Use of modern forensic methods for post-mortem diagnosis of blood loss

In forensic medical practice, when diagnosing the cause of death from blood loss, it is often necessary to solve questions related to the etiology of loss of circulating blood volume (CBV), the degree and severity of the injury, as well as its role in thanatogenesis and the duration of the terminal (agonal) period. When investigating the cases of death from acute blood loss, the authorities often ask forensic experts to solve issues related to the possibility of performing active targeted actions by the dying person, as well as to assess the timeliness of medical care and the actions of medical personnel. The solution of these issues is often difficult for experts, and it is associated with both objective and subjective reasons. For example, in cases where the circumstances of death are unknown, or there are no medical documents, or they do not contain sufficient information, without which it is impossible to conduct a retrospective clinical and anatomical analysis for the purpose of differential diagnosis between hemolytic shock and post-hemorrhagic anemia. The article deals with the use of new methodological approaches in postmortem morphological diagnostics of blood loss by the rate of its development and its role in thanatogenesis, in forensic medical practice. For example, a particular forensic expertise (case study) shows that the application of two new methods allowed to solve the issues for the investigator related to the cause of death and duration of dying from blood loss. Experts knowledge of new methodological approaches to the forensic diagnosis of acute blood loss will help law enforcement authorities to counteract crimes against the life of citizens, as well as to development the measures to improve the methods for prevention and reduction of mortality from traumatic injuries with blood loss.

Comparative characteristics of the main sanogenetic mechanisms in large laboratory animals (pigs) with acute blood loss and after infusion of an isotonic colloidal solution based on dextran and an isotonic solution based on polyglucin in conditions of general external cooling

The experiment was carried out on male pigs, which in the operating room were simulated with acute blood loss (air temperature 23oC). Then the animals were placed in a climatic chamber (minus 50 ° C) for 10 minutes. Then the temperature in the climatic chamber was raised to minus 10 ° C and the introduction of the test solutions to the animals began. It was found that in both groups there were similar indicators of blood pressure. The heart rate and respiratory rate in animals in the group with the experimental solution based on polyglucin derivatives were lower than in the group with the solution based on dextran. Key words: external general cooling, pigs, blood pressure, heart rate, respiratory rate, infusion solution.

A United States national analysis of basic demographics and commodities in sudden cardiac arrest

Background Cardiac arrest is a condition associated with high mortality rate and can cause significant social-economical burden in United States. Our study aim is to analyze the basic demographic of patients admitted for cardiac arrest and the incidence of complications following cardiac arrest. Methods Using the National Inpatient Sample from 2016–2018, we identified all the hospital admissions with a primary diagnosis code at discharge for cardiac arrest during the study period. We identified the basic characteristics including age, gender, race and admitting hospital status. The set primary outcome was inpatient mortality, length of stay (LOS) and total costs of admission. The secondary outcomes were the incidence of acute kidney injury, acute blood loss anemia, acute embolism and thrombosis of deep veins of lower extremity (DVT), pulmonary embolism, non-traumatic intracranial hemorrhage, and thromboembolic stroke. Multivariable logistic regression model analysis was performed to address potential confounders. The Charlson Comorbidity Index (CCI) was used to adjust for the severity of each patient's co-morbidities. Results A total of 44,655 patients was admitted for cardiac arrest during the study period. Mean age was 64 years; 56% were men; 63% were white, 20.7% were black, 9.2% were latino, 2.8% were Asian or pacific Islander. The total in-hospital mortality was 73.5%. The average length of stay was 4.2 days and the average total costs of admission was 83,516 dollars. Among the seven demographic characteristics: age, gender, race, hospital size, hospital region, hospital teaching status, insurance type; only hospital teaching status and hospital size were found to significantly impact the mortality. Acute kidney injury was the most common complication in post-cardiac arrest patient (42%), followed by acute blood loss anemia (3.6%), pulmonary embolism (2.3%) and DVT (2.1%). Thromboembolic stroke (0.2%) and non-traumatic intracranial hemorrhage (0.1%) are less common. During subgroup analysis, acute kidney injury was also found out to be a predictive factor of increased mortality (OR 1.64, p<0.001). Conclusion Cardiac arrest remains one of the conditions with highest mortality rate. In our study, age, gender or race dit not impact on the outcome of cardiac arrest. Among all the complications from cardiac arrest, acute kidney injury was the most common one and was associated with higher mortality rate. FUNDunding Acknowledgement Type of funding sources: None.

RESEARCH OF THE EFFECT OF A NEW ANTIHYPOXANT AND ANTIOXIDANT AGENT IN EXPERIMENTAL HYPOXIA CAUSED BY ACUTE BLOOD LOSS

Aim. To study the antihypoxic and antioxidant effect of the new blood substitute «Rheoambrasol» in acute blood loss.Material and methods. The experiments were carried out on 60 rats, in which the experimental model of acute blood loss was reproduced. The effectiveness of using the new blood substitute «Rheoambrasol” in acute blood loss was determined in comparison with the drug “Rheopolyglyukin”.Results. The results obtained, it can be seen that blood loss is accompanied by hypoxia, as evidenced by the concentration of hypoxia-inducible factor (HIF-1α), which increased in the second group by 4.1 times. After the infusion of “Rheoambrasol”, the content of hypoxia-inducible factor HIF-1α in blood plasma decreased 2.9 times, compared with the value after blood loss, which was 44.4% lower than after the infusion of the drug “Rheopolyglucin”. After the use of the drug “Rheoambrasol”, the balance of lipid peroxidation activity/ antioxidant system activity (LPO/AOS) in the blood, myocardium and liver was restored. Conclusion. The new drug “Rheoambrasol” has a pronounced antihypoxant effect in acute blood loss, which is manifested in the ability to reduce the content of HIF-1α in the blood of experimental animals.The introduction of “Rheoambrasol” in acute blood loss effectively inhibits lipid peroxidation processes in the blood, myocardium and liver and increases the activity of AOS enzymes, which indicates its antioxidant effect.

