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The effects of different sampling techniques on peripheral post mortem tryptase levels: a recommended sampling method

  • J. Garland
  • W. Philcox
  • S. McCarthy
  • S. Hensby-Bennet
  • B. Ondruschka
  • L. Woydt
  • U. Da Broi
  • C. Palmiere
  • L. Lam
  • Y. Ahn
  • K. Kesha
  • S. Stables
  • R. TseEmail author
Method Paper

Abstract

Different sampling techniques can impact on post mortem tryptase levels. A previous study demonstrated significantly lower femoral post mortem total tryptase levels in samples collected via transcutaneous aspiration compared with directly sampling during internal examination. However, an outlier with high tryptase level was noted in one transcutaneous aspiration sample. This 6-month prospective study compared total post mortem tryptase levels between 21 paired aspirated venous and arterial femoral blood samples, and 19 paired aspirated and cutdown femoral venous blood samples in non-anaphylactic deaths only. No statistical differences were demonstrated between the different sampling methods. However, four outlier cases with higher tryptase levels in aspirated arterial and femoral cutdown samples compared with aspirated venous femoral samples were noted. The reasons for the outliers may be due to the bloods collected from these two methods being contaminated by central arterial and venous blood with high tryptase levels respectively. None of the aspirated venous femoral post mortem tryptase levels were above recognized post mortem tryptase cutoff to diagnose anaphylaxis. This study recommends aspirating blood samples from a clamped femoral/external iliac vein for post mortem tryptase analysis should be defined as the gold standard. Further study using the recommended sampling method on post mortem tryptase levels in non-anaphylactic and anaphylactic cases is warranted.

Keywords

Anaphylaxis Post mortem Tryptase Sampling Venous Arterial Aspirate Cutdown 

Notes

Compliance with ethical standards

This study was approved by the Coroner’s office.

Conflict of interest

The authors declare no conflict of interest.

Supplementary material

414_2019_2038_MOESM1_ESM.xlsx (17 kb)
ESM 1 (XLSX 17 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Forensic & Analytical Science Service, NSW Health PathologyNew South WalesAustralia
  2. 2.Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
  3. 3.Department of Forensic Pathology, LabPLUSAuckland City HospitalAucklandNew Zealand
  4. 4.Waikato District Health BoardHamiltonNew Zealand
  5. 5.Institute of Legal MedicineUniversity of LeipzigLeipzigGermany
  6. 6.Department of Medicine, Section of Forensic MedicineUniversity of UdineUdineItaly
  7. 7.CURML, University Center of Legal MedicineLausanne University HospitalLausanneSwitzerland
  8. 8.Department of Biochemistry, LabPLUSAuckland City HospitalAucklandNew Zealand
  9. 9.Department of Immunopathology, LabPLUSAuckland City HospitalAucklandNew Zealand
  10. 10.School of Medicine, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand

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