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Quantifying Macrophages and Hemosiderin in Pediatric Dura Mater
Alison Krywanczyk1, Elizabeth A Bundock2
1Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, VT, 05401-1416.
Abstract:
Determining the age of a subdural hematoma at autopsy is of great interest for medicolegal purposes. The appearance of pigment-laden macrophages is often referenced as evidence that the subdural hematoma is 3-4 days old. However, understanding the significance of macrophages and hemosiderin requires understanding the histology of infant dura. Samples of grossly unremarkable dura taken from 17 pediatric autopsies were identified and histologically confirmed to lack subdural neomembrane. CD68 immunostaining and Prussian blue staining was performed. The CD68-positive cells per high-power field were quantified, and the presence of iron-containing cells was recorded. CD68-positive cells were present in all cases, even in the dural border layer. Iron-containing cells were identified in 59% of cases, and in the dural border layer in 29%. Therefore, CD68-positive and iron-containing cells can be present in pediatric dura without neomembrane or macroscopic subdural hemorrhage, and this requires consideration when estimating the age of a subdural hematoma.
Insights
Pigment-laden macrophages indicate subdural hematoma age. However, these cells and iron deposits can be present in infant dura, even without bleeding, complicating age estimation.
Area of Science:
- Forensic Pathology
- Pediatric Histology
Background:
- Accurate subdural hematoma (SDH) dating is crucial for medicolegal investigations.
- Pigment-laden macrophages and hemosiderin are traditionally used to estimate SDH age (3-4 days).
- The presence of these indicators in infant dura requires careful histological interpretation.
Purpose of the Study:
- To investigate the baseline presence of macrophages and iron in infant dura.
- To determine if CD68-positive cells and iron deposits occur in pediatric dura without subdural neomembrane or macroscopic hemorrhage.
- To inform the interpretation of histological findings when dating pediatric SDH.
Main Methods:
- Histological examination of dura samples from 17 pediatric autopsies lacking subdural neomembrane.
- CD68 immunostaining to identify macrophages.
- Prussian blue staining to detect iron-containing cells (hemosiderin).
- Quantification of CD68-positive cells and recording of iron-containing cells.
Main Results:
- CD68-positive cells were universally present in the dura, including the dural border layer.
- Iron-containing cells were identified in 59% of cases.
- Iron-containing cells were found in the dural border layer in 29% of cases.
- These findings were present even in the absence of neomembrane or macroscopic SDH.
Conclusions:
- CD68-positive and iron-containing cells can be baseline findings in pediatric dura.
- Their presence does not necessarily indicate a subdural hematoma or neomembrane formation.
- Consideration of these baseline histological features is essential for accurate medicolegal age estimation of pediatric subdural hematomas.
