1.
ENHANCING THE EFFICIENCY OF
POST MORTEM DIAGNOSIS
BY IMPROVING
THE POST MORTEM FACILITY,
TECHNIQUES AND
HEALTH ISSUES
Asha Ann Philip
MVSc Scholar
Division of Pathology (VPL)
Indian Veterinary Research Institute

2.
OVERVIEW
 Introduction
 Review of Literature
 Facilities To Be Available
 Techniques
 Risk Assessment
 Biosafety And Health Issues
 Supportive Diagnostic Tests
 Waste Management
 Cleaning/Disinfection
 Conclusions

3.
 Post mortem is the systematic and scientific examination of the
dead body to ascertain the cause of death.
(Rajan and Valsala, 2002)
 Types of Post mortem Examination
1.Complete Post mortem examination
2.Incomplete Post mortem examination (Eg:Rabies)
3.Cosmatic Post mortem examination( VVIP/ pet animals)
(Sinha, 2011)
INTRODUCTION
WHAT IS POST MORTEM DIAGNOSIS?

4.
WHY ONE SHOULD PERFORM A NECROPSY?
i. • Identification of disease.
ii. • Indicate appropriate .
treatment of disease in a herd.
iii. • Limit future losses.
iv. • Improve understanding of disease effects on animals.
v. • Enhance discussion of health maintenance programmes
with animal health specialists.
( Severidt, 2001)
Contd….

5.
IMPORTANCE OF POST MORTEM REPORT ?
 1. Outbreak of diseases - Vaccination of healthy animals
 2.Insured animals - Death certificate
 3.Government animals
 4.Experimental animal
 5.Medico-legal or vetero-legal
(Sinha, 2011)
Contd….

6.
RULES FOR POST MORTEM EXAMINATION
(Sharma, 2009)
 Conducted as early as possible within 20 minutes
 Site of necropsy
 Done in sufficient light (preferably in daylight)
 Anamnesis and Clinical history of the disease- not be guided
by it.
 Person should wear protective coverings.
 Post mortem kit.
 Record the observed changes.
( Severidt, 2001)
Contd….

7.
REVIEW OF LITERATURE
“Autopsy can represent a key instrument in auditing clinical diagnosis
performance, on which in turn the accuracy of diagnoses, as used in a
variety of epidemiological investigations depend.”
(Saracci,1993)
“Once a cornerstone of medical education and medical practice, the
autopsy has fallen into disuse and disregard in many circles in the
USA”. (Hill,1993)
“Since most autopsies are for the coroner, there is a need to emphasize
the importance of taking tissue for histology, of pathologists having
access to the information they require, and of clinicians and relatives
being properly informed of the results.”
(Carr, 2002)

8.
Contd…..
“The autopsy continues to be a vital part of medical education and
quality assurance if a problem-oriented autopsy can be performed
based on questions raised by the clinician and the pathologist as a
result of the gross dissection and microscopic evaluation.”
(Garner, 2002)
“The one major category clearly falling below the recommended
standard was Conclusions/Commentary. Other major categories such
as History, External description and Histology report were also in
need of improvement.”
(Bjuqn and Berland , 2002)
“The overall quality of sudden unexpected infant death necropsies in
Ireland is less than adequate. A minimum accepted standard of necropsy
is required before a diagnosis can be made.”
( Sheehan et al, 2003)

9.
Contd….
“ Necropsy organ weights are largely useless.
We should stop this ritualistic, pseudoscientific practice and
concentrate on providing a relevant, meaningful service to our
colleagues.” (Barker, 2005)
“National autopsy rates have declined for several decades, and the
reasons for such decline remain contentious”.
(Nemetz. et al, 2006)
“The autopsy rate has declined world wide in the last decades due to
several reasons; progress in diagnosis of diseases, fear of legal
consequences if wrong diagnosis is made, infectious risk to the
pathologists and time consumption.” (Ioan et al, 2012)

10.
WHAT IS THE EFFICIENCY OF OUR
POST MORTEM EXAMINATION ?
 What are the Facilities available?
 What Techniques that we are following?
 How much knowledge and experience we have?
 How far our diagnosis is efficient?

11.
COMPONENTS OF AN EFFICIENT POST
MORTEM DIAGNOSIS
 POST MORTEM FACILITIES
 POST MORTEM TECHNIQUE
 THOROUGH KNOWLEDGE
 HEALTH ASPECTS/ BIOSAFETY
 SUPPORTING DIAGNOSTIC METHODS

12.
FACILITIES TO BE AVAILABLE
 All work should be conducted in a manner that will minimize
accidents and also comply with environmental, health and
safety laws and regulations.

