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HelpEPIC ORDER CODE LAB396 2,3-Dinor 11 Beta-Prostaglandin F2 Alpha, Random, Urine
Additional Codes
SQ: 23BPGM
MAYO: 23BPR
Ordering Guidance
Although a random urine collection is acceptable, the preferred specimen for 2,3-dinor-11beta-prostaglandin F2 alpha analysis is a 24-hour urine collection; order 23BPT / 2,3-Dinor 11 Beta-Prostaglandin F2 Alpha, 24 Hour, Urine.
If ordering this test with NMHR / N-Methylhistamine, Random, Urine, both tests must be ordered under different order numbers. They cannot share an order number.
Specimen Required
Patient Preparation: Patients taking aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) may have decreased concentrations of prostaglandin F2 alpha. If possible, discontinue for 2 weeks or 72 hours, respectively, prior to collecting a specimen.
Supplies: Sarstedt Aliquot Tube, 5 mL (T914)
Container/Tube: Plastic, 5-mL tube
Specimen Volume: 5 mL
Collection Instructions: Collect a random urine specimen.
Useful For
Screening for mast cell activation disorders including systemic mastocytosis using random urine specimens
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| R23BP | 2,3-dinor 11B-Prostaglandin F2a | No | Yes |
| CRETR | Creatinine, Random, U | No | Yes |
Method Name
R23BP: Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
CRETR: Enzymatic Colorimetric Assay
Reporting Name
2,3-dinor 11B-Prostaglandin F2a,RUSpecimen Type
UrineSpecimen Minimum Volume
3 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Urine | Refrigerated (preferred) | 14 days | |
| Frozen | 30 days | ||
| Ambient | 8 hours |
Reject Due To
All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.Clinical Information
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.
Reference Values
<1802 pg/mg creatinine
Interpretation
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%.
Clinical Reference
1. Gotlib J, Pardanani A, Akin C, et al. International Working Group-Myeloproliferative Neoplasms Research and Treatment (IWG-MRT) and European Competence Network on Mastocytosis (ECNM) consensus response criteria in advanced systemic mastocytosis. Blood. 2013 Mar 28;121(13):2393-2401. doi: 10.1182/blood-2012-09-458521
2. Butterfield JH. Increased leukotriene E4 excretion in systemic mastocytosis. Prostaglandins Other Lipid Mediat. 2010 Jun;92(1-4):73-76. doi: 10.1016/j.prostaglandins.2010.03.003
3. Roberts LJ 2nd, Sweetman BJ, Lewis RA, Austen KF, Oates JA. Increased production of prostaglandin D2 in patients with systemic mastocytosis. N Engl J Med. 1980;303(24):1400-1404. doi:10.1056/NEJM198012113032405
4. Metcalfe DD. Mastocytosis syndromes. In: Middleton E Jr, Reed CE, Ellis EF, et al. eds. Allergy Principles and Practice. Vol II. 4th ed. Mosby Yearbook Inc; 1993:1537-1551
5. Butterfield J, Weiler CR. The utility of measuring urinary metabolites of mast cell mediators in systemic mastocytosis and mast cell activation syndrome. J Allergy Clin Immunol Pract. 2020;8(8):2533-2541
Method Description
2,3-Dinor-11beta-prostaglandin F2 alpha (2,3 BPG) is quantified in urine by liquid chromatography tandem mass spectrometry (LC-MS/MS). Deuterium-labeled 2,3-dinor-11beta-prostaglandin F2 alpha (d9-2,3 BPG) and reagent are added to all controls and specimens, which are then liquid/liquid extracted. The extractant is evaporated and samples and controls then reconstituted. Chromatographic separation is achieved with an analytical column. This eluent is transferred to an API 5000 MS/MS. The ratios of the integrated peak heights of 2,3 BPG and d9-2,3 BPG internal standard are used to calculate the concentration of the analyte. All 2,3 BPG concentrations are normalized to urine creatinine levels.(Unpublished Mayo method)
Creatinine:
All 2,3 BPG concentrations are normalized to urine creatinine levels measured using a Roche cobas enzymatic method. The enzymatic method is based on the determination of sarcosine from creatinine with the aid of creatininase, creatinase, and sarcosine oxidase. The liberated hydrogen peroxide is measured via a modified Trinder reaction using a colorimetric indicator. Optimization of the buffer system and the colorimetric indicator enables the creatinine concentration to be quantified both precisely and specifically.(Package insert: Creatinine plus ver 2. Roche Diagnostics; V15.0, 03/2019)
Day(s) Performed
Tuesday, Thursday
Report Available
3 to 8 daysSpecimen Retention Time
14 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
84150
82570
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| 23BPR | 2,3-dinor 11B-Prostaglandin F2a,RU | 97658-9 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| CRETR | Creatinine, Random, U | 2161-8 |
| 603459 | 2,3-dinor 11B-Prostaglandin F2a | 97658-9 |