Postmortem serum erythropoietin levels in establishing the cause of death and survival time at medicolegal autopsy

Abstract

Circulating erythropoietin (EPO) is mainly produced in the kidneys, depending on blood oxygen level. The present study investigated the postmortem serum EPO levels with regard to the cause of death and survival time. Serial medicolegal autopsy cases of postmortem time within 48 h (n = 536) were examined. Serum EPO levels were within the clinical reference range in most cases. Uremic patients with medical administration of an EPO agent (n = 11) showed a markedly high level (140-4,850 mU/ml; median, 1,798 mU/ml). Otherwise, an elevation in serum EPO level (>30 mU/ml) was mainly seen in protracted deaths due to blunt injury and fire fatality, depending on the survival time (r = 0.69, p < 0.0001, and r = 0.45, p < 0.0001, respectively), and in subacute deaths from gastrointestinal bleeding and infectious diseases. However, mildly to moderately elevated serum EPO levels were sporadically found in acute deaths due to mechanical asphyxiation, fire fatality, and acute ischemic heart disease, and in fatal hypothermia cases, especially for elderly subjects. Protracted deaths due to mechanical asphyxiation and ischemic heart disease did not show any survival time-dependent increase in serum EPO level (p > 0.05). EPO was immunohistochemically detected in the tubular epithelia and interstitial cells, showing no evident difference among the causes of death, independent of survival time or serum level. These findings suggest that serum EPO can be used as a marker for investigating anemia and/or hypoxia as a consequence of fatal insult in subacute or prolonged deaths, or a predisposition to traumatic deaths or fatal heart attacks in acute deaths.

Postmortem chemistry update part II

“…Marker analysed [143] higher serotonin values in both fluids were observed in cases of sedative-hypnotic drug intoxication as well as of hyperthermia cases, whereas hypothermia cases tended to show low 5-HT levels. According to the authors, the results of the study would indicate that a systemic neuronal dysfunction might be involved in these causes of death, as already suggested by previous investigations which indicated in the same situations similar changes in catecholamine levels observed in postmortem serum from cardiac blood and cerebrospinal fluid [133][134][135].…”

“…EPO levels increase as early as 2 h post-anaemia and/or systemic hypoxia initiation with a half-life of about 5-9 h. Most anaemic patients have an elevated plasma EPO concentration that depends on the degree and type of anaemia. However, plasma EPO in patients with anaemia from chronic renal failure is usually inappropriately low due to reduced EPO synthesis by the kidney [142,143].…”

“…Quan et al [143] investigated EPO levels in postmortem serum from various sample sites (left and right heart and external iliac vein) in 536 forensic autopsy cases. No difference was observed depending on the sampling site, and values were within the clinical reference range in most cases.…”

An unusual presentation of thoracic aortic aneurysm rupturing into the esophagus: an autopsy case report

“…In biochemistry, an elevation in serum erythropoietin level of 88.0 mU/ml (reference interval, 8-36 mU/ml) was detected [6]. Blood urea nitrogen level (40.4 and 41.4 mg/dl in left and right heart blood, respectively) was slightly higher than the postmortem reference interval (11-25 mg/dl) [7].…”

Cesedin Ayrışma Durumuna Göre Birikmiş Gün Sıcaklıkları ile Postmortem İnterval Tahmini

“…Bu değişimlerin cesette neden olduğu değişiklikler esas alınarak PMİ tahmini yapılmaktadır. PMİ tahmininde kullanılan yöntemlerin başlıcaları; ölü lekeleri (1)(2)(3)(4)(5), ölü katılığı (6,7), ölü soğu-ması (2,(8)(9)(10), vücut sıvılarının postmortem biyokimyasal incelemeleri (2,3,6,7,(11)(12)(13)(14)(15)(16) mide boşalması (1,2,7), elektrofizyolojik çalışmalar (17,18), flow-sitometrik ça-lışmalar (19,20), mikrobiyolojik çalışmalar (21-23) ve entomolojik çalışmalardır (24-34). Bunun dışında ülke-mizde yapılan, iskelet kas dokusundaki postmortem element seviyesi tespiti (35), beyaz kan hücrelerindeki deği-şim (36) ve böbrek üstü bezinin morfometrik değişiklik-lerinin tespiti (37) ile de postmortem interval konusunda yapılmış çalışmalar bulunmaktadır.…”