13.
A)TRANSPORT OF ANIMALS AND SAMPLES
(Necropsy Room Policy and procedures, 2009)
 Animals to be necropsied will be double-bagged and
transported.
 Large animals wrapped and covered as much as practical.
 The transport cart should be left outside the entrance of Room.
 Any blood on sample bottles must be disinfected before
removed from the necropsy room.

14.
B)NECROPSY ROOM (Sadalla, 2004)
 A large room that is self contained
(separate air system, light and
drainage)
 The room can accommodate an
animal as large as a rhinoceros.
 A special I-beam with a hoist.
 A large walk-in cooler can be
attached to this room for storage of
deceased animals until they can be
properly disposed of.

15.
1.NECROPSY SUPPLIES
Animal necropsy table Autopsy sink wall mount

16.
 Gloves
 Boning knife
 Steel - for sharpening
 Scissors
 Forceps
 Pruning shears - Rib cutters
[NADC Procedures for Incineration and Operation of the Necropsy
Facility. (Sept. 2004)]

17.
NECROPSY INSTRUEMENTS
(Mortech manufacturing INC, 2012)

18.
2.PERSONAL PROTECTIVE EQUIPMENT (PPE)
 Boots
 Coveralls
 Disposable bouffant cap
(hair net)
 Surgical or procedural
mask
 Protective glasses

19.
3.SHIPPING SUPPLIES
 Plastic wide mouth
containers
 10% buffered formalin
 Sealable bag
(Zip-lock bags)
 Permanent marker
 Needles and Syringes
10% buffered formalin Microbiology collection tools

20.
TECHNIQUES
1.Euthanasia
" The intentional causing of a painless and easy death to a
patient suffering from an incurable or painful disease"
(Webster II University Dictionary, 1996)
 Beneficial to euthanize an affected animal for examination,
especially if there is an outbreak of disease within the herd.

21.
 Types of euthanasia:
(AVMA Guidelines for euthanesia of Animals,2013)
1. Captive bolt
2. Gunshot
3. Chemical (OIE Guidelines, 2012)
4. Exsanguination (Bleeding out)

22.
2.Diagnostic Sampling
(Severidt, 2001)
 Anything that does not
look normal.
 Samples should reflect
the clinical signs of
animal.
 Don't worry about
taking too many
samples, too much is
better than too little.

23.
3.The "digital" necropsy
Feedlot Health
Management Systems (FHMS)
trains its own non-veterinarian
personnel to perform standard
necropsies, digitally photograph
them and load them onto a web-based
application for evaluation
and diagnosis by trained FHMS
veterinarians on the same day.
(Wren, 2012)

24.
4.Needle Necropsy:
(Underwood et al 1983)
 Limited necropsy by histological examination of needle tissue
cores obtained percutaneously.
 Indicated when a full necropsy is not justified due to risk of
infection or when tissue for special investigations is needed
soon after death, and owner’s sentimence.

25.
5.Postmortem Radiology and Imaging (Minimally invasive
autopsy) (Virtopsy)
(Levy, 2012)
 Conventional radiography complement the forensic autopsy
document.
 Forensic pathologist can view postmortem anatomy in 2 and 3
dimensions without dissection
 Radiography, C-arm fluoroscopy, MDCT scanning ,
Angiography and MDCT angiography and MRI
MIA is a feasible procedure with high diagnostic performance
for detection of common causes of death such as pneumonia and
sepsis . (Weustink et al, 2009)
MDCT was a more accurate imaging
technique than MRI for providing a
cause of death (Roberts et al,2012)
Haematoma Haemorrhage
Fracture

26.
RISK ASSESSMENT - GENERAL
(Latham Hall Necropsy Room 120A-Policy and procedures, 2009)
 Inhalation exposure: Aerosols
Epidermal invasion: cut/ wound/scratches
 Ingestion: Food/ water/contaminated hand
 Ocular or mucous membrane exposure: Splashing. ( Rabies)
 Contact contamination: Outside necropsy room
Animals known to contain a pathogen of zoonotic
potential are not to be necropsied at this facility.

