Test Catalog

Test ID: 23BPG    
2,3-Dinor-11 Beta-Prostaglandin F2 Alpha, Urine

Useful For Suggests clinical disorders or settings where the test may be helpful

Screening for mast cell activation disorders including systemic mastocytosis

Testing Algorithm Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

When this test is performed, urine creatinine will always be performed at no additional charge.

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

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 1 of the following minor criteria: abnormal mast cell morphology, KIT Asp816Val variant, CD25-positive mast cells, or 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 Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

<5,205 pg/mg creatinine

Interpretation Provides information to assist in interpretation of the test results

Urinary 2,3-dinor-11beta-prostaglandin F2 alpha (2,3 BPG) values above 3263 pg/mg creatinine are consistent with, but not necessarily diagnostic of, systemic mastocytosis. Values should be interpreted in the context of clinical presentation and additional mast cell disease markers (serum tryptase, urinary N-methyl histamine, and/or urinary leukotriene E4).

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

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.

Supportive Data

An internal study of 203 patients presenting with symptoms consistent with systemic mastocytosis found a receiver operating characteristic (ROC) area under the curve (AUC) of 0.62 for 2,3-dinor-11beta-prostaglandin F2 alpha concentration discrimination for detection of systemic mastocytosis.

Clinical Reference Recommendations for in-depth reading of a clinical nature

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;121(13):2393-2401

2. Butterfield JH: Increased leukotriene E4 excretion in systemic mastocytosis. Prostaglandins Lipid Mediat. 2010;92(1-4):73

3. Roberts LJ, Sweetman BJ, Lewis RA, Austen KF, Oates JA: Increased production of prostaglandin D2 in patients with systemic mastocytosis. N Engl J Med. 1980;303:1400-1404

4. Metcalfe DD: Mastocytosis syndromes. In: Middleton Jr E, Reed CE, Ellis EF, et al. eds: Allergy Principles and Practice. Vol II. 4th ed. Mosby Yearbook Inc; 1993:1537-1551

Special Instructions Library of PDFs including pertinent information and forms related to the test