FATAL AMNIOTIC FLUID EMBOLISM: AN OVERVIEW OF POSTMORTEM BIOMARKERS

A. A. Simionescu, M. Vieru, S. Schmitzer, F. D. Popescu,

Abstract: Amniotic fluid embolism (AFE) is a rare clinical condition with a high maternal fatality rate. The definitive diagnosis in fatal cases is based on various postmortem biomarkers: histochemical (amniotic fluid components in the maternal pulmonary vessels visualized by routine and special stains), immunohistochemical (cytokeratin from fetal squamous cells visualized by AE1/AE3 antibody cocktail, tryptase release from mast cell degranulation assessed by AA1 monoclonal anti- tryptase antibody, complement C3a by anti-C3a, mucin-type glycoprotein sialyl Tn visualized by monoclonal antibody TKH-2), and serum biomarkers, especially the specific fetal antigen sialyl Tn (determined by immunoradiometric competitive inhibition assay) and the mast cell tryptase (quantified by fluorescence enzyme immunoassay with capsulated cellulose polymer solid- phase). Herein we present a comprehensive overview of postmortem biomarkers for AFE diagnosis and their usefulness.
Keywords: amniotic fluid embolism, pregnancy, postmortem, biomarkers, immunohistochemistry, serum specimens.