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

Useful For

Screening for mast cell activation disorders including systemic mastocytosis

Additional Tests

Test ID Reporting Name Available Separately Always Performed
AACT Creatinine, U No Yes

Testing Algorithm

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

Method Name

23BPG: Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

AACT: Enzymatic Colorimetric Assay

Reporting Name

2,3-dinor 11B-Prostaglandin F2a, U

Specimen Type


Advisory Information


Specimen Required

Submit only 1 of the following specimens:


Preferred: 24-hour urine collection

Supplies: Plastic, 5-mL tube (T465)

Specimen Volume: 4 mL

Collection Instructions:

1. Collect urine for 24 hours.

2. No preservative preferred.

Additional Information: See Urine Preservatives-Collection and Transportation for 24-Hour Urine Specimens in Special Instructions for multiple collections.


Acceptable: Random collection

Supplies: Plastic, 5-mL tube (T465)

Specimen Volume: 4 mL

Collection Instructions:

1. Collect a random urine specimen. 

2. No preservative preferred.

Specimen Minimum Volume

3 mL

Specimen Stability Information

Specimen Type Temperature Time
Urine Refrigerated (preferred) 14 days
  Frozen  30 days
  Ambient  8 hours

Reject Due To









Clinical Information

2,3-Dinor-11beta-prostaglandin F2 alpha 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.


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 mutation, 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 (NMH), 2,3-dinor-11beta-prostaglandin F2 alpha (2,3 BPG), or leukotriene E4 (LTE4) are consistent with the diagnosis of systemic mast cell disease.

Reference Values

<5,205 pg/mg creatinine


Elevated urine 2,3-dinor-11beta-prostaglandin F2 alpha is consistent with systemic mastocytosis.


Elevated levels of 2,3-dinor-11beta-prostaglandin F2 alpha 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-dinor-11beta-prostaglandin F2 alpha 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.

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 (2,3 BGP) concentration discrimination for detection of systemic mastocytosis (SM)

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;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, et al: Increased production of prostaglandin D2 in patients with systemic mastocytosis. N Engl J Med 1980;303:1400-1404

4. Metcalfe DD: Mastocytosis syndromes. In Allergy Principles and Practice. Vol II. Fourth edition. Edited by E Middleton Jr, CE Reed, EF Ellis, et al. St. Louis, Mosby Yearbook Inc, 1993, pp 1537-1551

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). All 2,3 BPG concentrations are normalized to urine creatinine levels measured using a Roche Cobas enzymatic method.(Package insert: Roche Diagnostics, Indianapolis IN, 2004)

Day(s) and Time(s) Performed

Monday, Thursday; 11 a.m.

Analytic Time

2 days

Specimen Retention Time

14 days

Performing Laboratory

Mayo Medical Laboratories in Rochester

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information


LOINC Code Information

Test ID Test Order Name Order LOINC Value
23BPG 2,3-dinor 11B-Prostaglandin F2a, U In Process


Result ID Test Result Name Result LOINC Value
37931 2,3-dinor 11B-Prostaglandin F2a, U In Process

Urine Preservative Collection Options







6N HCl


50% acetic acid








Boric acid