26649 2,3-Dinor 11 Beta-Prostaglandin F2 Alpha, Random, Urine (23BPR)

​​11 Beta-Prostaglandin F2 Alpha; 11BPG; 2,3 11 Beta-Prostaglandin F2 Alpha; 23BPG; BPG2; Mastocytosis; Prostaglandin

​​Screening for mast cell activation disorders including systemic mastocytosis using random urine specimens.

​Patient Preparation: Patients taking aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) may have decreased concentrations of prostaglandin F2 alpha. If medically feasible, for 2 weeks before specimen collection, patient should not take aspirin and for 72 hours before specimen collection, patient should not take NSAIDs.

​Elevated levels of 2,3-dinor-11beta-prostaglandin F2 alpha (2,3 BPG) in urine are not specific for systemic mast cell disease and may be found in patients with angioedema, diffuse urticaria, or myeloproliferative diseases in the absence of diffuse mast cell proliferation.​

Systemic mast cell disease is a heterogeneous disease, and some patients may not have elevated 2,3 BPG in urine.

Patients taking aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) may have decreased concentrations of prostaglandin F2 alpha if dosage has not been discontinued for 2 weeks or 72 hours, respectively.

​2,3-Dinor-11beta-prostaglandin F2 alpha (2,3 BPG) is the most abundant metabolic product of prostaglandins released by activated mast cells. Systemic mastocytosis (SM) is a disease in which clonally derived mast cells accumulate in peripheral tissues. Degranulation of these mast cells releases large amounts of histamines, prostaglandins, leukotrienes, and tryptase.​

The World Health Organization diagnostic criteria for SM require the presence of elevated mast cell counts on a bone marrow biopsy and one of the following minor criteria:

-Abnormal mast cell morphology

-KIT Asp816Val variant

-CD25-positive mast cells

-Serum tryptase greater than 20 ng/mL

Alternatively, SM diagnosis can be made with the presence of 3 minor criteria in the absence of abnormal bone marrow studies.

Measurement of mast cell mediators in blood or urine is less invasive and is advised for the initial evaluation of suspected cases. Elevated levels of serum tryptase, urinary N-methylhistamine, 2,3 BPG, or leukotriene E4 are consistent with the diagnosis of systemic mast cell disease.

​Elevated urinary 2,3-dinor-11beta-prostaglandin F2 alpha (2,3 BPG) concentrations greater than 1820 pg/mg creatinine are consistent with the diagnosis of systemic mast cell disease when combined with clinical signs and symptoms. Pharmacological treatment with aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) has been shown to decrease production of 2,3 BPG.​

Urinary 2,3 BPG has been shown to improve sensitivity in the screening of mastocytosis when used in conjunction with urinary leukotriene E4 and urinary N-methylhistamine. An internal study showed when all three urine markers are measured; sensitivity for systemic mastocytosis detection is 90%.