Death of Anna Nicole Smith - The Immediate & Delayed Results

What can be learned right away? Why do results take so long?

Medical Author: Melissa Conrad Stoppler, MD
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR

The death of Anna Nicole Smith in February 2007 sparked widespread interest in the autopsy procedure . Exactly what, people wondered, can one learn immediately when an autopsy is performed? Why can't the cause of death always be determined right away?

An autopsy is the postmortem (after death) examination of a body. Autopsies are performed by pathologists, physicians who have received special training in the diagnosis of diseases by the examination of organs and tissues. An autopsy is a medical procedure that involves an external examination of the body, examination of the internal organs (usually the organs of the chest and abdomen along with the brain) in their natural anatomic location, and further examination of the organs upon removal from the body. A number of special procedures, such as cultures of blood and body fluids to identify infectious agents, genetic studies, and toxicology studies to identify drugs or poisons can be carried out on blood or other tissues removed during an autopsy. Finally, samples of the organs are taken and prepared for microscopic analysis.

After performing an autopsy, the pathologist may release a provisional report on the findings. This is generally done on the day of the procedure or shortly thereafter. The provisional report generally contains a description or list of abnormalities that can be discerned with the naked eye (not requiring microscopic evaluation). These are termed gross findings, and sometimes these observations will be able to reveal the cause of a person's death. Examples of conditions that can often be diagnosed immediately during the performance of an autopsy include pulmonary embolism, myocardial infarction (heart attack), stroke with bleeding into the brain, and organ ruptures. Also in cases of foul play, the victim will often (but not always) have characteristic injuries (such as bullet holes) that can determine the cause of death.

Examination of the tissues under a microscope is carried out after the tissues have been preserved and microscopic slides have been prepared and stained. After reviewing the microscopic findings, the pathologist then awaits the results of any special studies that have been ordered, such as cultures for infectious agents and other laboratory tests. Sometimes material must be sent to different laboratories for analysis, and some of the procedures, such as cultures of blood and fluids and special stains of tissues, may take a week or longer for definitive results to be released.

Rapid screening tests for levels of alcohol and other substances in the blood can also be performed if necessary during an autopsy. While results of the rapid screening tests can be available immediately, the full toxicologic analysis is performed in a clinical laboratory. Results may, therefore, not be available for several days.

In summary, the autopsy provides a wealth of information, but a large part of this information is available only after microscopic evaluation of tissues and performance of specialized laboratory studies, both of which may take days to weeks to complete.


Last Editorial Review: 2/14/2007