title: Comparison of bromcresol green and agarose protein electrophoresis for quantitation of serum albumin in multiple myeloma.
abstract: BACKGROUND
  The International Staging System for multiple myeloma has increased the importance of accurate measurement of serum albumin. Two common albumin assays, bromcresol green (BCG) and agarose gel protein electrophoresis (PEL), frequently yield discordant results, creating confusion regarding which assay is superior for use in myeloma.
  
  
  METHODS
  We measured albumin by BCG on a Roche Modular system, by PEL with a Helena SPIFE SPE Vis agarose gel, and by immunonephelometry performed on a Dade Behring BNII nephelometer. BCG and PEL were used to measure albumin in 5777 patient samples, and all 3 methods were used in an additional 252 samples. The clinical impact was assessed on 698 myeloma patient samples.
  
  
  RESULTS
  For sera with zero/low monoclonal immunoglobulin protein (M)-spike (0 to <15 g/L), results for both BCG and PEL correlated well to nephelometry, although median PEL results were 8 g/L lower than corresponding BCG measurements. Correlation between PEL and nephelometry or BCG diminished with increasing M-spike, with PEL eventually overestimating albumin compared with both other assays. IgG and IgA M-spikes showed significantly different effects on albumin discordance. For 35% of myeloma patients, discrepancy between BCG and PEL had a potentially clinically significant effect on staging, but no difference in group survival was found.
  
  
  CONCLUSIONS
  Both BCG and PEL correlate well to nephelometry in sera with zero/low M-spikes. In the presence of larger M-spikes, PEL correlates poorly to nephelometry or BCG, whereas BCG compares well with nephelometry regardless of M-spike. Thus, albumin measurement can be performed reliably in myeloma patient sera by use of inexpensive, automated BCG assays.
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Christine L H
authors.initials: CL
authors.lastname: Snozek
authors.forename: Amy K
authors.initials: AK
authors.lastname: Saenger
authors.forename: Philip R
authors.initials: PR
authors.lastname: Greipp
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Bryant
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kyle
authors.forename: S Vincent
authors.initials: SV
authors.lastname: Rajkumar
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Katzmann
mesh_terms: D001961:Bromcresol Green; D004587:Electrophoresis, Agar Gel; D006801:Humans; D007118:Immunoassay; D007202:Indicators and Reagents; D009101:Multiple Myeloma / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D009391:Nephelometry and Turbidimetry; D010266:Paraproteins / Q000032:analysis; D011446:Prospective Studies; D012709:Serum Albumin / Q000032:analysis*; D015996:Survival Rate
chemical_list: D007202:Indicators and Reagents; D010266:Paraproteins; D012709:Serum Albumin; D001961:Bromcresol Green