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?​

One anodal peak too many!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.