[Billy1]

The ISS and Serum Albumin Tests

by Billy1 on Sun Dec 04, 2011 1:58 pm

Be carefull out there if you are having concurrent Serum albumin tests run using SPEP and a seperate albumin test such as provided under Liver Profile. A friend of mine had such tests with blood drawn on the exact date and time at a local hospital. The local lab reported a T.P. of 7.5 g/dL and sAlbumin of 3.30 g/dL (range 3.20-5.50). The SPEP blood vials were sent out of state for testing. The SPEP results were as follows: T.P. 7.6 (very close) with the Albumin at 3.77 g/dL (range 2.37-4.57). The M-Spike was 1.53. At the same time a B2 Micro. test was run and came back at 3.4 mg/L. Now where does all of this lead?

The International Staging System uses the following criteria for staging of Type1 multiple myeloma.
A B2 Microglobulin <3.5 mg/L and the serum Albumin must be over 3.5 g/dL for diagnoses of type 1. These findings were reported under a broad tracking chart with numerous tests recordered. Well, the oncologist happened to select the lowest albumin reading from the local hospital (3.30) and the B2Micro at 3.4. You can see where this leading as the diagnoses was made of stage II (ISS). The variance of these numbers is not minor. The differance being .47 g/dl ( about 14%) which should of made the diagnoses stage 1 if the albumin electrophoresis test results were used.

I decided to look into this and started by contacting the local lab director. He informed me that the lab uses the BCP (purple) protocal for there albumin tests. Nothing wrong with this. He assured me that the tests were accurate but he also informed me that significant lower values could be reported using BCP over that using the more common BCG (green) which correlates supposedly closer to the electrophoresis regimen.

This started me on a internet search to find out what was going on. The first article I uncovered was from the Mayo Clinic addressing this exact problem. Many tests were conducted to determine variances between the BCG protocal and electrophoresis (PEL) protocal and to see how variances occured according to the level of th M-Spike in Myeloma patients. About one third of the samples obtained showed discordance using the >3.5 g/dL albumin variances when using the ISS criteria.

Many other articles are out there addressing this issue with variances betwwen BCP and BCG with numbers going all over the place but the common thread is that PCP is almost always lower than BCG. Some articles claim close concordance with BCG and PEL while others do not.

Regards:

Billy

[Dr. Peter Voorhees]

Re: The ISS and Serum Albumin Tests

by Dr. Peter Voorhees on Mon Dec 05, 2011 3:32 am

Dear all,

Billy's research emphasizes the fact that our tests are fallible and subject to variability (recognizing that certain tests are more vulnerable than others). As such, it is always important to interpret lab results with this fact in mind. Albumin can fluctuate depending on the methodology used, the M spike can fluctuate (especially if the M spike is in the beta region of the SPEP), and what might be 5% plasma cells on a bone marrow biopsy to one pathologist (MGUS) might be 12% to another (smoldering myeloma).

Thanks for sharing this information!

Pete V.