Immunohistochemistry of pulmonary surfactant apoprotein A in forensic autopsy: reassessment in relation to the causes of death

To reassess the immunohistochemical distribution of pulmonary surfactant ap oprotein A (SP-A) in relation to the causes of death, 282 forensic autopsy cases were reviewed. The most intense and dense granular immunostaining of intra-alveolar SP-A was observed in the hyaline membrane syndrome from vari ous traumas, protracted death from drowning, and perinatal aspiration of am niotic fluid. Similar granular staining pattern was found in Fatal poisonin g by a muscle relaxant and organophosphate pesticides. An evident increase of intra-alveolar granular staining was noted in most fatalities from mecha nical asphyxia and drowning, and some cases of fire death. SP-A staining wa s usually very weak or sparse in alcohol intoxication, poisoning by hypnoti cs and also carbon monoxide poisoning. These findings suggest that the amou nt of intra-alveolar granular SP-A staining may be a possible indicator of severity and duration of respiratory distress (agony) from peripheral (non- central nervous system) origin and alveolar damage. (C) 2000 Elsevier Scien ce Ireland Ltd. All rights reserved.