Autopsy Report

March 23, 2000: We received the final autopsy report today. Here are the details. In a nutshell, it says that all complications were caused by radiation damage, and that it "cooked" Greg's internal organs. His lung damage was listed as the cause of death, but his kidneys would have caused his death if his lungs had not already been damaged. In addition, he had suffered a small heart attack, a large portion of his liver and pancreas were rotted, and he had multiple infarctions in his spleen (like a heart attack, but in the spleen). Sure makes me wonder about Greg's comments regarding radiation. He had said "It makes me sick at my stomach, but it also makes me feel all toasty warm inside." The autopsy report also said that there was no evidence of leukemia, bacterial infection, or rejection of the donor's marrow. Here's the same info, in more medical terminology:

Cause of death was Diffuse Alveolar Hemorrhage in his lungs. He also had early thrombotic microangiopathy (kidney damage). Both are known complications of allogenic BMT (unrelated bone marrow transplant) that carry a very high mortality rate.

Additional abnormal findings, all attributed to radiation and drugs:

Respiratory system:

Diffuse alveolar hemorrhage with prominent hyaline membrane formation and extensive intra-alveolar hemorrhage. Fibrin thrombi present within lungs. There were no pulmonary emboli found in arteries or veins. Parietal pleural surfaces smooth with multiple areas of dark red hemorrhage versus early infarcts. No adhesions or pleural effusions.

Heart:
Posterior descending artery enlarged. Right ventricle slightly dilated. 0.2 cm infarction and subsequent hemorrhage of the papillary muscle of the mitral valve in the left ventricle, and anterior left ventricle infarction. No thromboemboli found.

Liver: Centrilobular necrosis of liver and ascites with 300 ml serosanguinous fluid.

Pancreas: Marked necrosis with focal acute inflammatory infiltrate with extension into peripancreatic adipose tissue.

GI tract: Autolytic cell changes throughout GI tract, but no ulcers or erosions. Fibrous obliteration of appendix. Mild fibrous adhesions among the intestional loops. Near the hepatic flexure, there is mucosal congestion and focal petechial hemorrhages.

Kidneys: Normal appearance, but more pale than usual. Microscopic exam shows changes associated with thrombotic microangiopathy and radiation effect. Extensive acute tubular necrosis. Attributed to radiation damage that usually occurs later on.

Spleen: Multiple large infarctions scattered throughout. Splenic congestion.

Adrenal gland: Adrenal congestion and medullary necrosis.

Prostate, bladder, testicles: normal

Thyroid, brain, muscles, bones: normal

Bone marrow: Normal in appearance. Microscopic exam shows hypocellular for age with trilineage maturation noted. No definite evidence of residual leukemia blasts. No lymph nodes enlarged in body.

Central nervous system: normal

Microbiology: blood cultures negative