Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Autopsy among recipients of stem cell transplant for hematologic malignancies in the modern era

Bone Marrow Transplantation volume 56, pages 282–284 (2021)Cite this article

Subjects

The role of the autopsy is to complement and confirm premortem diagnoses and to identify unexpected findings that will inform care of subsequent patients. The rate of obtaining autopsies has declined significantly over time, from 30–40% in the 1960s to <6% worldwide in 2000 [1,2,3,4]. Discrepancies in premortem diagnoses and postmortem findings often exist. In an autopsy series performed in a general hospital population, Shojania reported a major error rate of 8.4–24.4%, and class I error rate, missed major diagnoses, of 4.1–6.7% for the USA in 2003 [1].

Limited data from autopsy series are available for the HSCT population [5,6,7,8,9]. Primary cause of death is often difficult to determine, with multiple contemporaneous diagnoses reflected in medical records and unreliable attribution on death certificates.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Shojania KG, Burton EC, McDonald KM, Goldman L. Changes in rates of autopsy-detected diagnostic errors over time: a systematic review. JAMA. 2003;289:2849–56. https://doi.org/10.1001/jama.289.21.2849.

    Article  PubMed  Google Scholar 

  2. Hoyert DL. The changing profile of autopsied deaths in the United States, 1972–2007. NCHS Data Brief. 2011;67:1–8.

  3. Turnbull A, Osborn M, Nicholas N. Hospital autopsy: endangered or extinct? J Clin Pathol. 2015;68:601–4. https://doi.org/10.1136/jclinpath-2014-202700.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Nemetz PN, Ludwig J, Kurland LT. Assessing the autopsy. Am J Pathol. 1987;128:362–79.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Al-Saidi F, Diaz-Granados N, Messner H, Herridge MS. Relationship between premortem and postmortem diagnosis in critically ill bone marrow transplantation patients. Crit Care Med. 2002;30:570–3. https://doi.org/10.1097/00003246-200203000-00012.

    Article  PubMed  Google Scholar 

  6. Pastores SM, Dulu A, Voigt L, Raoof N, Alicea M, Halpern NA. Premortem clinical diagnoses and postmortem autopsy findings: discrepancies in critically ill cancer patients. Crit Care. 2007;11:R48. https://doi.org/10.1186/cc5782.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hofmeister CC, Marinier DE, Czerlanis C, Stiff PJ. Clinical utility of autopsy after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2007;13:26–30. https://doi.org/10.1016/j.bbmt.2006.09.006.

    Article  PubMed  Google Scholar 

  8. Seftel MD, Ho M, Pruthi D, Orbanski S, Rubinger M, Schacter B, et al. High rate of discordance between clinical and autopsy diagnoses in blood and marrow transplantation. Bone Marrow Transplant. 2007;40:1049–53. https://doi.org/10.1038/sj.bmt.1705855.

    Article  CAS  PubMed  Google Scholar 

  9. Allan DS, Belanger R, Busque L, Cohen S, Fish D, Roy DC, et al. Maintaining high autopsy rates in a Canadian blood and marrow transplant program: preserving a diagnostic and research tool. Bone Marrow Transplant. 2005;35:781–5. https://doi.org/10.1038/sj.bmt.1704869.

    Article  CAS  PubMed  Google Scholar 

  10. Copelan E, Casper JT, Carter SL, van Burik JA, Hurd D, Mendizabal AM, et al. A scheme for defining cause of death and its application in the T cell depletion trial. Biol Blood Marrow Transplant. 2007;13:1469–76. https://doi.org/10.1016/j.bbmt.2007.08.047.

    Article  PubMed  Google Scholar 

  11. Combes A, Mokhtari M, Couvelard A, Trouillet JL, Baudot J, Henin D, et al. Clinical and autopsy diagnoses in the intensive care unit: a prospective study. Arch Intern Med. 2004;164:389–92. https://doi.org/10.1001/archinte.164.4.389.

    Article  PubMed  Google Scholar 

  12. Goldman L, Sayson R, Robbins S, Cohn LH, Bettmann M, Weisberg M. The value of the autopsy in three medical eras. N Engl J Med. 1983;308:1000–5. https://doi.org/10.1056/nejm198304283081704.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Hematologic Malignancies, OHSU Knight Cancer Institute, Portland, OR, USA

    Eva Medvedova & Richard T. Maziarz

  2. Division of Infectious Diseases, Oregon Health and Science University, Portland, OR, USA

    Lynne Strasfeld

  3. Department of Pathology, Oregon Health and Science University, Portland, OR, USA

    Peter Stenzel

Authors
  1. Eva Medvedova
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lynne Strasfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter Stenzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Richard T. Maziarz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eva Medvedova.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Medvedova, E., Strasfeld, L., Stenzel, P. et al. Autopsy among recipients of stem cell transplant for hematologic malignancies in the modern era. Bone Marrow Transplant 56, 282–284 (2021). https://doi.org/10.1038/s41409-020-0992-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41409-020-0992-4

Search

Advanced search

Quick links