1. ¹Section of Haematology/Oncology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
2. ²Manitoba Blood and Marrow Transplant Program, CancerCare Manitoba, Winnipeg, Manitoba, Canada
3. ³Health Sciences Centre, Winnipeg, Manitoba, Canada
4. ⁴Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
5. ⁵Department of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI, USA

Correspondence: Dr MD Seftel, Department of Medical Oncology, CancerCare Manitoba, ON2081 675 Mcdermot Avenue, Winnipeg, Canada MB R3E0V9. E-mail: matthew.seftel@cancercare.mb.ca

Received 4 June 2007; Revised 20 July 2007; Accepted 31 July 2007; Published online 17 September 2007.

Abstract

We analyzed autopsies performed in a Canadian blood and marrow transplantation (BMT) program. We aimed to assess variables that predict the performance of an autopsy, whether rates of autopsy are changing, and the rate of discordance between clinical and autopsy diagnoses. All deceased adult patients from January 1990 to December 2004 were reviewed. Autopsy rates were compared to a large teaching hospital. Of 476 myeloablative BMT patients, 225 died and 48 (27%) underwent autopsy. Autopsy was more likely in patients dying: <100 days post-BMT, in the intensive care unit, after allografting, and on weekends. Autopsy rates among BMT patients declined during the three time periods (1990–1994, 1995–1999, 2000–2004). The autopsy rate at the teaching hospital showed a similar downward temporal trend. Major and minor disagreements at autopsy were present in 16 (34%) and 14 (30%) of cases, respectively. There was no change in discordance rates over time. Thus, despite advances in diagnostic procedures, high levels of disagreement between clinical and autopsy diagnoses for BMT patients persist as autopsy rates decline. We recommend that the autopsy regains its role as a valuable investigation. This may become especially relevant in an era where patients with medical comorbidities are undergoing reduced-intensity BMT.