Waszczuk-Gajda Anna, Kamiński Michał F, Koperski Łukasz, Kamińska Anna, Drozd-Sokołowska Joanna, Lewandowski Zbigniew, Wasiutyński Aleksander, Górnicka Barbara, Jędrzejczak Wiesław W
Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Poland.
Department of Gastroenterology, Hepatology and Oncology, Medical Centre for Postgraduate Education, The Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warszawa, Poland.
Adv Clin Exp Med. 2018 Jan;27(1):63-70. doi: 10.17219/acem/65866.
Despite progress in diagnostic procedures, clinical diagnosis is not always confirmed by an autopsy. An autopsy is a valuable tool in evaluating diagnostic accuracy.
The aim of the study was to compare clinical diagnoses of immediate causes of death with autopsy findings in patients with hematological malignancies or aplastic anemia.
In this study, the results of 154 autopsies (1993-2004) of patients with hematological diseases were reviewed and compared with clinical data. The most probable causes of death in the case of particular hematological diseases as well as the discordances between clinical and autopsy diagnoses and their relation to the clinical characteristic were identified in the studied cohort, which primarily included patients whose death at that particular time was not explained by the clinical course, and in 50% of cases was sudden.
Although various combined infections have been found to be responsible for the largest number of deaths (26.6%), the most common single cause was myocardial infarction (29 patients, 18.8%). The discordance between clinical and post-mortem diagnoses of immediate causes of death was found in 55 patients (35.7%; 95% CI 28.2-42.8%), with 50.9% of cases considered class I discrepancies according to Goldman's criteria. The myocardial infarction was found to be clinically undiagnosed in 69% of cases. In 41% of cases, it was a class I discrepant diagnosis.
This data suggests that hematological patients require special attention and probably preventive measures concerning coronary heart disease, particularly during the initiation of antineoplastic therapy.
