Bisalbuminemia: An Uncommon Finding on Serum Electrophoresis
Correspondence Address :
Dr. Archana Dhavale,
Assistant Professor, Department of Biochemistry, Government Medical College and Cancer Hospital, Naralibag, Buddilane, Opposite Aamkhas Maidan, Aurangabad, Maharashtra, India.
E-mail: dr.archanadhavale@gmail.com
Bisalbuminemia is a rare finding, characterised by the presence of two albumin fraction on serum protein electrophoresis. The disorder can either be inherited in autosomal dominant pattern or acquired. Acquired bisalbuminemia have discovered in various pathological conditions like diabetes mellitus, multiple myeloma, alzheimer’s disorder, sarcoidosis, nephrotic syndrome, chronic kidney disease, pancreatic pseudocyst and in patient receiving high doses of penicillin. Hereby, authors reports an uncommon case of a 55-years-old male, who presented with symptoms of lower back pain since 4 month. X-ray skull shows multiple lytic lesions. Bone marrow aspirate was hypercellular and showed 60% plasma cells. Patient was diagnosed with multiple myeloma and was sent for further biochemical investigations. Serum protein electrophoresis showed two distinct bands in the albumin region and a prominent M peak in gamma globulin region. The band may be mistaken as an abnormal globulin peak specifically while screening suspected or confirmed cases of monoclonal gammopathies.
Albumin fraction, M band, Multiple myeloma, Serum albumin
A 55-years-old male presented to the Oncology Department with symptoms of lower back pain since 4 month. He had dull backache that had been increasing with time. Patient had no any significant personal or past medical history. There was no significant family history.
On physical examination, patient showed severe pallor. X-ray skull showed multiple lytic lesions (Table/Fig 1). Bone marrow aspirate was hypercellular and showed 60% plasma cells (Table/Fig 2). Patient was diagnosed with multiple myeloma. Patient was referred to Department of Biochemistry for further investigation. Biochemical investigation revealed, haemoglobin was 6.9 gm%, haematocrit was 20.6%, red blood cells count was 2.39 million/cumm, white blood cells count was 4100/cumm, platelet was 200,000/cumm. Serum urea and creatinine was 78 mg/dL and 1.8 mg/dL respectively. Serum lactate dehydrogenase was 489 U/L, serum protein was 10.8 gm/dL and albumin 4.2 gm/dL.
Serum protein electrophoresis was done on fully automated capillary electrophoresis system Sebia Minicap Flex Piercing system. Serum protein electrophoresis showed two distinct bands in the albumin region and a prominent M peak in gamma globulin region (Table/Fig 3). Serum protein electrophoresis showed: albumin-45.9%, alpha 1-3.1%, alpha 2-10.9%, beta 1-4.6%, beta 2-3.5% and gamma-32% (Table/Fig 4). He had eight 28 day cycles of bortezomib (1.3 mg/m2 on days 1, 8, 15, 22 of each cycle), cyclophosphamide (300 mg/m2 on days 1, 8, 15, 22) and dexamethasone (40 mg on days 1, 8, 15, 22) followed by 2 weekly bortezomib (2 mg) was given.
Bisalbuminemia is a rare disorder characterised by the presence of two distinct fractions of albumin on serum protein electrophoresis. Bisalbuminemia may be hereditary or acquired and is very uncommon in Indian population (1). Hereditary bisalbuminemia transmitted as an autosomal dominant pattern, is a relatively very rare genetic disorder (2). The incidence of inherited bisalbuminemia is stated to be 1:10,000 to 1:1000 (3). Acquired bisalbuminemia have discovered in various pathological conditions like diabetes mellitus (4), multiple myeloma (5),(6), alzheimer’s disorder (7), sarcoidosis (3), nephrotic syndrome (8), chronic kidney disease (9), pancreatic pseudocyst (10) and in patient receiving high doses of penicillin (11),(12).
Serum protein electrophoresis is an investigative procedure which is performed routinely for diagnostic purpose, specifically as an screening test for monoclonal gammopathies. Here reporting case of bisalbuminemia in patient of multiple myeloma. In this case serum protein electrophoresis showed two distinct bands in the albumin region and a prominent M peak in gamma globulin region. The patient had no any other co-morbidity. Few cases of bisalbuminemia have been reported in patients with multiple myeloma (5),(6). There was no clinical importance of this entity except stated above. In a study by Chan PC, found that bisalbuminemia is not associated with monoclonal gummopathies but is an incidental finding (13). Bisalbuminemia can interfere with the serum protein electrophoresis diagnosis, but is of little diagnostic or therapeutic significance (6),(14). This can cause difficulty in the reporting of serum protein electrophoresis diagnosis in multiple myeloma. Therefore, it is important to recognize such variant while interpreting serum protein electrophoresis.
Though bisalbuminemia does not influence disease process, it should not be mistaken as an abnormal globulin peak specifically while screening suspected or confirmed cases of monoclonal gammopathies. One must keep this entity in the radar and interpret it with caution.
DOI: 10.7860/JCDR/2022/57377.16798
Date of Submission: 28 Apr, 2022
Date of Peer Review: 26 May, 2022
Date of Acceptance: 29 Jun, 2022
Date of Publishing: Aug 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
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