27.
SAFETY PRECAUTIONS
(University of Nebraska, Lincoln)
1.Unauthorised persons are not
allowed within the necropsy hall.
2.Personal belongings must be stored
and secured outside the necropsy
room.
3.Individuals should not work alone
in the necropsy room.
4.Food and drink of any type is not
allowed in the necropsy room.
5.Motorized tools will not be used
during any necropsy, with the
exception of fish and turtle.
KEEP THESE RULES
Unauthorised persons are not
allowed within the necropsy hall.
Personal belongings must be
secured outside the necropsy
room.
Individuals should not work alone
Food and drink of any type is not
allowed in the necropsy room.
Motorized tools will not be used

28.
6.Personal protective equipment (PPE)
must be worn at all times during a
necropsy.
7. An N100 respirator must be worn for
avian and rodent necropsies
8. Protective eye wear should be used
where ocular exposure to animal fluid
might occur.
Contd.....

29.
Contd.....
9.Special precautions must be taken with sharp items.
10.Perforated or split gloves should be changed and new
gloves put on after washing hands.
11.PPE must be removed and either disposed or
disinfected.
12.Hand-washing with soap and warm water is required
before exiting the necropsy room.

30.
SEQUENCE FOR PUTTING ON PPE
(Australian Veterinary Association Guidelines for Veterinary Personal Biosecurity , 2011)
GOWN
• Fully cover from neck to knees, arms to end of wrist and wrap around the
back.
• Fasten the back of neck and waist
MASK
• Secure ties or elastic bands at middle of head and neck
PROTECTIVE EYE WEAR OR FACE SHIELD
• Place over face and eyes and adjust to fit.
GLOVES
• Extend to cover writ of isolation gown

31.
SEQUENCE FOR REMOVING PPE
GLOVES
• Grasp outside of the glove with opposite gloved hand;
peel off
• Slide finger of ungloved under remaining glove at wrist.
PROTECTIVE EYE WEAR OR FACE SHIELD
• Outside the eye protection or face mask is contaminated
• To remove handle by head band or eye pieces.
GOWN
• Unfasten the ties
• Pull away from neck and shoulder touching only the inside.
MASK
• Do not touch front of the mask since contaminated
• Grasp bottom ,then top ties and then remove.

32.
INCIDENT RESPONSE PROCEDURES
(Necropsy Room Policy and procedures, 2009)
 In the case of an eye exposure
Immediately flush eyes at the eye-wash station
for 5-10 minutes, using continuous irrigation
 In the case of a needle stick:
Clean and wash affected area thoroughly (use antimicrobial hand
soap or mild disinfectant) for a minimum of 5 minutes. Gently
massage the affected area to encourage bleeding while washing.
 In the case of a mucous membrane exposure
Immediately flush the affected membrane area as much as
physically possible. Then, proceed to an appropriate healthcare
provider .

33.
BIOSAFETY AND HEALTH ISSUES
“Tuberculosis acquired in staff of laboratories and necropsy rooms by
inhalation of aerosols and skin lesions through cut and abrasions”.
(Collins and Grange ,1999) and (Posthaus et al, 2011)
“Salmonella typhimurium was isolated from two adult cows and a veterinary
pathologist who performed necropsy examination of one of the cow”.
(Bemis et al, 2007)
ZOONOTIC DISEASES
Tuberculosis
Rabies
Avian influenza
Nipah and Hendra virus
Brucellosis
Anthrax
Botulism
Monkey pox
Rift valley fever

34.
1.Respiratory Protection Program and completion of fit-testing will be
required for avian and rodent species.
2.Rabies and tetanus vaccination will be offered (Latham Hall Necropsy Room
120A-Policy and procedures, 2009)
3.The workers handling specimens from animals with monkeypox
virus, should use Smallpox Vaccine (CDC Guidelines And
Resources,2003)
Excluded Necropsies
 1. Animals suspected for Anthrax
 2.Old World monkeys or apes where there is no knowledge of
the origin and current health status
 3. Badgers from known TB-affected areas
(Post Mortem Room Code Of Practice, 2013)

35.
BSL – 3 NECROPSY BUILDING
( University of Minnesota, 2006) and (HSADL, Bhopal)
 The BSL-3 Laboratory diagnose diseases of animals and birds
with highly pathogenic organisms in a safe and secure facility.
(The project cost $2,146,200)
 Biosafety level 3 (BSL-3) facilities established responding to
outbreaks of highly pathogenic avian influenza (‘bird flu’) and
other zoonotic (transmissible to humans) diseases including
West Nile virus, rabies, anthrax, mad cow disease, and more
recently, bovine tuberculosis.

