Pulmonary microvascular injury is involved in severe trauma or disease. The present study investigated the immunohistochemical distribution of von Willebrand factor (vWF) and platelet CD61 factor in forensic autopsy cases ( n = 157, >18 years of age, within 48 h postmortem), which comprised fatalities from blunt and sharp instrument injuries, strangulation, fire fatality and acute cardiac death (ACD). vWF immunoreactivity was clearly detected in the endothelia of large vessels (LV, ϕ > 200 μm), small vessels (SV, ϕ 40–200 μm) and capillaries (Cap, ϕ < 40 μm). Cap-vWF positivity was also detected in microthrombi with CD61 immunopositivity. The vWF positivity was higher in non-edema areas than in the edema area in the lungs. For acute deaths, Cap-vWF positivity of non-edema areas was frequently detected for strangulation ( n = 8/13, 61.5%), fire fatality ( n = 11/26, 42.3%) and ACD ( n = 8/15, 53.3%), but was infrequent for blunt and sharp instrument injuries ( n = 6/27, 22.5%, and n = 2/15, 13.3%, respectively), irrespective of the complication of chest injury. However, for non-acute deaths, Cap-vWF positivity was more frequent for non-chest blunt injury ( n = 12/27, 44.4%) than for blunt chest injury ( n = 3/13, 23.1%) and sharp instrument injury ( n = 0/10, 0%). For fire fatality, Cap-vWF positivity was relatively frequent in cases with a lower blood carboxyhemoglobin (COHb) level of <60% ( n = 6/14, 42.8%) than in cases with a higher COHb level of >60% ( n = 3/12, 25.0%). These findings suggest that Cap-vWF positivity is closely related to the death process involving pulmonary microvascular injury.
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