A study of neutrophil as a morphological marker of death from hemorrhagic shock in forensic practice cases.

Excessive autolytic inflammation accompanied by dysfunction of "shock organs" is recognized as arising from hemorrhagic shock due to the promotion of endovascular recruitment of neutrophils. Here, activated neutrophils in the organs of autopsy cases were evaluated as a marker of death from hemorrhagic shock. Morphologically-determined injury to the heart, lung, liver, and kidney was investigated in death from five major causes: hemorrhagic shock, head injury, exsanguination, asphyxia, and drowning. The frequency of activated neutrophils was assessed by immunohistochemical staining. When the antemortem interval was less than 2h, it was found that neither morphological damage nor neutrophil frequencies were significantly different after death due to any of these 5 causes. In contrast, at longer antemortem intervals up to 8h, the frequency of neutrophils in hemorrhagic shock was significantly greater than in head injury, whereas the degree of morphological damage was no different. Thus, the appearance of activated neutrophils in the primary organs could be useful to identify death caused by hemorrhagic shock after longer antemortem intervals.