soon as possible (within 72 hours) to avoid tissue damage, development of postmortem artifacts and autolysis of the adrenal glands, which can alter diagnosis.

·         Samples for both histopathological and toxicological examination should be sent to approved and accredited government reference laboratories through investigating police agencies. The samples should be collected and transported to forensic laboratories 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.

·         Sampling for histopathology examination to be sent to pathologist for underlying disease/pathologies in the deceased which may be the cause of death or contributed in the cause of death: The samples should be representative of the suspicious area of disease/pathology; however, in general 80 to 100 gms of liver, 100 gms of brain with meninges, fragments from both adrenal glands, half of transverse section of kidneys, half of Spleen and whole heart should be taken.

·         All the visceral specimens should be collected in separate containers, a wide – mouthed bottle as prescribed and 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.

Emedinews:Insights on MEdicolegal Issues:Postmortem examination: Ideal containers/preservative for viscera

For preservation of viscera, clean, wide-mouthed glass bottles fitted with glass stoppers of one liter capacity should be used. Rubber inserts under caps should preferably not be used. • 20–30 ml of blood taken from femoral artery or vein by skin puncture should be collected in 60ml screw–capped bottles or in plastic capped tubes/10 mg of sodium or potassium fluoride per ml of blood should be added in blood for preserving blood. • 20–30 ml of urine is obtained from direct puncture of the bladder during the postmortem examination with a syringe and needle and should be collected in 60 ml screw–capped bottles or in plastic capped tubes and 20–30mg of thymol blue or boric acid or acetic acid should be added as preservative. • Saturated sodium chloride solution (common salt) for all the visceral samples for chemical/toxicological examination. • If there is an associated history of death due to acid intoxication then all the samples should be preserved in rectified spirit.

Emedinews:Insights on Medicolegal issues: Forensic anatomy and importance of larynx in postmortem examination

• The larynx consists of a large ‘V’-shaped thyroid cartilage. Below the smaller cricoid cartilage, at the upper margin of the posterior wing of the thyroid on each side, are the superior horns or ‘cornuae’, which are connected by the thyrohyoid membrane to the greater horns of the hyoid bone, which lies immediately above.
• The hyoid bone lies at the root of the tongue. The hyoid calcifies at variable times; the body is usually calcified, but the horns may calcify irregularly, both in space and time. In teenagers and young adults they are usually cartilaginous and the joints mobile.
• In middle and later life, the hyoid and thyroid horns calcify and become more brittle.
• The cricoid cartilage is a modified upper tracheal ring but can also become partly calcified as age increases.
• No meaningful ages can be placed on any calcification, but traumatic fractures can occur at any time except in children and most teenagers.
• The pressure is mainly bilateral, so that the sides of the larynx are squeezed. Particularly vulnerable structures are the four ‘cornuae’ or horns, which protect backwards to maintain the patency of the airway around the glottis
• Lateral pressure of the fingers can displace any of the four horns inwards, either by direct pressure or by pressure on the thyrohyoid membrane, which then drags the horns medially. In young persons, the horns are so pliable that they return to their normal position on release of the pressure but, variably beyond the third decade, they may be sufficiently calcified to fracture.
• Though the hyoid bone has received most attention in publications as being the marker of violence to the larynx, in fact the thyroid horns are far more vulnerable. Simpson (1985) found that, in 25 successive deaths from manual strangulation, there were 22 fractures of thyroid horns but only one fractured hyoid.