Death from

Anaphylactic Shock
Presented by:
Aulia Mujizatun Fitriani
Hilwa Salsabila
Nazar Kusuma

Supervisor:
Dr.dr. Taufik Suryadi,Sp.F(K), Dipl-BE

BAGIAN/ SMF ILMU FORENSIK FAKULTAS KEDOKTERAN

UNIVERSITAS SYIAH KUALA/ RSUD dr. ZAINOEL ABIDIN BANDA ACEH
2019

1
 -INTRODUCTION

Anaphylactic shock is a
manifestation of the most severe
anaphylaxis, known as a type 1
allergic reaction and can cause death
within a few minutes due to
cardiovascular blood vessel collapse

Even after autopsy, the diagnosis

of anaphylactic shock is difficult
because of the complexity of
pathogenetic factors and the lack of
pathognomonic data

2
 Introduction

Symptoms of anaphylactic
reactions are pale, loss of
consciousness, shallow
breathing, insensitivity to
external stimuli, impalpable
pulse, and severe
hypotension caused by the
release of vasoactive and
inflammatory mediators
mediated by
immunoglobulin E (IgE)
from mast cells and basophils,
which occur after contact with
certain allergenic antigens.
3
• Unlike the case in Shanghai, all cases involving
antbiotcs, especially cephalosporins (81.8%)
• Anaphylactic events due to anesthesia were Shock
recorded one of every 3500–25,000 given general Anaphylactc
anesthesia of
Cause
• The main causes of anaphylactic shock being treated in
the emergency department in the United States are
related to food, accounting for 30,000 emergency
visits with 150-200 deaths per year
Introduction
 POST-MORTEM DIAGNOSIS
“Postmortem diagnosis of fatal
anaphylactic reactions is a
challenge for forensic
pathologists, because the findings
at autopsy are relatively
unspecified”
Evaluate allergy history (atopic or previous
antecedent) anaphylactic events to know,
unknown or suspected allergens.
Application of clinical diagnostic criteria
such as:
a. the onset of acute illness involving the
skin or mucous tssue or both and
includes respiratory symptoms or low
systolic blood pressure or both
b. two or more symptoms that arise on
the skin
c. low systolic blood pressure of more
than 30% from a person's normal
blood pressure after exposure to
known allergens
 EXTERNAL
EXAMINATION

rash, urtcaria or angioedema, integrity of the skin

and find the place of inoculaton which is ultimately important
to investigate the place which is covered by hair.

 If there are positive findings, then proceed to the autopsy

process.
 INTERNAL EXAMINATION
At an autopsy, things that can be found are NOT SPESIFIC.

These findings can

change according to
the type of allergen, the way of
administraton and the tme passed
oLaryngeal edema is often
between expositon and death
found, but complete
obstruction is rare.

o Pumphrey and
Roberts reported laryngeal
and pharyngeal edema of 8%
and 49%, respectively.
If the death is very fast, the
only macroscopic finding is that the
important multivisceral congestion
 MICROSCOPIC FINDINGS

Increase of
capillary
permeability Smooth
vasodilatation muscle
contraction

ANAPHYLACTIC
SYMPTOMPS
MICROSCOPIC FINDINGS

Broncus constricton and acute emphysema in

anaphylactc case

Asthma
MICROSCOPIC FINDINGS

Mucous placque in tracheobronchial and

broncus at anaphylactc case

Thickening mucous in chronic ashtma

 MICROSCOPIC FINDINGS

SPLEEN IN ANAPHYLACTIC DEATH NON ANAPHYLACTIC DEATH

• Proteases are produced after Triptase
degranulated mast cells
• Mast cells degranulation product
Histamin
• antigen
IgE
LABORATORY FINDINGS
 C ONCLUSIONS

Anaphylaxis is the most dangerous reaction among other allergic reactions

and is a severe systemic reaction, with frequent sudden onset that occurs in a
time that varies from a few seconds to several minutes after antigen exposure.

In each case the death from anaphylactic shock requires a complete autopsy
examination, with histo-pathological and chemical-toxicological investigations.
This diagnosis, in the medico-legal aspect, cannot refer only to the findings of one
type of investigation but must be integrated with the results of further
investigation.
 REFERENCE
1. Isabella M, et.all. Serum tryptase, Immunoglobuline E assay and circumstantial data are fundamental tools
for the post-mortem diagnosis of food anaphylaxis: a case report and literature review. Forensic Pathol.
2018;26:47–50.
2. Sun K, He J, Huang H, Xue Y, Xie X, Wang Q. Diagnostic role of serum tryptase in anaphylactic deaths in
forensic medicine : a systematic review and meta-analysis. Forensic Sci Med Pathol. 2018;
3. Cecchi R. Diagnosis of anaphylactic death in forensics : Review and future perspectives. Leg Med
[Internet]. 2016;22:75–81. Available from: http://dx.doi.org/10.1016/j.legalmed.2016.08.006
4. Shen Y, Li L, Grant J, Rubio A, Zhao Z, Zhang X, et al. Anaphylactic deaths in Maryland ( United States )
and Shanghai ( China ): A review of forensic autopsy cases from 2004 to 2006. Forensic Sci Int. 2009;186:1–5
5. Broi U Da, Moreschi C. Post-mortem diagnosis of anaphylaxis : A difficult task in forensic medicine.
Forensic Sci Int [Internet]. 2011;204(1–3):1–5. Available from:
http://dx.doi.org/10.1016/j.forsciint.2010.04.039
6. Trani N, Bonetti LR, Gualandri G, Barbolini G, Trani M. Forensic Investigation in Anaphylactic Deaths.
Itali: Department of Diagnostic Services, Pathology and Legal Medicine, section of Legal Medicine,
University of Modena and Reggio Emilia, Modena Italy;
7. Yilmaz R, Yuksekbas O, Erkol Z, Bulut ER. Postmortem Findings After Anaphylactic Reactions to Drugs.
Am J Forensic Med Pathol. 2009;30(4):4–7.
8. Trani N, Reggiani L, Gualandri G, Barbolini G. Immediate anaphylactic death following antibiotics
injection : Splenic eosinophilia easily revealed by pagoda red stain. Forensic Sci Int. 2008;181:21–5.
THANK – YOU !