Forensic autopsy-confirmed thrombosis-related deaths: the danger in the bones.

Thrombosis is a potentially life-threatening condition related to roughly a quarter of all deaths globally. Many of these deaths occur inside healthcare facilities due to possibly preventable causes. Therefore, understanding the etiological factors involved in excessive thrombosis may significantly contribute to the successful identification, management and education of people who have an increased risk of thrombosis. We performed a retrospective file-audit of all forensic autopsy reports conducted at the Free State Forensic Pathology Mortuary in Bloemfontein, South Africa, over 10 years. We collected the age at death, gender and ethnicity of each person included in the study. The presence and location of the thrombosis and any underlying disorder or disease were noted. The overall prevalence of thrombosis for the total study population was 0.97%. Pulmonary embolisms (PE's) were much more common than coronary thromboses. Most PE's had known contributory risk factors, where coronary thrombosis-related deaths occurred suddenly without known risk factors. Bone fractures were the most prominent risk factor associated with PE's. Females of African descent had a consistently high prevalence of thrombosis after the age of 30 years. Males of European descent showed an unexpected peak in prevalence during the 4th decade. Since most deaths occurred in patients with conditions known to contribute to venous thrombosis, we conclude that intensified public awareness efforts are required in our region to assist the general public in identifying risk factors for thrombosis, thereby decreasing the burden this potentially preventable disorder places on society.

An audit of disseminated intravascular coagulation screen requests at an academic hospital laboratory in central South Africa.

INTRODUCTION: Disseminated intravascular coagulation (DIC) is a feared complication of various systemic illnesses. We aimed to evaluate the laboratory requesting practices of clinicians, especially concerning the laboratory parameters, included in the International Society of Thrombosis and Haemostasis (ISTH) DIC score. METHODS: A retrospective descriptive study was performed and included data from DIC screen requests analysed at Universitas National Health Laboratory Service (NHLS) laboratory, Bloemfontein, South Africa, for one calendar year. Laboratory request forms were analysed, recording the pretest diagnosis and whether the diagnosis was associated with DIC. Parameters of the DIC screen, prothrombin time, activated partial thromboplastin time, thrombin time, d-dimer and fibrinogen were used to calculate the ITSH DIC score and diagnose heparin contamination. The platelet count, currently not part of the DIC screen test set, was also recorded. RESULTS: A total of 778 DIC screen requests were processed. One hundred and eighty-three requests were excluded due to laboratory-defined rejection criteria, heparin contamination or for lacking an ISTH score parameter. Of the remaining 595 complete requests, 283 (47.7%) were laboratory-defined overt DIC. The pretest diagnosis was not predictive of either a positive or negative finding of overt DIC. The contribution of fibrinogen to assigning overt DIC was questionable. CONCLUSION: The number of DIC screen requests received highlights the need for laboratory evidence of DIC. To improve laboratory DIC testing, the authors suggest critical evaluation of the contribution of the pretest diagnosis and fibrinogen in a prospective study and adding the platelet count in our local DIC test set.