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March 1991

The Medicolegal Implications of Detecting Hemosiderin in the Eyes of Children Who Are Suspected of Being Abused-Reply

Author Affiliations

Ann Arbor, Mich
Boston, Mass
Fort Myers, Fla

Arch Ophthalmol. 1991;109(3):322. doi:10.1001/archopht.1991.01080030023020

In Reply.  —We appreciate the comments by Massicotte et al. As with every other clinical or laboratory test, the finding of hemosiderin in tissue must be interpreted in the context of clinical history and pathologic findings. When so used, we believe that iron stains for hemosiderin may be helpful in dating hemorrhages. Although Massicotte et al refer to general pathology texts in an incomplete discussion concerning the deposition of hemosiderin, the timing of iron deposition in traumatic brain lesions is well documented.1-4 Hemosiderin first appears 3 days after injury, but does not become obvious on histochemical staining for 5 to 7 days after trauma.1-4 In two of three cases in our report,5 the children died within 3 days of hospital admission. In the third case, death occurred on the sixth day of hospitalization, but histologic evidence for hemorrhages of different ages was incontrovertible (see below). In all

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