American Association for Clinical Chemistry
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NACB - Scientific Shorts
NACB - Scientific Shorts (formerly NACB Blog)
By Dr. Sutirtha Chakraborty, MD and Dr. William Winter, MD
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Case: Serum protein electrophoresis (SPE) was requested on a patient with recently diagnosed chronic kidney disease who presented to the hospital with a community-acquired pneumonia (CAP). What is the abnormality observed on this SPE tracing?​

 

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It can be seen that the albumin peak has as a bifid distribution. This condition is commonly known as bisalbuminemia. Bisalbuminemia is a result of two types of serum albumin being expressed that differ in their electrophoretic mobility. Alternatively, albumin can be modified in a way that alters its electrophoretic mobility.
 
Bisalbuminemia is of two types: genetic and acquired. Genetic bisalbuminemia is quite rare and is inherited in an autosomal dominant fashion. Bisalbuminemia is of little diagnostic or therapeutic significance. Acquired dysalbuminemia may result from long term, aggressive beta lactam antibiotic therapy or result from acute pancreatitis (1-8).
 
References:
1) Faviou E, Nounopoulos C, Dionyssiou-Asteriou A, Bisalbuminemia from a clinical chemist's viewpoint: a case report and review of the recent literature. Minerva Med 2006 Jun; 97(3):287-93

2. Desramé J, Delacour H, Béchade D, Adem C, Raynaud JJ, Lecoules S, Coutant G, Algayres JP. Pancreatic peritoneal fistula with bisalbuminemia. Presse Med. 2005 Feb 12;34(3):223-6.
 
3. Galezowski N, Jouanique-Bayrod C, Dazza F, Gehrig D, Trivin F, Herreman G. Bisalbuminemia disclosing primary hyperparathyroidism with fistulized pancreatic false cyst. Rev Med Interne. 1997;18(9):720-3.
 
4. Masciangelo F, Terlizzi R, Salvati F, D'Alessio O, Di Diego E, Feliziani V, Ferri U, Natale G, Nativio N, Pupillo M, Riario-Sforza G. Transitory bisalbuminemia secondary to pancreatitis with ascitic effusion. Minerva Med. 1981 Apr 14;72(15):961-8.].
5. Giménez Fernández J, Arderiu Freixa A, Bada Ainsa JL. Bisalbuminemia (author's transl)]. Med Clin (Barc). 1979 Dec 15;73(10):451-5.
 
6. Rocha J, Bohner J, Kömpf J. Transient bisalbuminemia: separation by isoelectric focusing of human albumin fractions linked to different numbers of benzylpenicilloyl groups. Electrophoresis. 1995 Jun;16(6):1031-3.
 
7. Winter V, Rosenvall A, Heikkilä S, von Essen R.
Acquired bisalbuminemia in staphylococcal endocarditis treated with dicloxacillin. Scand J Infect Dis. 1992;24(6):811-4.
 
8. Soffiati G, Pradella M, Biasioli B, Rigolin F. Transient bisalbuminemia induced by penicillin and gentamicin. Immunoelectrophoretic study and thorough examination of bibliography (author's transl)]. Ann Sclavo. 1980 Mar-Apr;22(2):116-24.

 

 

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Posted by Anthony Killeen
On 11/21/2012

An important point here is that the two albumin peak heights are about equal, as is expected with bisalbuminemia. There are genetic variants of albumin that are of significance that bind T4 with higher affinity (familial dysalbuminemic hyperthyroxinemia). In those genetic variants, total T4 is elevated but the patients are euthyroid. fT4 results in this situation are method dependent (see Cartwright D, et al. Familial dysalbuminemic hyperthyroxinemia; a persistent diagnostic challenge. Clin Chem 2009;55:1044–6.)

Posted by David Bullock
On 11/8/2012

The rarity of the genetic condition depends on the population. When I worked in Wolverhampton England in the 1970s we used to see them quite frequently, particularly from the South Asian community. Good peak separation also depended on the buffer being fresh.

Posted by Wendy Mellen
On 11/3/2012

Where is the tracing?