The impact of change in albumin assay on reference intervals, prevalence of ‘hypoalbuminaemia’ and albumin prescriptions

Abstract

Background: We studied the impact on reference intervals, classification of patients with hypoalbuminaemia and albumin infusion prescriptions on changing from a bromocresol green (BCG) to a bromocresol purple (BCP) serum albumin assay. Methods: Passing-Bablok regression analysis and Bland-Altman plot were used to compare Abbott BCP and Roche BCG methods. Linear regression analysis was used to compare in-house and an external laboratory Abbott BCP serum albumin results. Reference intervals for Abbott BCP serum albumin were derived in two different laboratories using pathology data from adult patients in primary care. Prescriptions for 20% albumin infusions were compared one year before and one year after changing the albumin method. Results: Abbott BCP assay had a negative bias of approximately 6 g/L compared with Roche BCG method. There was good agreement (y ¼ 1.04 x À 1.03; R 2 ¼ 0.9933) between in-house and external laboratory Abbott BCP results. Reference intervals for the serum albumin Abbott BCP assay were 31-45 g/L, different to those recommended by Pathology Harmony and the manufacturers (35-50 g/L). Following the change in method there was a large increase in the number of patients classified as hypoalbuminaemic using Pathology Harmony references intervals (32%) but not when retrospectively compared to locally derived reference intervals (16%) compared with the previous year (12%). The method change was associated with a 44.6% increase in albumin prescriptions. This equated to an annual increase in expenditure of £35,234. Conclusions: We suggest that serum albumin reference intervals be method specific to prevent misclassification of albumin status in patients. Change in albumin methodology may have significant impact on hospital resources.

The effect of different analytical platforms and methods on the performance of population-specific adjusted calcium equation

“…assessed the impact of albumin assays on the achievement of K/DOQI target for calcium; they established that use of BCG albumin increased the prevalence of hypocalcaemia and reduced the prevalence of hypercalcaemia compared with the use of BCP albumin. 23,26 Our study confirms the results of previous publications and shows that the use of either BCG or BCP assays has a major impact on albumin-adjusted calcium equation performance and thus impacts on the classification of the calcaemic status of patients.…”

“…21,22 The difference in albumin concentrations resulting from the use of BCG and BCP methods has previously been reported to be of clinical significance. 23 Clase et al. compared the performance of BCG and BCP methods and demonstrated differences, with significantly higher BCG albumin results compared with BCP in renal and non-renal patients.…”

New lung cancer treatments (immunotherapy and targeted therapies) and their associations with depression and other psychological side effects as compared to chemotherapy

“…34 An albumin bromosresol green (BCG) assay is used for the quantification of albumin in human serum or plasma. 53 Standard laboratory procedures were used to obtain neutrophil and lymphocyte values from the standard complete blood counts in the clinical lab at MSKCC.…”

Factors Related to Hypocalcemia in human Brucellosis: a retrospective review

“…Since the decrease of albumin in patients had an effect on serum calcium, calcium correction formula was adopted: adjusted [Ca](mmol/L) = total [Ca](mmol/L) + 0.02 (40 -[albumin] (g/L)).Albumin ranges from 35 to 50 g/L [13] .According to the corrected calcium level, patients were divided into three groups: hypocalcemia (< 2.10 mmol/L) hypercalcemia (> 2.50 mmol/L) and normal corrected calcium(2.10 ~ 2.50 mmol/L). All patients were diagnosed as brucellosis on the basis of criteria established by the National Health and Family Planning Commission of China (WS 269-2007) [14] .We wanted to compare the relationship between brucellosis patients with hypocalcemia group and normal corrected calcium group, we conducted one-way ANOVA and multivariate analysis of the hypocalcemia group and normal corrected calcium group.…”