9. Risk Factors
Inherited
◦ Anti-thrombin deficiency
◦ Protein C deficiency
◦ Protein S deficiency
◦ Factor V leiden
◦ Prothrombin 20210A
◦ Non O blood group
◦ Dysfibrinogenimia
10. Risk Factors
Mixed / Unknown
◦ High Levels of factor viii
◦ High Levels of factor ix
◦ High Levels of factor xi
◦ High Levels of fibrinogen
◦ High Levels of TAFI
◦ Low Levels of TFPI
16. Ageing of Trombus
Hemolysis of RBCs and amorphous mass
formation----------------------- 24-48 hrs
PTAH Staining
Purplish fibrin strands ------ 1 day
Meshwork of strand and sheets-- 4 days
Deeply purple strand--------- 2 wks
17. Ageing of Thrombus
Endothelial proliferation bud – 2nd day
Covering by endothelium starts 24 hrs
Covering by endothelium finish 24-72 hr
Anchoring thrombus 4th day
18. Ageing of Thrombus
Fibroblast starts 1 wk
Fibroblast Maximum 4 wk
Elastic fibers >4 wk
Maximum density 2 month
Capillary formation
Begins 2nd day
Contains RBCs 2nd wk
Canalization 3 month
Full lumen restoration 6-12
months
23. P M APPEARANCE
Frozen Section + staining sudan black
Skin --- petechial hemorrhages
Brain – white matter of cerebrum,
cerebellum, brain stem
Heart – interfiber capillaries
Kidney – glomerulli
Eye - retina and optic nerve
24. Mason scale
Oil Red O Frozen Section of lung
0: no emboli seen
1: emboli found after some searching
2: emboli easily seen
3: emboli present in large amount
4: emboli present in potentially fatal No.
25. Air embolism
Risk Factors
◦ Venous air embolism
aspiration of air in neck vein
refilling of therapeutic pneumothorax
tearing of visceral pleura
◦ Arterial air embolism
lung laceration
baro-trauma
bends
criminal abortion
mercy killing
27. Methods
Window in sternum
Open heart with clamping of vessels
Submerge opening or syringing
Aspirometer withTween 80
Pyrogallol test
◦ 2% , 4 ml , 2drops NaOH , yellow , brown (+)
28. Amniotic Fluid Embolism
Risk Factors
Multiparity
Abruption
Intrauterine Fetal Death
Tumultuous labour
Oxytocin or Prostaglandin hyper stimulation
Caesarean section
Manual removal of the placenta
29. Pathophysiology
Probably an anaphylactoid-type reaction to
the intravascular ingress of amniotic fluid
This causes widespread vasoconstriction
including pulmonary and cardiac vessels
There is ↓myocardial contractility and acute
left heart failure
If the mother survives the initial cardio
respiratory failure then DIC and
haemorrhage is inevitable
Survivors may suffer stroke due to cerebral
infarction
30. Clinical Feature
Acute fetal distress followed quickly by
maternal collapse with hypotension,
dyspnoea and cyanosis.
Sudden loss of consciousness or seizure.
Often proceeds or occurs immediately after
delivery.
Maternal collapse during Caesarean
section.
Followed by profuse post partum
haemorrhage.
31. P M Findings
Classical findings are presence of
squamous cells shed from fetal skin, lanugo
hair, fat from vernix caseosa and mucin
derived from the respiratory/ GI tract.