Genesis and diagnostic value of leukocyte and platelet accumulations around "air bubbles" in blood after venous air embolism

Abstract

Leukocyte and platelet accumulations around apparently empty spaces ("air bubbles") in the blood of the right heart or branches of the pulmonary artery should constitute histomorphological evidence of a venous air embolism prior to death. Such findings have been evaluated as the result of active cellular reactions to air bubbles and as a vital reaction. This interpretation was reviewed by injecting a frothy mixture of blood and air into the pulmonary artery of six human lungs 12-110 h post mortem. The lungs were fixed and (immuno)histologically prepared (haematoxylin-eosin staining, immunohistological visualization of platelets, fibrinogen and fibrin). Leukocyte and platelet accumulations around "air bubbles" in blood were provoked late post mortem by injection of the frothy blood-air mixture and are thus possibly not the result of vital cellular reactions. The case is rather that attachment of particles (cells) to flowing air bubbles in an aqueous medium (blood) could correspond physicochemically to a flotation process such as those used in industry for separation techniques. A flotation process would, however, require an intensive dynamic blood-air bubble contact, which would only be obtainable if cardiac action is maintained for a sufficient length of time after air embolism. Leukocyte and platelet accumulations around "air bubbles" in the blood would then indeed be properly interpreted as a vital reaction (albeit possibly not resulting from vital cellular reactions) and could be used as evidence of an air embolism prior to death.

Proof of air embolism after exhumation

“…The detection of gases of putrefaction alone does not exclude an air embolism. Final evaluation will always have to consider other evidence (typical previous history, typical circumstances of dying [2,[13][14][15][16][17], detection of entrance sites, absence of other causes of death, histological findings [18][19][20], "matching" confession of a suspect).…”

Proof of fatal air embolism

“…Ritz-Timme et al [28] produced leukocyte and platelet accumulations experimentally and interpreted this phenomenon as result of a vital flotation process.…”

Muerte por establecer y muerte súbita

“…El volumen de aire en el sistema venoso necesario para causar la muerte se estima en 100-250 ml; igualmente con cantidades menores puede generarse [14,[42][43][44][45].…”