36.
showers
The animal wing
Three small
animal rooms
PM AREA LAB WING
Isolator
room
ALKALI
WASH
ROOM
Three rooms for
lab animals.
Four large
animals rooms
Pass through
cabinet
CLEAN CORRIDOR
DIRTY CORRIDOR
sshhoowweersrs
Showers
HSADL, Bhopal

37.
Clean Corridor-Animal wing
Entry
to small
animal
room
Dirty Corridor
Exit from
large
animal
room
Leading to post-mortem area

38.
SUPPORTIVE DIAGNOSTIC
 Histopathology:
 Microbiology, Toxicology and Other Services:
 Tru-cut biopsy post mortems.
Clearly needle post mortem is inferior (11%) to the conventional
autopsy in determining cause of death.
Dr. Radasch performs a tru cut biopsy
Tru-cut biopsy needle
Nylon biopsy bag
TESTS
(Foroudi and Cheung, 1995)

39.
PATHOLOGY LABORATORY FACILITIES IN
NECROPSY ROOM
FOR STAINING PROCEDURES
 Rapid seller’s staining for Rabies
 Peripheral blood smear for Anthrax
 Leishman’s staining for Pasturella
 Acid fast staining for Mycobacterium
 Giemsa staining for Haemoprotozoans
 Cytology for tumours

40.
WASTE MANAGEMENT
(University of Nebraska, Lincoln)
 A waste container with lid and autoclave bag for
disposable PPE other non-animal solid wastes.
 The waste must be decontaminated by autoclaving.
 Liquid biological waste may be flushed down the drain.
 Animal parts and all solid biological remains transported
double bagged to a dedicated rendering.

41.
METHODS OF WASTE MANAGEMENT
 1.Sanitary Land Fills
Daily covering of soils
(Strafuss,1988)

42.
Rendering
3.Rendering Plant
Efficient and safe manner

43.
2. Incineration/ Burning-
• Limited to baby pigs, young chicks, and poults.
• It is too time-consuming and costly to burn large
animals.
Carcass Incinerator

44.
4.Deep burial/ Disposal pit-
Disposal of dead animals on the owner’s land.
Deep burial of carcass (Schultz, 2012)

45.
CLEANING/DISINFECTION
(University of Nebraska, Lincoln)
 The necropsy room (floors and walls) and equipment must
be cleaned thoroughly with disinfectant.
 Drains must be flushed with warm water and disinfectant
as well.
 Reusable PPE (e.g: rubber boots, eye protection) must be
disinfected, air-dried, and left in the room.

46.
TYPES OF DISINFECTANTS
(University of Nebraska, Lincoln)
 Best to choose one that kills wide spectrum of microbes.
 1. Phenolics -General disinfectant
Active against most bacteria (except for spore forming bacteria,
such as Anthrax and Clostridium)
 2. Alkalies -Lye, Lime, and Sodium Carbonate
These act against most bacteria including spore forming bacteria
(i.e. Anthrax,Clostridium) as well as some viruses.
 3. Chlorine compounds
 Hypochlorites - Eg:Sodium hypochlorite ,Chlorinated lime
 Quaternary Ammonium
 Chloramine
Chlorhexidine
Hydrogen peroxide
Virkon

47.
SOME DISINFECTANTANTS USED

48.
CONCLUSIONS
 Evolution of veterinary science was heavily influenced by
examination of dead cadavers.
 Post mortem examination is “a message from dead to the living”.
 Necropsy is pushed back due to advancement in other diagnostic
techniques, the health issues and time consumption for the procedure
 The lack of adequate facilities and poor technical knowledge is always
challenging the efficiency of necropsy diagnosis.
 PM examination can be done accurately and efficiently with
improvement in PM facilities, techniques, biosafety and also with
support of other laboratory tests.
 SOP and Biosecurity programs are designed to minimize the risks
associated with infectious and zoonotic diseases.
 Always go for a complete necropsy, but in case of emergency we can
think of needle necropsy, digital necropsy or virtopsy

49.
REFERENCES
 A.C. Strafuss ,Procedures and Basic Diagnostic Methods for
Practicing Veterinarians .1988. pages-195-203
 A predesign study for the construction of the Veterinary diagnostic
laboratory building BSL – 3 necropsy laboratory University of
Minnesota, 2006
 B.K.Sinha, Post mortem techniques and diagnostic procedures, 3rd
edition, 2011.Page 1-9
 J. L .Burton, Health and safety at necropsy. J Clin Pathol. 2003;
56(4): 254–260.
 J.C.Underwood et al, The needle necropsy. Br Med J.1983.
26(6378):1632-4
 J. A. Severidt et al .2002. Integrated Livestock Management.
Colorado State University.
 Latham Hall Necropsy Room 120A-Policy and procedures, 2009
 NADC-:TSE–SOP–005 Necropsy Procedure(21 AUG 2006)
 United States Department of Agriculture Guidelines for Necropsy