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International Journal of Legal Medicine

, Volume 121, Issue 4, pp 275–280 | Cite as

Mast cell tryptase in postmortem serum—reference values and confounders

  • Erik EdstonEmail author
  • Olle Eriksson
  • Marianne van Hage
Original Article

Abstract

We have investigated the effects of some factors suspected of inducing spuriously increased tryptase concentrations, specifically sampling site, conjunctival petechial bleeding and prone position at the time of death as indicators of premortem asphyxia, and resuscitation efforts by external cardiac massage. Tryptase was measured in blood from the femoral vein in 60 deaths: 39 control cases who died rapidly (within minutes) from natural causes (sudden cardiac death and acute aortic dissection), 16 with death caused by prolonged asphyxia (traumatic compression of the chest and suffocation due to body position or smothering), and five anaphylactic deaths. In 44 of these cases, tryptase was measured in both heart and femoral blood. Mast cell tryptase was analyzed with a commercial FEIA method (Pharmacia Diagnostics AB, Uppsala, Sweden) measuring both α- and β-tryptase. Assuming that tryptase values in the control group were gamma distributed, we calculated the upper normal limits for tryptase concentrations in femoral blood. It was found that 95% of the controls had values below 44.3 μg/l (femoral blood), SD 5.27 μg/l. All but one of the anaphylactic deaths had tryptase concentrations exceeding that limit. Tryptase was significantly elevated in femoral blood from anaphylactic deaths (p<0.007), compared with the controls. Also, in the cases where death had occurred due to asphyxia tryptase was elevated in femoral blood (p<0.04). A significant difference in tryptase concentrations was seen between blood from the heart and the femoral vessels (p<0.02) in the whole material (n=44). Tryptase concentrations in femoral blood were not influenced by prone position at death, or resuscitation efforts. It is concluded that asphyxia premortem seems to affect tryptase concentrations, that postmortem tryptase measurements should be done in serum from femoral blood, and that the normal upper limit, covering 95%, is 44.3 μg/l.

Keywords

Mast cell Tryptase Postmortem Asphyxia Anaphylaxis Allergy 

Notes

Acknowledgements

The study was supported by grants from The National Board of Forensic Medicine in Sweden and approved by the Local Ethics Commission in Linköping, Sweden, M99-04.

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Erik Edston
    • 1
    • 2
    • 3
    • 4
    Email author
  • Olle Eriksson
    • 1
    • 2
    • 3
    • 4
  • Marianne van Hage
    • 1
    • 2
    • 3
    • 4
  1. 1.Institution for Clinical and Molecular MedicineLinköping UniversityLinköpingSweden
  2. 2.Department of Forensic MedicineUniversity HospitalLinköpingSweden
  3. 3.Department of MathematicsLinköping UniversityLinköpingSweden
  4. 4.Clinical Immunology and Allergy Unit, Department of MedicineKarolinska Institute and University HospitalStockholmSweden

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