Reticulocyte and Erythrocyte Hemoglobin Parameters for Iron Deficiency and Anemia Diagnostics in Patient Blood Management. A Narrative Review

Anemia, iron deficiency and other hematinic deficiencies are a major cause of perioperative transfusion needs and are associated with increased morbidity and mortality. Anemia can be caused either by decreased production of hemoglobin or red blood cells or by increased consumption and blood loss. Decreased production can involve anything from erythropoietin or vitamin B12 insufficiency to absolute or functional lack of iron. Thus, to achieve the goal of patient blood management, anemia must be addressed by addressing its causes. The traditional parameters to diagnose anemia, despite offering elaborate options, are not ideally suited to giving a simple overview of the causes of anemia, e.g., iron status for erythropoiesis, especially during the acute phase of inflammation, acute blood loss or iron deficiency. Reticulocyte hemoglobin can thus help to uncover the cause of the anemia and to identify the main factors inhibiting erythropoiesis. Regardless of the cause of anemia, reticulocyte hemoglobin can also quickly track the success of therapy and, together with the regular full blood count it is measured alongside, help in clearing the patient for surgery.

Stress Induced Cardiomyopathy (Takotsubo) in a Post-Operative Pregnancy Induced Hypertension Patient Operated for Caesarean Section: A Case Report

This is a case of a 30 year old female, with Pregnancy Induced Hypertension and history of psychiatric illness in the past, subsequently developed TCM in the intra-operative period. ECG showed subtle fresh changes. There were multiple stressors for our patient namely acute blood loss, spinal anaesthesia and history of psychiatric illness. The decision on the timing and mode of delivery should be guided by obstetrical reasons. A multidisciplinary team of cardiologists, obstetricians, neonatologists, and psychologists should be involved. This case highlights the importance of being extra vigilant in patients having psychiatric disorders undergoing any surgical procedure especially caesarean section.

A rare anomaly: duodenal Dieulafoy’s lesion in a preterm baby

Neonatal Dieulafoy’s lesion is a rare but serious condition that can be life-threatening if not diagnosed and intervened in a timely manner. It presents with episodes of sudden acute gastrointestinal haemorrhage in the form of blood in vomit and/or blood in stool. In general, most of the lesions are successfully treated with endoscopic or angiographic intervention. Surgery is usually reserved for cases that fail endoscopic or angiographic intervention. We present a neonatal case of duodenal Dieulafoy’s lesion that occurred in a 29-week-old male baby with birth weight of 1.2 kg. He developed melena and haematemesis at 4 weeks of life. He required normal saline boluses and transfusion of blood products for acute blood loss. The lesion was successfully treated with endoscopic intervention.

Evaluation of the quality of medical care in cases of death from acute blood loss (according to data of forensic-medical examinations)

The peculiarities and specificity of the medical field complicate not only the assessment of quality and timeliness of medical care, but also the correctness of the choice of the method of treatment and diagnosis of the disease. The number of forensic medical examinations in «medical cases» has the tendency to increase, and experts in this case face difficulties with forensic medical assessment of medical care provision. Forensic medical analysis of the medical care provision to patients who died of acute blood loss, based on examinations of different forensic medical bureaus of Ukraine has been analyzed. The aforementioned examinations related to the corpses of people who died as a result of acute blood loss, including shock (150 from the total number of 6129 medical examinations were selected). This cause of a death was chosen as one of the leading causes of death in trauma (including a combination with shock). When evaluating gross medical care defects that were found during the examinations that influenced the result, 40.0% (60) – in the form of improper provision (action) were noted in 10 cases (the case of incorrect diagnosis made by the doctors due to underestimation of examination data), defects in the form of non-provision of medical care (inactivity) – in 83.3% (15 cases). In the statistical analysis of defects in the provision of medical care, the majority of cases were connected with delayed provision of medical care – 41,7%. Defects in cases of blood loss were under the following conditions: a) lack of instrumental research, medical treatment and surgery, b) lack of medical treatment and surgery by indications (each of 3,3%). When considering the reasons that led to defects in cases of blood loss, the isolated underestimation of the examination data was in 16,7% (25), a combination of reasons: a) underestimation of the examination data together with the underestimation of additional research data – 16,7% (25); b) underestimation of the examination data together with the negligent attitude to the patient who had a sloppy appearance – 6,7%. The unprofessional nature of the medical staff was in 16,7% of acute blood loss. When providing medical care in cases of death from acute blood loss, defects in the provision of medical care are made by experienced medical professionals in city hospitals (especially large cities of Ukraine), where there are adequate conditions for the provision of medical care, more qualified specialists of different profiles, and there are protocols for providing medical care in acute blood loss.