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Fallbeskrivning
Ansvarig: Gt)ran Lindstcdt
forts. från sid. 42
Mot bakgrunden av förhällandet att heparinbe–
handling kan leda till nedsättning av benmineral–
tätheten (2) uppkom frägan om patienten hade en
förhöjd endogen heparinproduktion, ex. som följd
av mastocytos. Därför gjordes under hösten 1990
en förnyad granskning av det benmärgspunktat
som togs som led i myelomutredningen, varvid
man räknade antalet mastceller. Antalet befanns
vara ca 10 ggr högre än normalt.
Inför möjligheten av mastoytos som orsak till
patientens osteoporos remitterades patienten till en
Klinisk kemi
i
Norden 2, 1994
hudklinik. Teleangiectasierna i ansiktet och pä
skuldrorna befanns likna dem vid mastocytos. Man
observerade vidare ett antal bruna till brunröda smä
fläckar pä hälen, vilka vid gnuggning gav ett tydligt
"triple response" ledande tanken till urticaria
pigmentosa. Ljusmikroskopisk undersökning av
stansbiopsier frän sädana partier visade en bild
förenlig med mastocytos. Vidare biokemisk utred–
ning gjordes därför.
Hur kan man med biokemiska metoder dia–
gnosticera generell mastocytos?
forts. sid. 54
53
