[quote]idaho wrote:
so, as a matter of self knowledge, that would not have not came up in the autopsy? Thanks, dont mean to derail the thread, just curious. Thanks. [/quote]
Disclaimer: I am not a pathologist or medical examiner. My last forensics lecture/course work happened in under grad.
My initial thought is that a big part of the anaphylactic diagnosis comes from either history or response to treatment (Basically the patient responds to things that would help anaphylaxis so a positive response to treatment confirms the diagnosis). Being that this is an allergic reaction we are talking about there would likely be certain markers with blood or tissue samples (higher histamines) and of course allergy testing can be done, on a living patient.
As much as the white coat invokes infallibility there is good reason that pathologists and ME’s are rendering professional “opinions”. I couldn’t find any better report of the autopsy in this case so I do not know what testing was done. If someone dies from upper or lower respiratory occlusion (throat or bronchi swelling) that would show up. On the other hand if they went into shock quickly there may not be much in the way of overt evidence. You and I could stare at the body and gather that they weren’t stabbed, shot, strangled, burned, etc. It is harder to see vasodilation leading to shock.
I did a short search and came up with this journal article for post mortom dx, relevant in subject and for being a UK study.
It is a quick read, but I am going to post the abstract and first paragraph of the into(with comment). I believe that partial posting does not violate any copyright laws and that limited posting for discussion falls under fair use.
[quote]Pumphrey and Roberts wrote in the Journal of Clinical Pathology:
Abstract
Aims:To determine the frequency at which classic manifestations of anaphylaxis are present at necropsy after fatal anaphylactic reactions.
Methods:A register has been established of fatal anaphylactic reactions in the UK since 1992, traced from the certified cause of death and other sources. Details of the previous medical history and the reaction suggest anaphylaxis as the cause of death for 130 cases; a postmortem report was available for 56.
Results:The 56 deaths studied included 19 reactions to bee or wasp venom, 16 to foods, and 21 to drugs or contrast media. Death occurred within one hour of anaphylaxis in 39 cases. Macroscopic findings included signs of asthma (mucous plugging and/or hyperinflated lungs) (15 of 56), petechial haemorrhages (10 of 56), pharyngeal/laryngeal oedema (23 of 56), but for 23 of 56 there was nothing indicative of an allergic death. Mast cell tryptase was raised in 14 of 16 cases tested; three of three tested had detectable IgE specific for the suspected allergen.
Conclusions:In many cases of fatal anaphylaxis no specific macroscopic findings are present at postmortem examination. This reflects the rapidity and mode of death, which is often the result of shock rather than asphyxia. Investigations that might help determine whether anaphylaxis was the cause of death had rarely been performed. In the presence of a typical clinical history, absence of postmortem findings does not exclude the diagnosis of anaphylaxis
[/quote]
Their conclusion was there may not always be macroscopic evidence, but that specific blood markers should be likely be present in a case where systemic shock was fatal. These tests were not often done.
Here is the first paragraph of the into. I am going to comment/translate in italics. I hope that no one takes me doing so as condescending. I just don’t want anyone to think the clinical language is a barrier.
[quote]From J of Clinical Path:
Acute allergic reaction is an uncommon but well recognised cause of sudden death. Anaphylactic reactions can cause variable combinations of symptoms including generalised flushing, urticariahives, angio-oedema(deeper tissue swelling, like hives but of lower skin layers. Ever seen someone’s eyes swell shut due to allergy? This is it. Also fatal airway compromise is possible. So this should be considered a medical emergency., vomiting, diarrhoea(This is how british people spell diarrhea. It’s like they don’t even try to speak english.), conjunctivitis(inflammation of part of the eye/“pink eye”), rhinorrhoea(Runny nose or a rhino with the trots, I can’t remember which. We will either need a tissue or hip waders and a filter mask.), sneezing, and coughing; there may be loss of consciousness as a result of shock, or breathing difficulty caused by increased upper or lower airways resistance(Swelling making it so you get the “breathing through a straw” effect.) More severe reactions can lead to respiratory or cardiac arrest. Asphyxia can follow upper airways obstruction as a result of pharyngeal or laryngeal oedemai[/i], or lower airways obstruction as a result of bronchospasm, in some cases with mucous plugging. Cardiac arrest can follow respiratory arrest, or can occur without respiratory difficulty, as a result of either direct effects of mediators of anaphylaxis on the heart(chemicals causing the observed problems), or profound shock resulting from peripheral vasodilatation, often combined with angio-oedema causing loss of intravascular fluid.(Intravascular fluid is basically blood volume. Massive systemic vaso dilation would result in greatly lowered blood pressure. The loss of fluid volume from the vascular system to the swelled tissues would compound this. The end result is there is not enough blood volume to go around to all the critical tissues and the patient ends up in “shock” In cases where shock is established within minutes of the start of the reaction, there may be no time for other features to appear. [/quote]
Again, I hope that was helpful. If I can answer any questions I would be happy to do so within the bounds of my limited knowledge of the subject.
Regards,
Robert A
