Ramsthaler Frank, Kröll Ann-Katrin, Verhoff Marcel, Birngruber Christoph G, Kettner Mattias
Institute of Legal Medicine, Saarland University, Saarbrücken, Kirrbergerstraße, Geb. 80.2, 66421, Homburg, Saar, Germany.
Institute of Legal Medicine, Goethe University Frankfurt Main, Kennedyallee 104, 60596, Frankfurt Main, Germany.
Int J Legal Med. 2017 Jul;131(4):955-961. doi: 10.1007/s00414-017-1599-1. Epub 2017 May 2.
In forensic case work, blood stain pattern analysis frequently aids in deducing the chain of actions or parts thereof taking place during an event leading to blood loss. Wiped single blood stains and/or groups of blood stains are seen at a majority of complex crime scenes. The appearance of wiped blood stains depends on droplet volume and stain age (as a function of blood viscosity and the degree of stain skeletonization) and characteristics of the stained surface (i.e., texture, temperature). Furthermore, based on the biochemical and biophysical properties of blood, not only the drying processes, but also complex coagulation cascades are relevant to the assessment of wiped blood stains. This study was designed to determine if anticoagulation therapies markedly affect the wipeability of blood stains over times elapsed since deposition and the overall drying process. A total of 813 blood stains, originating from donors being treated with acetylsalicylic acid (ASA), clopidogrel + ASA, low-molecular-weight heparin, or rivaroxaban, were dropped on common household tiles. Wipeability at an ambient temperature of 20 °C was tested for 22 time periods (1, 2, 3, 5, 10, 15…105 min since deposition). Whereas stains consisting of untreated blood were dried within 55 min, wipeability of all droplets originating from donors with prior anticoagulation treatment showed pronounced delays compared with the control, ranging from 20 min (ASA and clopidogrel + ASA) to 45 min (rivaroxaban). This pronounced effect was not seen in earlier studies, which might be explained by the higher volume of droplets used in this study, which resulted in a shift in relevance from drying to clotting processes. Significant differences between the drying times of the various anticoagulation regimes might be attributed to anticoagulant activity against different targets in the coagulation cascades. In conclusion, anticoagulation treatment prior to blood loss significantly affected the wipeability of blood stains. Anticoagulation therapy should therefore be taken into account in the analysis of blood stain patterns.
在法医案件工作中,血迹形态分析常常有助于推断导致失血事件发生期间的一系列行为或部分行为。在大多数复杂犯罪现场都能看到擦拭状的单个血迹和/或血迹组。擦拭状血迹的外观取决于血滴体积、血迹形成时间(这是血液粘度和血迹骨架化程度的函数)以及沾染表面的特性(即质地、温度)。此外,基于血液的生化和生物物理特性,不仅干燥过程,复杂的凝血级联反应也与擦拭状血迹的评估相关。本研究旨在确定抗凝治疗是否会随着血迹沉积后的时间推移以及整个干燥过程,显著影响血迹的可擦拭性。共有813个血迹,来源于接受乙酰水杨酸(ASA)、氯吡格雷+ASA、低分子量肝素或利伐沙班治疗的献血者,滴落在普通家用瓷砖上。在20°C的环境温度下,对22个时间段(自血迹沉积后1、2、3、5、10、15…105分钟)的可擦拭性进行了测试。未处理血液形成的血迹在55分钟内干燥,而所有来自接受过抗凝治疗献血者的血滴,与对照组相比,其可擦拭性均出现明显延迟,延迟时间从20分钟(ASA和氯吡格雷+ASA)到45分钟(利伐沙班)不等。在早期研究中未观察到这种显著影响,这可能是由于本研究中使用的血滴体积更大,导致相关性从干燥过程转向凝血过程。不同抗凝方案的干燥时间存在显著差异,可能归因于抗凝剂对凝血级联反应中不同靶点的活性。总之,失血前的抗凝治疗显著影响了血迹的可擦拭性。因此,在分析血迹形态时应考虑抗凝治疗。