白血病死亡的法医学鉴定

材料和方法回顾性研究我所2003～2005年间检案实践中4例白血病死亡的法医学鉴定案件。结果4例死者生前均无明显的血液病症状,其中1例死亡前经临床确诊为急性颗粒增多型早幼粒细胞性白血病（M3）,另外3例均无血液病相应的临床资料。尸体解剖主要所见：（1）多器官（尤其是脑）白血病细胞浸润;（2）肝、脾肿大;（3）凝血功能障碍引起的出血倾向,如：皮肤紫癜、创口渗血或迁延不愈等;（4）可排除暴力死亡。结论白血病细胞脑浸润引起的脑内血肿和血液病的并发症弥漫性血管内凝血（DIC）是导致死亡的常见原因;在白血病患者突发死亡的案例中,死者生前往往缺乏典型的血液病症状,或仅有轻微的症状未引起注意;此类案件的法医学鉴定应注意收集临床资料,必须进行系统的尸体解剖检验,在有检验条件的情况下应进行骨髓细胞学病理检验。

A Study of Four Cases of Sudden Death due to Leukemia

Material and Method 4 cases died of leukemia were studied retrospectively based on autopsy records in our institute from 2003 to 2006. Results None of 4 cases showed the typical symptom of hematonosis prior to death. Only one of them was diagnosed the acute promyelocytic leukemia （M3）, and another 3 had no clinical records to verify hematonosis. Autospy findings included the following items： 1. leukemic cells infiltration in multi-organs, especially in cerebrum; 2. hepatomegaly and splenomegaly; 3. bleeding tendency caused by blood disorders, such as purpura, bleeding wound and long-term un-healing, etc; 4. excluding deaths caused from violent force. Conclusion The cases died of leukemia usually have no apparent and typical symptom, or only have slight symptom which is often ignored. In such cases, the clinical records and medical history should be collected, and systematic autopsy must be performed. Microscopic examination should also be performed for marrow cells with a good lab condition. The general cause of death is the disseminated intravascular coagulation （DIC） and intracranial hematoma caused from leukemia.