R Tse1, J Garland2, K Kesha3, H Elstub4, A D Cala4, Y Ahn5, S Stables3, C Palmiere6. 1. Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland, 1148, New Zealand. rexson.tse@gmail.com. 2. Hornsby Ku-Ring-Gai Hospital, Hornsby, NSW, Australia. 3. Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland, 1148, New Zealand. 4. Department of Forensic Medicine, Newcastle, Forensic and Analytical Science Service (FASS), NSW Health Pathology, John Hunter Hospital, Newcastle, NSW, Australia. 5. Department of Immunopathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand. 6. CURML, University Center of Legal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
Abstract
BACKGROUND: The measurement of mast cell tryptase is commonly used to support the diagnosis of anaphylaxis. In the post-mortem setting, the literature recommends sampling from peripheral blood sources (femoral blood) but does not specify the exact sampling technique. Sampling techniques vary between pathologists, and it is unclear whether different sampling techniques have any impact on post-mortem tryptase levels. AIM: The aim of this study is to compare the difference in femoral total post-mortem tryptase levels between two sampling techniques. METHODS: A 6-month retrospective study comparing femoral total post-mortem tryptase levels between (1) aspirating femoral vessels with a needle and syringe prior to evisceration and (2) femoral vein cut down during evisceration. RESULTS: Twenty cases were identified, with three cases excluded from analysis. There was a statistically significant difference (paired t test, p < 0.05) between mean post-mortem tryptase by aspiration (10.87 ug/L) and by cut down (14.15 ug/L). The mean difference between the two methods was 3.28 ug/L (median, 1.4 ug/L; min, - 6.1 ug/L; max, 16.5 ug/L; 95% CI, 0.001-6.564 ug/L). CONCLUSIONS: Femoral total post-mortem tryptase is significantly different, albeit by a small amount, between the two sampling methods. The clinical significance of this finding and what factors may contribute to it are unclear. When requesting post-mortem tryptase, the pathologist should consider documenting the exact blood collection site and method used for collection. In addition, blood samples acquired by different techniques should not be mixed together and should be analyzed separately if possible.
BACKGROUND: The measurement of mast cell tryptase is commonly used to support the diagnosis of anaphylaxis. In the post-mortem setting, the literature recommends sampling from peripheral blood sources (femoral blood) but does not specify the exact sampling technique. Sampling techniques vary between pathologists, and it is unclear whether different sampling techniques have any impact on post-mortem tryptase levels. AIM: The aim of this study is to compare the difference in femoral total post-mortem tryptase levels between two sampling techniques. METHODS: A 6-month retrospective study comparing femoral total post-mortem tryptase levels between (1) aspirating femoral vessels with a needle and syringe prior to evisceration and (2) femoral vein cut down during evisceration. RESULTS: Twenty cases were identified, with three cases excluded from analysis. There was a statistically significant difference (paired t test, p < 0.05) between mean post-mortem tryptase by aspiration (10.87 ug/L) and by cut down (14.15 ug/L). The mean difference between the two methods was 3.28 ug/L (median, 1.4 ug/L; min, - 6.1 ug/L; max, 16.5 ug/L; 95% CI, 0.001-6.564 ug/L). CONCLUSIONS: Femoral total post-mortem tryptase is significantly different, albeit by a small amount, between the two sampling methods. The clinical significance of this finding and what factors may contribute to it are unclear. When requesting post-mortem tryptase, the pathologist should consider documenting the exact blood collection site and method used for collection. In addition, blood samples acquired by different techniques should not be mixed together and should be analyzed separately if possible.
Authors: Sarah C Beck; Thomas Wilding; Richard J Buka; Richard L Baretto; Aarnoud P Huissoon; Mamidipudi T Krishna Journal: Front Immunol Date: 2019-04-05 Impact factor: 7.561