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

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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.

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Authors and Affiliations

  1. Forensic & Analytical Science Service, NSW Health Pathology, New South Wales, Australia

    J. Garland

  2. Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

    W. Philcox

  3. Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland, 1148, New Zealand

    S. McCarthy, K. Kesha, S. Stables & R. Tse

  4. Waikato District Health Board, Hamilton, New Zealand

    S. Hensby-Bennet

  5. Institute of Legal Medicine, University of Leipzig, Leipzig, Germany

    B. Ondruschka & L. Woydt

  6. Department of Medicine, Section of Forensic Medicine, University of Udine, Udine, Italy

    U. Da Broi

  7. CURML, University Center of Legal Medicine, Lausanne University Hospital, Lausanne, Switzerland

    C. Palmiere

  8. Department of Biochemistry, LabPLUS, Auckland City Hospital, Auckland, New Zealand

    L. Lam

  9. Department of Immunopathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand

    Y. Ahn

  10. School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

    R. Tse

Authors
  1. J. Garland
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  2. W. Philcox
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  3. S. McCarthy
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  6. L. Woydt
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  7. U. Da Broi
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  8. C. Palmiere
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  9. L. Lam
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  10. Y. Ahn
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  11. K. Kesha
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  12. S. Stables
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  13. R. Tse
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Correspondence to R. Tse.

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This study was approved by the Coroner’s office.

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The authors declare no conflict of interest.

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Garland, J., Philcox, W., McCarthy, S. et al. The effects of different sampling techniques on peripheral post mortem tryptase levels: a recommended sampling method. Int J Legal Med 133, 1477–1483 (2019). https://doi.org/10.1007/s00414-019-02038-9

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  • DOI: https://doi.org/10.1007/s00414-019-02038-9

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