Abstract
Death in anaphylactic shock cannot be diagnosed by autopsy alone. Morphological diagnosis of anaphylactic death by counting mast cells in the lung and airways have failed to give consistent results. Previously it has been observed that eosinophils seem to accumulate in the spleen in anaphylaxis. The purpose of this study was to investigate if it is possible to safely diagnose anaphylactic deaths by counting eosinophils, mast cells, and basophils in the spleen. In 43 forensic autopsy cases specific antibodies to mast cells, eosinophil-, and basophil granulocytes were used on sections from lung and splenic tissue. The cells were counted in 20 × 40 fields in a Leica photo-microscope. Presumed deaths in anaphylaxis were compared with sudden deaths after intravenous injection of opiates, and sudden cardiac deaths (control group). The main result was that significant (p < 0.05)increases of both eosinophil granulocytes (mean 26.6 ± 17.8/SD/)and mast cells (3.2 ± 2.0/SD/) versus controls (eosinophils mean 7.0 ± 10.5 and mast cells mean 0.9 ± 1.1) were seen in splenic tissue in anaphylactic deaths. Comparing cases with high and low concentrations of mast cell tryptase in serum showed a similar increase in eosinophils and mast cells in the spleen in cases with elevated tryptase, but not in the lung. The numbers of pulmonary mast cells and eosinophils were not different in anaphylactic deaths compared with controls. It is concluded that by quantifying eosinophil granulocytes and mast cells in the spleen in combination with tryptase measurements in serum it is possible to diagnose anaphylaxis with a high degree of certainty.
Similar content being viewed by others
References
Schwartz LB, Lewis RA, Austen KF. Tryptase from human pulmonary mast cells: purification and characterization. J Biol Chem. 1981;256:11939–43.
Schwartz LB, Metcalfe DD, Miller JS, Earl H, Sullivan T. Tryptase levels as an indicator of mast cell activation on systemic anaphylaxis and mastocytosis. N Engl J Med. 1987;316:1622–6.
Yunginger JW, Nelson DR, Squillace DL, et al. Laboratory investigation of deaths due to anaphylaxis. J Forensic Sci. 1991;36:857–65.
Randall B, Butts J, Halsey JF. Elevated post-mortem tryptase in the absence of anaphylaxis. J Forensic Sci. 1995;40:208–11.
Edston E, van Hage-Hamsten M. Beta-tryptase measurements post-mortem in anaphylactic deaths and in controls. Forensic Sci Int. 1998;93:135–42.
Pumphrey RSH, Roberts IS. Postmortem findings after fatal anaphylactic reactions. J Clin Parthol. 2000;53:273–6.
Heard BE, Nunn AJ, Kay AB. Mast cells in human lungs. J Pathol. 1989;157:59–63.
Delage C, Irey NS. Anaphylactic deaths. A clinicopathological study of 43 cases. J Forensic Sci. 1972;17:525–40.
Trani N, Bonetti LR, Gualandri G, Barbolini G. Immediate anaphylactic death following antibiotics injection: splenic eosinophilia easily revealed by pagoda red stain. Forensic Sci Int. 2008;181(1–3):21–5.
Edston E, Gröntoft L. Saffron—a connective tissue counter stain in routine pathology. J Histotechnol. 1997;20:123–5.
Plager DA, Weiss EA, Kephart GM, Mocharia RM, Matsumoto R, Checkel J, Schwartz LB, Gleich GJ, Leiferman KM. Identification of basophils by a mAb directed against pro-major basic protein 1. J Allergy Clin Immunol. 2006;117:626–34.
Voigt J. Eosinophils in the spleen in cases of lethal anaphylactic shock. Med Sci Law. 1966;6:162–3.
Mukai K, Obata K, Tsujimura Y, Karasuyama H. New insights into the roles for basophils in acute and chronic allergy. Allergol Int. 2009;58:11–9.
Edston E, Gidlund E, Wickman M, Ribbing H, van Hage Hamsten M. Increased mast cell tryptase in sudden infant death—anaphylaxis, hypoxia or artefact? Clin Exp Allergy. 1999;29:1648–54.
Fineschi V, Cecchi R, Centini F, Pglicci Reatelli L, Turilazzi E. Immunohistochemical quantification of pulmonary mast cells and post-mortem dosages of tryptase and eosinophil cationic protein in 48 heroin-related deaths. Forensic Sci Int. 2001;120:189–94.
Edston E, van Hage Hamsten M. Anaphylactoid shock—a common cause of death in heroin addicts? Allergy. 1997;52:950–4.
Sheen CH, Schleimer RP, Kulka M. Codeine induces human mast cell chemokine and cytokine production: involvement in G-protein activation. Allergy. 2007;62:532–8.
Acknowledgments
The study was supported by grants from the Swedish National Board of Forensic Medicine.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Edston, E. Accumulation of eosinophils, mast cells, and basophils in the spleen in anaphylactic deaths. Forensic Sci Med Pathol 9, 496–500 (2013). https://doi.org/10.1007/s12024-013-9468-9
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12024-013-9468-9