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.
Similar content being viewed by others
References
Pumphrey RSH, Roberts ISD (2000) Postmortem findings after fatal anaphylactic reactions. J Clin Pathol 53:273–276
Ewan PW (1998) ABC of allergies. Anaphylaxis. BMJ 316:1442–1445
Schwartz LB, Metcalfe DD, Miller JS, Earl H, Sullivan T (1987) Tryptase levels as an indicator of mast cell activation on systemic anaphylaxis and mastocytosis. N Engl J Med 316:1622–1626
Schwartz LB, Sakai K, Bradford TR, Ren S, Zweiman B, Worobec AS, Metcalfe DD (1995) The alpha form of human tryptase is the predominant type present in blood at base line in normal subjects and is elevated in those with systemic mastocytosis. J Clin Invest 96:2702–2710
Yunginger JW, Nelson DR, Squillace DL, Jones RT, Holley KE, Hyma BA, Biedrzycki L, Sweeny KG, Sturner WO, Schwartz LB (1991) Laboratory investigation of deaths due to anaphylaxis. J Forensic Sci 36:857–865
Edston E, van Hage-Hamsten M (1998) β-Tryptase measurements post-mortem in anaphylactic deaths and in controls. Forensic Sci Int 93:135–142
Randall B, Butts J, Halsey JF (1995) Elevated postmortem tryptase in the absence of anaphylaxis. J Forensic Sci 40:208–211
Horn KD, Halsey JF, Zumwalt RE (2004) Utilization of serum tryptase and immunoglobulin E assay in the postmortem diagnosis of anaphylaxis. Am J Forensic Med Pathol 25:37–43
Edston E, van Hage-Hamsten M (2003) Mast cell tryptase and hemolysis after trauma. Forensic Sci Int 131:8–13
Platt MS, Yunginger JW, Sekula-Perlman A, Irani A-M, Smialek J, Mirchandani HG, Schwartz LB (1994) Involvement of mast cells in sudden infant death syndrome. J Allergy Clin Immunol 94:250–256
Holgate S, Walters C, Walls AF, Lawrence S, Shell DJ, Variend S, Fleming PJ, Berry PJ, Gilbert RE, Robinson C (1994) The anaphylaxis hypothesis of sudden infant death syndrome (SIDS): mast cell degranulation in cot death revealed by elevated concentrations of tryptase in serum. Clin Exp Allergy 24:1115–1122
Edston E, Gidlund E, Wickman M, Ribbing H, van Hage-Hamsten M (1999) Increased mast cell tryptase in sudden infant death syndrome-anaphylaxis, hypoxia or artefact? Clin Exp Allergy 29:1648–1654
Johnson NL, Kotz S, Balakrishnan N (1994) Continuous univariate distributions, vol 1. Distributions in statistics, 2nd edn. Wiley, New York, pp 337–414
Fineschi V, Cecchi R, Centini F, Paglicci Reattelli L, Turillazzi E (2001) Immunohistochemical quantification of pulmonary mast-cells and post-mortem blood dosages of tryptase and eosinophil cationic protein in 48 heroin-related deaths. Forensic Sci Int 120:189–194
Edston E, van Hage-Hamsten M (1997) Anaphylactoid shock—a common cause of death in heroin addicts? Allergy 52:950–954
Dix R, Orth T, Allen J, Wood JG, Gonzalez NJ (2003) Activation of mast cells by systemic hypoxia, but not local hypoxia, mediates increased leukocyte-endothelial adherence in cremaster venules. J Appl Physiol 95:2495–2502
Schwartz LB, Yunginger JW, Miller J, Bokhari R, Dull D (1989) Time course of appearance and disappearance of human mast cell tryptase in the circulation after anaphylaxis. J Clin Invest 83:1551–1555
Hjort JSU (1994) Computer intensive statistical methods. Validation, model selection, and bootstrap. Chapman & Hall, London, New York
Stassen M, Hultner L, Schmitt E (2002) Classical and alternative pathways of mast cell activation. Crit Rev Immunol 22:115–140
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Edston, E., Eriksson, O. & van Hage, M. Mast cell tryptase in postmortem serum—reference values and confounders. Int J Legal Med 121, 275–280 (2007). https://doi.org/10.1007/s00414-006-0101-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00414-006-0101-2