What is the Significance of Haemosiderin in the Lungs of Deceased Infants?

Abstract

In infants, pulmonary haemosiderin has been put forward as a marker of previous asphyxic abuse and possible grounds for suspicion of homicide. Review of the available literature does not provide a strong enough evidence base to support this claim. Further research is needed before instigation of criminal proceedings can be justified on this pathological finding.

Unclassified sudden infant death associated with pulmonary intra-alveolar hemosiderosis and hemorrhage

“…7 Conversely, Forbes and Acland concluded from their literature review that previous episodes of imposed suffocation are not proven by the presence of PS. 12 In our study, the mean PS count in cases of accidental and inflicted suffocation was 47 ± 64; the PS counts in the two inflicted suffocation cases were 117 and 10.4. 9 These numbers are very low in comparison to the present case with a PS count of 1732.…”

Abusive Suffocation Presenting as New-Onset Seizure

“…In addition, the presence of HLMs would indicate older alveolar bleeding and thus may support remote suffocation; however, this also is not a diagnostic finding. 12,13 The same goes for the presence of pulmonary edema at autopsy. 14 The case presented here had no pulmonary findings other than some pulmonary edema.…”

The frequency and significance of alveolar haemosiderin-laden macrophages in sudden infant death

“…However, 20% of controls also demonstrated alveolar HLMs, albeit only occasional collections. Moreover, in the latter study the NAI cases comprised traumatic homicides in which the mechanism of pulmonary haemorrhage was likely to be different to that observed in the asphyxial deaths included in the aforementioned papers [1]. Several studies have attempted to quantify pulmonary HLMs in post-mortem lung sections, although a precise anatomical distribution of the HLMs is not specifically mentioned in some of these [16,18,19].…”

“…non-lethal episodes of imposed asphyxia, and as such pulmonary HLMs may represent a possible marker for non-accidental injury (NAI) in infants that have died suddenly and unexpectedly [8][9][10], although the published evidence for this remains contentious [1]. The aim of this study, therefore, is to establish the frequency and clinical significance of pulmonary haemosiderin-laden macrophages detected on routine post-mortem examination of the lungs in sudden unexpected infant deaths referred to a single specialist paediatric pathology centre.…”