Table IV.

Diagnostic algorithm for adult mastocytosis patients

1. History (the onset and duration of the disease, provoking factors, presence of mediator-related symptoms and anaphylaxis, mastocytosis in family)

2. Physical examination (inspection of the skin, Darier's sign, organomegaly: liver, spleen, lymph nodes)

3. Skin biopsy

4. Peripheral blood analysis and serum biochemistry

5.Liver function tests

6. Serum tryptase levels

7. Abdomen ultrasound (or other imaging studies depending on individual presentation)

8. Bone densitometry

9. Bone marrow trephine biopsy (>2 cm). Antibodies against CD25, CD 117, and tryptase should be applied; in SM-AHNMD further immunohistochemical staining

10. Blood and bone marrow smears

11. Flow cytometric analysis of bone marrow MC for the presence of CD2 and CD25

12. Genetic examination – determination of KIT mutation (D816V) in bone marrow MC