title: Measurement of β-tryptase in postmortem serum, pericardial fluid, urine and vitreous humor in the forensic setting.
abstract: In the realm of forensic pathology, β-tryptase measurement for diagnostic purposes is performed in postmortem serum obtained from femoral blood. This may be partially or completely unavailable in some specific cases, such as infant autopsies and severely damaged bodies. The aim of this study was to investigate the usefulness of determining β-tryptase levels for diagnostic purposes in alternative biological samples. Urine, vitreous humor and pericardial fluid were selected and measured in 94 subjects including: fatal anaphylaxis following contrast material administration (6 cases), hypothermia (10 cases), diabetic ketoacidosis (10 cases), gunshot suicide (10 cases), heroin injection-related deaths (18 cases), trauma (10 cases), sudden death with minimal coronary atherosclerosis (10 cases), severe coronary atherosclerosis without myocardial infarction (10 cases) and severe coronary atherosclerosis with myocardial infarction (10 cases). Postmortem serum and pericardial fluid β-tryptase levels higher than the clinical reference value (11.4ng/ml) were systematically identified in fatal anaphylaxis following contrast material administration and 6 cases unrelated to anaphylaxis. β-tryptase concentrations in urine and vitreous humor were lower than the clinical reference value in all cases included in this study. Determination of β-tryptase in pericardial fluid appears to be a possible alternative to postmortem serum in the early postmortem period when femoral blood cannot be collected during autopsy and biochemical investigations are required to objectify increased β-tryptase levels.
authors.affiliation: University Center of Legal Medicine, Lausanne University Hospital, 21 rue du Bugnon, 1011 Lausanne, VD, Switzerland.
authors.forename: Lionel
authors.initials: L
authors.lastname: Comment
authors.affiliation: Department of Diagnostic Services, Pathology and Legal Medicine, Section of Pathology, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Reggiani Bonetti
authors.affiliation: University Center of Legal Medicine, Lausanne University Hospital, 21 rue du Bugnon, 1011 Lausanne, VD, Switzerland.
authors.forename: Patrice
authors.initials: P
authors.lastname: Mangin
authors.affiliation: University Center of Legal Medicine, Lausanne University Hospital, 21 rue du Bugnon, 1011 Lausanne, VD, Switzerland. Electronic address: cristian.palmiere@chuv.ch.
authors.forename: Cristian
authors.initials: C
authors.lastname: Palmiere
mesh_terms: D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000201:enzymology; D005260:Female; D049429:Forensic Pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000737:chemistry*; D011180:Postmortem Changes; D012016:Reference Values; D053802:Tryptases / Q000032:analysis*; D014822:Vitreous Body / Q000737:chemistry*; D055815:Young Adult
chemical_list: D053802:Tryptases
keywords: Anaphylaxis; Beta-tryptase; Forensic pathology; Mast cells; Pericardial fluid; Postmortem biochemistry