To the Editor:—
We were most interested in the communication by Elveback et al on "Health, Normality and the Ghost of Gauss" (211:69, 1970) because the question of "normal values" is a topic of concern to all of those in the clinical laboratory field.In their concern for statistics, however, the authors (and many others) have apparently overlooked an important physiological observation in relation to serum albumin determinations. In their charts comparing "normal values" obtained by Hoffmann's method from patient data with the "clinical limits" determined from healthy persons, one of the greatest degrees of "false negatives" occurs with the albumin determination. In a daily review of our clinical laboratory data, we have frequently observed that the serum albumin value on an ambulatory outpatient will be approximately 0.5 gm/100 ml higher than the albumin value when the same patient is recumbent in the hospital. In a manual on the
McLendon WW. The Question of Normal Values. JAMA. 1970;212(12):2122–2123. doi:10.1001/jama.1970.03170250076027
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